Tips for better cooperation in a care network
The emergence of care networks is a fact. Various initiatives with and for the patient are developing at lightning speed. Understandable, because the demand for care is changing. Multimorbidity and complexity of care is increasing. At the same time, people stay longer at home and return home as quickly as possible after being admitted to a hospital. Care, treatment and support are increasingly taking place in or close to home. This results in a shift of duties from hospitals to care providers in the neighbourhood; the general practitioner and nurse district play an increasingly important role. There is also a greater appeal for social and informal caregivers. Thus, a different focus and working approach is badly needed, but also difficult to achieve. This is evident given the high failure rate of care networks in practice. What exactly is the cause for this failure? And how do we ensure that things do go well?
What is a care network?
Before answering these questions, it is good to first briefly reflect on what a care network exactly is. People with complex needs who receive care and support often have to deal with multiple health and social care providers, such as: the general practitioner, medical specialists, a physiotherapist, the district nurse, domestic help, the pharmacist, informal caregivers, volunteers, etc. All these people play their part in the care process and together form the care network. The size and composition of such a network differs per person.
In a care network, the power is divided between the various organizations that are involved. It is managed according to the principles of the organization network. We also call this the “pancake” (see figure 1). An organization network adapts itself easily to changes. It is often controlled by means of a mutually accepted form of control. Leadership and power are divided between different people; not “everyone a boss”, but “everyone is the boss” is the adage. Through the relationship between parties, knowledge, products and services can easily be exchanged. Of course, this requires something that can be exchanged, which is why there must be heterogeneity across parties within the network. Or in other words: different organizations and professionals with different specialties.
Why it often goes wrong
There are several reasons why care networks are not always succeeding. First, the cooperation in a network regularly causes a “hassle”. This is because as a care provider you give up a part of your autonomy, and the duration of the collaboration is often unclear. This results in uncertainty. And as a consequence, the involved parties do not clearly express their (organisational) interests and expectations to each other. Because they’re afraid to give in, they do not show their hand.
But what they do not realize is that openness and transparency exponentially increase the chance of a fruitful, successful cooperation, according to research. And the fact that this may sometimes give rise to conflicts, should not be an issue, as long as the collective objectives and frameworks are clearly set out in advance. But are you not open to each other from the first moment? Are the individual interests not clear? Or were no clear agreements made and is there insufficient trust between the parties? Then care networks are doomed to fail.
In addition, the care delivery strategy is often based too much on the disease rather than on the needs and wishes of the patients. As a result, the supply of care does not match the real demand. Thirdly, there is no transparency in the area of health and cost outcomes. This is often the result of insufficient mutual openness. And finally, the financing of healthcare is fragmented in many high income countries, making joint initiatives sometimes very difficult to finance and therefore difficult to organize.
Lessons for successful care networks
International best practices show that care networks can be very successful. We can learn important lessons from this at the level of administrators, caregivers and patients:
It is important for administrators to promote effective partnerships between prevention, care and well-being. Create support for this in the local practice region. Be aware that significant investments are needed. Realize contract innovation and value-based payment mechanisms and invest primarily in prevention. In order to bring and keep the various stakeholders together, it is wise to appoint an external person as an independent party to supervise the jointly established performance indicators and rules of conduct. Have a general practitioner or district nurse coordinate the care of a patient as a case manager. Make sure that they are supported by a regional back office, where there are people who have an overview of all data and trends and who can identify problems. And finally: make sure you start to evaluate the process immediately after its deployed.
Tailor the care you want to provide as care providers to the local needs. Also keep the diversity in language and culture in mind. And do not be single-minded. That is to say: focus not only on the disease, but especially on what the patient thinks is important. These can even be “small” trivia, such as staying at home or continuing to practice a hobby. Research shows that people score higher on quality of life when you organize care according to their needs. And this in turn also has a positive effect on their health. Moreover, it is often more cost-effective. A win-win-win situation, if we might say. Make sure that the care you provide is empirically substantiated. And keep up with the times: be open to new role distributions (task delegation and differentiation) and technologies (eHealth). And if you want to implement new projects, form a special execution team to pull the raft.
The provision of care must be designed in such a way that the patient is encouraged to live healthy and prevent illness. Self-management is the key here. Make patients the owner of their medical records and ultimately also give them financial responsibility. That way, they can make their own choices. Transparency in performance indicators facilitates that choice process. And eHealth applications can also play an important role in this, if they have been shown to be (cost)effective. It is important that the provision of information is in line with what the patient wants and can handle.
A shared ambition is not enough
But first, a coherent policy agenda and administrative execution power are needed. More integrated laws, and regulations as well as financing systems are highly needed in many countries. Due to the fragmentation in these areas, there is little room for value-based care networks that really address the needs of people with complex problems. The pioneering enthusiasts who are so important to drive change in real-life settings, continually collide with walls and eventually burn down, tired. As a result, the implementation of care networks stagnates at all levels. This is unfortunate, because there is sufficient scientific evidence which proves that an integrated approach to care actually leads to better health and lower costs. In other words, real value!
Download the whitepaper to learn what further steps are needed to turn care networks into a value-based success.