Abstract
The phrases ‘connecting the dots’ and ‘joining the dots’ are often used to illustrate what needs to be done to integrate health and social care services. This follows from the notion that existing healthcare systems are fragmented. The increasing number of people facing multiple health and/or social problems need person-centred integrated health and social care services.
Moreover, it has been argued that instead of connecting the existing dots, a shift away from fragmentation and heading towards population health is required to address the determinants of health of local populations. In this scenario, integrated care can be understood as transit station to arrive at a state of promoting health and reducing health inequalities across whole populations. 1
Going beyond connecting the dots is not straightforward. System working, system thinking and system leadership have been put forward as necessary competencies for those involved in making this shift happening.2,3
System leadership is far from easy. Evidence can support system leadership in providing an evidence base for change. Evidence can support population health management in better understanding what works for whom under what circumstances.
This issue of the International Journal of Care Coordination illustrates that going beyond connecting dots is challenging and that it involves the help of different stakeholders, including patients, carers and healthcare professionals. Finding a coalition of the willing, experiencing that the current system gets in the way of system change, and accepting that it takes time to achieve results are just a few of the common themes brought forward by the authors.
Brockway et al. systematically mapped the differences and similarities between primary care providers’ and oncologists’ knowledge, attitudes and beliefs regarding coordination of care and comorbid disease management for patients undergoing active cancer treatment in one of three academic hospitals in New York City. 3 The lack of clarity regarding physician roles with respect to comorbidity management and the provision of general preventive care services calls for action, as this situation is clearly not favourable for patients. Collecting data from the perspectives of healthcare providers, patients and their caregivers about cancer care continuity in France, as was done by Lelorain et al., 4 also illustrates the importance of a system’s approach in tackling the concerns brought forward by stakeholders.
By performing a sequential mixed methods study, Hermans et al. analysed the collaboration processes of the various organisations involved in providing palliative care to nursing home residents in Flanders, Belgium. Their findings show that even after 20 years, the nature of inter-organisational collaboration in palliative care is still vulnerable, as it relies to a great extent on personal relations. 5
Going beyond connecting the dots is not new for the Basque Country as can be learned from the work by Domingo et al. 6 They monitored the degree of collaboration between different healthcare professionals participating in a multidisciplinary programme for patients admitted to the hospital with Atrial Fibrillation. Besides the progress experienced in many aspects of collaboration, an important point for improvement identified is that study participants were not feeling sufficiently prepared in managing complex cases due to changing roles and taking on new duties. Based on data from 20 Community Living Centres, as part of the Veterans Health Administration – an integrated delivery system in the US – Sullivan et al. 7 show that teamwork in nursing homes may improve by shifting to more person-centred models of care.
As described by Dickinson, governments who look beyond connecting the dots are welcoming out-of-the-box initiatives. 8 Started on the island of Jersey in 2012, the Call&Check service is attracting interest from different parts of the world as an innovative service to support people living in their homes. Call&Check is a very interesting example of how the health of a population can benefit from postal operators.
Finally, the International Journal of Care Coordination and Healthcare Management Forum are jointly producing a one-of-a-kind theme edition on system transformation. Authors are invited to submit their work to one journal or the other (not both) by 1 February 2020. For more information, please see: https://journals.sagepub.com/page/icp/cfp-icp-hmf.