Abstract
Background: Organizing integrated care is a dynamic and context dependent process that requires continuous evaluation and reflection [1]. According to leading theories [2], organizing integrated care takes place on three complementary levels: (I) the organizational level, the integration of sectors, policies and organizations, (II) the professional level, partnerships between practitioners and interprofessional collaboration, and (III) the clinical level, including person-centered support and the interaction between practitioners and clients. Dialogue between the three levels is crucial to develop integrated care initiatives that fit families’, practitioners’, and organizational needs. Moreover, to prevent initiatives to reinvent the wheel, learning between initiatives is needed.
Objectives: The aim of this action research project was to set up a learning community with five local integrated care initiatives in the Netherlands. All initiatives had the aim to improve integrated care for families with complex needs and included the organization of multidisciplinary teams of specialists in youth and family care. The initiatives were studied by means of observations and semi-structured interviews with families, practitioners, organizations and local policy makers. For the duration of a year, a learning community was set up by the researchers, including four learning sessions. The aim of the learning community was threefold: (I) to continuously reflect on preliminary research findings, (II) to stimulate dialogue, evaluation and reflection between the different levels within the initiatives, and (III) to facilitate learning between the five initiatives.
Results: Each initiative was represented by at least a practitioner, a policy maker, and a manager. The learning sessions improved familiarity between representatives of the different levels within a local integrated care initiative. For example, policy makers and practitioners exchanged their perspectives on the need of monitoring outcomes of integrated care initiatives. By doing so, shared understanding of the importance of monitoring was improved. Moreover, learning between initiatives occurred, for example regarding various funding systems for integrated care teams. An important element of each learning session was the participation of a family representative, who reflected on the findings and enriched discussions by incorporating families’ perspectives. It deemed crucial to prepare the learning session with the chair, by providing background information about the participants and the initiatives, and by formulating some reflective questions for the participants in advance. Another facilitator was the profound analysis of each initiative, which was shared with the participants in a factsheet prior to each learning session. Moreover, during the learning session, there should be sufficient room for the initiatives to bring in their own dilemmas and good practices.
Conclusion/implications: Organizing a learning community to improve dialogue and learning within, and between integrated care initiatives requires commitment from all parties involved, continuity of participants, and sufficient preparation for both the session leaders and the participants of the learning session. Moreover, a family representative should always be involved in the learning session to incorporate cliental perspectives. To ensure structural implementation, a facilitator should be appointed with the formal task to organize learning sessions within and between initiatives.
References:
[1] Nooteboom et al (under review)
[2] Valentijn et al (2013)