Abstract
Introduction and aims: In the evolving and complex healthcare landscape, understanding how various stakeholders, such as healthcare professionals, managers, regional officers, and decision-makers, perceive and understand person-centred integrated care is critical to its enactment and implementation. This study explores the sense-making processes of these key actors regarding their roles and daily practices within a stroke care and rehabilitation trajectory of different care providers, organisations and levels of care. The study examined factors influencing the stakeholder's understanding and application of person-centred integrated care. The following research questions were addressed:
- How do healthcare professionals, managers, regional civil servants, and policy-makers make sense of their role, daily practice, and the stroke care trajectory, and what influences their understanding of and use of person-centred integrated care?
- What are the barriers and facilitators to implementing person-centred integrated care in different healthcare contexts, and how can these be addressed to promote more widespread adoption of person-centred integrated care?
Methods: An ethnographic field study was conducted, involving healthcare professionals and leaders within different parts of the stroke care trajectory to capture perspectives from a micro and meso level, i.e. acute stroke units, geriatric wards, primary healthcare centres, specialised rehabilitation facilities, and nursing facilities. Regional civil servants and policy-makers were included in order to include the macro perspective. Observations, individual interviews, and interviews in dyads or focus groups were carried out with healthcare professionals, managers, civil servants and policy-makers regarding their role and daily practice, sense-making and views on and conditions for practising and implementing person-centred integrated care. Data is analysed thematically (ongoing) and draws on a sense-making approach to elucidate how participants interpret and operationalise person-centred integrated care.
Results: Findings (preliminary) from 110-hour observations and 38 interviews reveal significant variability in perceptions of person-centred integrated care and how it should be operationalised. The sense-making process highlights an interplay between factors such as identity, values, and one's view of one's role and responsibility for contributing to an integrated care trajectory. Further, organisational, cultural, and systemic constraints are important in facilitating or hindering a person-centred integrated care trajectory. Key barriers identified include fragmented communication channels, misaligned incentives, and a need for more support for individual and collective development. Facilitators encompass interdisciplinary collaboration, a culture of coordination, the integration of feedback mechanisms between levels of care, and dialogue based on benevolence.
Conclusion: The study contributes insights into important factors to consider when aiming for person-centred integrated care and rehabilitation both within and across organisations and levels of care. The knowledge generated can promote a broader operationalisation of person-centred integrated care. The implications extend to policy-makers, healthcare leaders, and practitioners/professionals, who must collectively foster environments that facilitate meaningful relationship building between individuals, organisations and levels of care.