Measuring relationships for enhancing the integration of health and social services in Multidisciplinary Care Practices: an Italian pilot case study.

Health and social care systems are increasingly investing to foster integration of services in order to guarantee a holistic and continuous answer to population’s complex needs. Recently, a primary care reform has been introduced in Italy aimed at strengthening the primary care system thanks to the standardization of the Community Health Centers model. This model includes a specific stress on the participation of community and the local actors – e.g. institutions and third sector associations – into the definition of needs and answers in specific territories. Furthermore, there is a stress on the need for a multidisciplinary approach to guaranteeing coordination inside the CHCs between different professionals who are called to build coherent and comprehensive answers for individuals and communities.

In this context, relationships are fundamental and a relational research approach could be central in supporting the planning, monitoring, and management of integrated professional responses for specific communities.

In this work, we present a pilot case study settled in a specific excellent CHC in Tuscany. The research is aimed at testing a Social Network Analysis approach to collect information useful for developing network interventions (Valente 2007) according to the internal and external relational system among services, that can impact the integration of their activities at a meso-level (interaction between services). The head of the health district and the managers of the CHC were involved in developing the questionnaire. Each professional was then invited to respond on behalf of the reference service, about the existence, frequency, and nature of the internal relationships with other services and with the local health authority services outside the CHC.

Preliminary results were elaborated to show the current networks among internal services and with external LHA other services. Researchers discussed the evidence with professionals and managers, who explained some specific situations by highlighting how the knowledge between services is fostered by contemporary presence into the CHC – thus supporting the co-location feature. Similarly, co-location demonstrated to be a boost variable for collaboration (Bonciani and Barsanti, 2019): in particular, distance limits the possibility of having time to interact with other professionals, at least in an informal way. The informal relationships were reported as fundamental, but more formal practices were called for guaranteeing a continuity in the collaboration among different services. Finally, the interaction with services outside of the institution (i.e. social services from the local municipality) can be harder because of physical and cultural barriers.

The case study is a first pilot for the overall implementation of a monitoring survey regarding the relationships inside and outside the services operating in CHCs. In fact, to design and implement network interventions aimed at improving the integration of different services inside the primary care centers, updated information is needed to address the structural influences on individuals’ actions. The next step of the research is to developing proposals of network interventions for the specific CHC and to expanding the analysis to other CHC in Tuscany and in other contexts to test the scalability of the tool.