Abstract
Background: A challenge in developing a definition of integrated care is that perspectives of integrated care are often role dependent. The purpose of this work is to determine the meaning of integrated care from the perspective of people in different roles, from frontline staff to executives, of a large homecare service provider in Ontario, Canada.
Approach: Structured interviews with open ended questions were conducted with the majority of executives, directors, and management (n=49) of a large homecare service provider in Ontario, Canada. Using a more semi-structured approach, the same questions used in the structured interviews will be used to guide focus groups with front-line staff, as well as patient and family partners. Thematic analyses will be used for both the structured interviews and semi-structured focus groups. The results of these analyses will provide the foundation for three surveys that will be developed for: 1) all front-line staff and their direct supervisors and 2) patient and family partners, and 3) external stakeholders (e.g. primary care physicians, hospital partners, and funders). All of the information gathered from the interviews, focus groups, and surveys will be used to co-design a road map for integrated care alongside a committee made up of members from different areas and levels of the organization, as well as patient and family partners and other external stakeholders.
Results: The preliminary results of the structured interview component of this work have highlighted how perspectives of integrated care vary considerably across the organization, often dependent on the role and experience-level of the participant. The insights shared span the ”little i”, or micro-level of integrated care, such as front-line communication, data sharing, and patient experience, to the “big I”, or macro level of integrated care, such as government funding, and full-system integration across all healthcare systems including data systems and partnerships. In-between, and the meso-level, there are organizational-level opportunities to consider, for example, new educational and operational processes.
Implications: As we move towards more integrated systems and models of healthcare, it is important to acknowledge and understand the different perspectives of integrated care from across an organization. This work highlights the micro (i.e. the “little i”), the marco (i.e. the “big I”), and meso (i.e. everything in-between) levels of integrated care for a single homecare service provider in Ontario, Canada. Next steps will be to understand the perspectives of patients and their families, other people and organizations involved in patient care (e.g. primary care providers, hospitals, and other homecare service providers), and funders. This information will help create a roadmap for better integrated care for the homecare service provider, both internally and externally.