Integration is a facilitator to effective care coordination, not the answer
Care coordination means slightly different things to different audiences, but no matter who you talk to, its value and importance are emphasised. Everybody wants quality, streamlined care especially those with long term conditions, for whom using the health service is often a way of life, not just an occasional occurrence. For most people effective coordination is much more important than “integration” which in any case, can create new boundaries to manage.
So what is care coordination?
A success or failure in coordination will be perceived (and likely measured) in different ways depending on the perspective: patient/service user, health care professional and at system level.
For patients, it’s simply about getting what they want from the health service – quality care. Having to tell your story over and over again, or fill out multiple forms in different departments that basically say the same thing, is both a reality faced by many health service users and a clear example of ineffective care co-ordination in action.
For staff, a positive patient experience and quality care delivery are also the bottom line; but staff are equally concerned with the logistics of care provision, such as thorough handovers and other organisational issues, a concern not shared by the general public. Indeed effective coordination can occur at this level but be invisible to the patient and can sometimes give the impression of disjointedness if clear explanations of what has happened are not given.
This is not necessarily surprising; in many sectors multiple coordination issues such as internal communication, team work, infrastructure provision and quality management, must be addressed for it to go from being a job done, to a job well done. This has been well understood in the airline industry for 60 years ever since systematic analysis of incidents like the tragic jumbo jet collision in Tenerife, showed how hand over, communications and process are key to safety. Also for health service providers, e.g. managers, commissioners and regulators, coordination covers both service to service communication and maintaining clinical outcomes within budget.
“An accessible, efficient, patient friendly service is a well coordinated service”
The concept of Integrated Care is testament to this difference of perception. While service restructuring is widely recognised within the health industry to support improved patient experience – when we get it right – achieving greater efficiency and value from healthcare systems, it often means little to the patients it serves. People ultimately want great, streamlined care and coordination plays a large part in that. Integration on the other hand, is something they do not necessarily care about. What matters most to them is the care provided is centred around them, and coordinated in a way that supports a person centred experience, with their wants and needs as the primary concern. For example, providing people with relevant information as and when they need it, always including them in decisions about their care and maintaining an accurate care record, so they are not expected to repeat their history every time they have a new appointment. These are fundamental aspects of effective coordination that are not achievable through integration alone.
How can effective care coordination be achieved?
An accessible, efficient, patient friendly service is a well coordinated service. It therefore stands to reason that tackling these three considerations will automatically improve care coordination. This improvement does not have to be a complicated process, but it does require thought and forward planning based on understanding a patient’s entire care journey, and not just each stop along the way.
A frequent and robust stream of service user observations and experiences, will ensure patient experiences stays the focus of great care delivery. Providing the feedback is obtained using an approach that begins by:
- asking appropriate, cognitively tested questions,
- asked via a methodology platform relevant to the target audience, whether that be SMS, hospital TV units or tablet devices, for example;
- and then analysed to give robust, accurate results, that clearly identify problems – and praise.
The data can then be used to find solutions to these issues and embed improvements. For example, if multiple patients feedback about excessive waiting times for specialist referrals after a GP appointment, it allows service providers to work out why this is the case and find a solution.
Qualitative feedback can also be equally valuable when used to inform commissioning choices. CCGs may on the surface be providing and tailoring services to each community group’s needs and requirements, but service user feedback may reveal avoidable glitches, that show though quality care is “available”, in reality it’s unattainable. E.g. If a translation service is provided for a specific ethnic minority group, in the wrong dialect to the majority of the people in that community, it is in effect useless and will not relay patient feedback correctly – as we demonstrated recently for a client. Gathering service user data gives a tangible output that shows in practical terms where and what problems are, so that they can be fixed. Aside from identifying new problems, regular surveys support long term improvements, clearly showing where care is consistent, fluctuating, improving or deteriorating over time.
For both service users and staff, patient records are core to care coordination improvement. A single, central electronic house for all records, eliminates both record access issues for staff and the need for patients to repeatedly fill out forms with the same information – particularly multiple service users with comorbidities. Patient-held records can be held another way to overcome such issues – entrusting patients to carry their records themselves would ensure that their care history always goes wherever they do in the service.
Taking care coordination to the next level
Just as no care experience is the same, nor is a service user’s experience of coordination.
In the long term, a sustainable focus and understanding of the care journey of individual service users and their families, will support improved care coordination and in turn enhanced care quality. However, if we are to maximise service potential and coordinate care effectively, a solution co-produced by patients, staff and service providers is required. One that factors in multi-agency feedback, considering each party’s requirements. Implemented effectively, integration can be a facilitator to care coordination, but it alone is not the answer.