Accountability in Integrated Health Service Delivery in The Netherlands: An Integrated Personalised Approach.

Abstract

Introduction Accountability in Dutch healthcare service delivery can be seen from four perspectives: (1) private, (2) public, (3) professional and (4) societal perspective. Although accountability in general is seen as an important part of governance, in literature there is debate about its definition and more synonyms are used. In essence, accountability refers to being accountable, being responsive and being responsible. Accountability processes are often assessed from a single organization perspective. Since the emerging partnerships and networks in integrated health service delivery, almost always multiple organizations and professionals or teams are involved. New organizational models ask for review and innovation of traditional accountability processes as an ingredient of integrated care governance. Two questions raise: (1) Is the current approach in accountability still maintainable and (2): How can accountability be further developed to suit integrated care governance? To answer these questions a deeper understanding of integrated care accountability and the state of play in the Netherlands is presented.\xa0\xa0\xa0\xa0\xa0 Methods A scoping review was conducted, following a systematic approach to map evidence and identify main concepts, theories, sources and knowledge gaps. Five stages were followed: (1) identifying the research question, (2) composing the search string and validating the search string, (3) database search, (4) assess the data, (5) collating en reporting on the results. The databases Academic Search Premier, Business Source Elite, CINHAL, PubMed, Springer Link and Wiley Online Library were searched from 2009 to 2019. Studies that used or cited accountability and multiple synonyms in the context of (integrated) healthcare and the Netherlands were eligible. Results Preliminary results claim a variety of data on how accountability as term is used in the different contexts. Most attention in literature is paid to policy development and compliance. The lack of thinking about integrated accountability in the context of partnerships and networks of integrated health service delivery seems to be a gap in the literature and in practice. In the workshop, our results will be illustrated by two examples of how accountability in integrated care settings is organized, and what challenges are faced. Conclusion This scoping review shows a variety of interpretations and perspectives in the description of the publications drafted from the different databases. On one hand, one can argue that this review has a disparate nature. On the other hand accountability in integrated healthcare services need a multifactorial approach. This scoping review is helpful in organizing and interpreting the different views and language given to the term accountability in healthcare. Lessons learned There are challenges in executing accountability if healthcare services become more integrated in the next future. Limitation A literature research on accountability in healthcare seems limited, but can be used as a starting point for accountability of integrated healthcare services. Suggestions for future research •\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0 Research on development accountability models in integrated care as part of integrated governance. •\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0 A Realist evaluation of implementation of accountability models in integrated care.