Monica Winge

Need for a New Care Model: Getting to Grips with Collaborative Home Care

In this paper we discuss the fact that more and more patients are treated in their homes by a set of organizations, sometimes with different ownership, and how this fact places new and severe demands on health care and home service staff to communicate and collaborate. We point to the need for managers in different organizations to agree on ways of communicating and collaborating on the operational level and how this aspect needs to be considered during procurement of home care services. Most importantly, by reasoning around a set of problematic areas, we derive a set of related problems and suggest solutions for dealing with them. The solutions are a mix of organizational/administrative measures and IT support for communication and coordination.

The coordination hub: Toward patient-centered and collaborative care processes:

The organization and processes of today’s health and social care are becoming ever more complex as a consequence of societal trends, including an aging population and an increased reliance on care at home. One aspect of the increased complexity is that a single patient may receive care from several care providers, which easily results in situations with potentially incoherent, uncoordinated, and interfering care processes. In order to describe and analyze such situations, the article introduces the notion of a process conglomeration. This is defined as a set of patient-care processes that all concern the same patient, that are overlapping in time, and that all are sharing the overall goal of improving or maintaining the health and social well-being of the patient. Problems and challenges of process conglomerations are investigated using coordination theory and models for continuous process improvement. In order to address the challenges, a solution is proposed in the form of a Coordination Hub, being an integrated software service that offers a number of information services for coordinating the activities of the processes in a process conglomeration.

Understanding Care Work and the Coordination of Care Process Conglomerations

Health and social care is becoming ever more complex as a consequence of societal trends, including an aging population and increased reliance on care at home. One aspect of the increased complexity is that a single patient may receive care from several care providers, which easily results in situations with potentially incoherent, uncoordinated, and interfering care processes. In order to describe and analyze such situations, the article introduces the notions of patient-centered care process and a conglomeration of such. The latter is defined as a set of patient care processes that all concern the same patient, are overlapping in time, and are all sharing the overall goal of improving or maintaining the health and social well-being of the patient. The processes are based on a PDCA-cycle comprising phases for assessing, planning, performing and following up the care for the patient independently of health and social care organizations.

scenario for a patient at home in health and social care

This paper describes and discusses the situation for a typical patient with multiple illnesses and how his case would benefit from improved coordination, communication, and collaboration among all ...