Sam Pless

Integrating and safeguarding care: The potential role of health information technologies:

The increasing burden of chronic diseases is one of the greatest challenges healthcare systems globally are facing. Across the world, compelling demands can be found for a fundamental shift in the organisation of health and social care to meet the needs of chronic patients. Integrated care has gathered momentum to overcome fragmentation of care in order to create care systems which are demand-driven, client-centred and cost-conscious. Health information technology – often referred to as eHealth – is usually considered to be an essential building brick of integrated care. Moreover, health information technology is said to hold potential for improving patient safety in chronic care settings. The current perspective paper explores the role of health information technology in integrating and safeguarding care. We argue that health information technology – which supports integrated care – may create optimal conditions to improve patient safety, but only when well-implemented, state-of-the-art technologies are used.

Making care organizations great again? A comparison of Care Pathways, Lean Thinking, Relational Coordination, and Modern Sociotechnical Design

Introduction Care organizations are often not well equipped to the increasing complexity and chronicity of diseases. Several organizational redesign models propose interventions that may help organizations adapt to this new reality. The objective of this study is to describe the redesign models in a uniform manner and to offer conceptual clarity. Methods This study presents a systematic comparison of the problem definition and proposed interventions of four redesign models: Care Pathways, Lean Thinking, Relational Coordination, and Modern Sociotechnical Design. Data were collected through a critical and thematic review of selected literature. Data were analyzed using a priori deducted coding derived from a theoretical framework based on Mintzberg. The COREQ checklist was used to minimize bias. Results Twenty conceptual documents and practical guidelines were included for data analysis. The problem definition of the four redesign models is largely similar and suggests that fragmented task division and centralized coordination hinder the delivery of complex and chronic care. The proposed interventions differ between the redesign models, but in general more attention is given to the coordination of tasks than to task division, and interventions are mainly situated at the micro (workplace) and meso (work unit) levels of the organization. Discussion The systematic comparison clarifies the similarities and differences between the analyzed redesign models, which can be useful for improving studies on redesign model effectiveness. Additionally, systematic comparison supports care organizations in selecting appropriate redesign models. Future studies may involve a larger selection of redesign models as well as the redesign of inter-organizational networks.

Advancing a Systemic Perspective on Multidisciplinary Teams: A Comparative Case Study of Work Organisation in Four Multiple Sclerosis Hospitals

Introduction: Many care organisations claim to employ multidisciplinary teams, but the term is used to describe quite different forms of collaboration. A systemic view of the work organisation of care delivery is presented and applied in this article that allows to identify and understand often overlooked yet important differences regarding team composition, working relationships and therapeutic relationships. Theory and Methods: We used modern socio-technical systems theory to study care delivery for a particular patient population as a system of interrelated activities. The concept of work organisation refers to the way in which the composite task of care delivery is divided into distinct tasks and how these are grouped in either monodisciplinary or multidisciplinary organisational units. The systemic perspective was applied in a comparative case study of four Multiple Sclerosis hospitals. Results: Among the hospitals, one was characterised by a functional work organisation, with similar tasks grouped in monodisciplinary teams. Cross-disciplinary working and therapeutic relationships were established on an ad hoc basis. The three other hospitals adopted a more process-oriented work organisation (which groups all tasks related to a specific care process within a single, multidisciplinary team). The more process-oriented the work organisation, the more working relationships and therapeutic relationships appeared to be fixed and continuous. Conclusion and discussion: The systemic view adopted in this study yields a better understanding of multidisciplinary teams through the concept of work organisation. The actual composition of multidisciplinary teams, and the related working and therapeutic relationships will vary depending on the type of underlying work organisation. Further validation of this conclusion will be needed in other settings.