The third WP in the Crosscare – Old project is focusing on:

Horizontal coordination: collaborations within and between municipalities in transitional care

Background

When older patients enter the realm of municipal care, it may be the start of a series of transitions between different care services. With the Coordination Reform, this transitional chain seems to be extended [1]. The reform, which transferred tasks and responsibilities from the specialist health services to the municipalities, has led to increased specialization and fragmentation in the municipal care services. Especially larger municipalities seem to have adopted the logic from specialist healthcare, both in terms of problem understanding and solution strategies [2]. This development has resulted in increased transitions, requiring extensive intra-organizational coordination. For example, a patient can be transferred between home care and municipal rehabilitation facilities, between home care and the nursing home, and between different wards in the nursing home (e.g short stay wards and long-term care wards). As the municipal services become more specialized, new challenges pertaining to transitions between different municipal units and services arise. These challenges may stem from different rules, institutional logics, funding streams and institutional and professional cultures. These aspects are, so far, sparsely described or explained in the research literature.

The increased specialization of services typically leads to increased demand for highly qualified and skilled municipal health care staff. To achieve this, many municipalities have to collaborate with neighboring municipalities to fulfill their responsibilities to the authorities and their citizens. In total, 86 % of the municipalities in Norway have entered inter-municipal collaboration in the health- and care sector [5]. So far, experiences in research on the municipal level show a low level of conflict in these collaborations [3]. However, research on the increasing importance of inter-municipal coordination for the quality of transitional care is limited. Health and care providers depend upon various communication strategies to ensure successful coordination and information continuity in the care trajectory. Coordinators have a central role in managing care trajectories of older patients [4; 5], and Norway has experienced a recent growth in the number of coordinator-positions. Yet, we know little about the organization of these positions and their variations across municipalities.

Approaches, hypotheses and choice of method

The main objective of the WP is to gain a comprehensive understanding of geriatric patients’ movements between different services in the municipalities, and of factors of particular importance to high quality transitional care. Well-functioning cooperation is a prerequisite for continuity of care, which in turn is considered essential for the quality of care [6]. Three dimensions of continuity of care are usually considered: Relational continuity; Management continuity; and Informational continuity [7]. Relational continuity refers to an ongoing health professional-patient relationship, management continuity refers to the timely and complementary provision of service whereas information continuity connects past, present and future care through information exchange. This WP addresses the following key research questions:

• Which organizational units and actors contribute to intra-municipal coordination of services, and how do these experience intra-municipal coordination? How do different actors in municipal care perceive the need for intra-organizational coordination for geriatric patients?
• How does the patient journal system support or obstruct intra-municipal coordination?
• What is the role of coordinators in horizontal (intra-municipal) and vertical (municipality- hospital) coordination of services for geriatric patients?

In order to answer the  research questions, we employ a concurrent data triangulation trough a mixed method design.

References

1. Grimsmo A. Hvordan har kommunene løst utfordringen med utskrivningsklare pasienter? Sykepleien Forskn 2, 2013; 8: 148-155.
2. Aarseth et al. Mot samhandlingskommunen? Nordiske Organisasjonsstudier 3/2015
3. Zeiner & Tjerbo. Helsekommunen? Interkommunalt samarbeid og samhandlingsreformen. Norsk Institutt for by- og regionsforskning. Notat 2015/10
4. Wodchis P et a Integrating care for older people with complex needs: key insights and lessons from a seven-country cross-case analysis. Journal of integrated care 2015, Vol 15, Special Issue: Integrating Care to Older People and those with Complex Needs.
5. Syse A et al. Kreftkoordinatorers rolle i samhandlingsarbeidet i kreftomsorgen i norske kommuner. Nordisk Tidsskrift for Helseforskning Nr. 1-2015
6. Sparbel K et al. A continuity of care integrated literature review, par 2: methodological issues. Journal of nursing scholarship, 2000, 32 (2), 131 – 135
7. Freeman G et al. Continuity of care 2006: what have we learned since 2000 and what are policy imperatives now? Report for the National Coordinating Centre for NHS Service Delivery and Organisation R & D. London: National Coordinating Centre for Service Delivery and Organisation. 2007