The desire to deliver services that meet all of a patient’s needs – in a way that makes sense to that patient – has captured the imagination of healthcare leaders around the world. However, because of the different characteristics of the organizations, or the national systems where they operate, what is meant by ‘integrated’ or ‘coordinated’ care varies.
For some, it means ensuring that when health and social services are delivered by separate, discrete providers, the services are delivered seamlessly and without the patient having to navigate the gaps between different organizations.
For others, coordinated or integrated care means creating a single organization which will become accountable for a much broader part of the spectrum of a person’s health and wellbeing needs. It is crucial to be clear at the outset of your change program which of these models is your end goal.
The creation of a single organization is having its biggest impact in the US with accountable care organizations (ACOs). The distinctive regulatory environment and payment systems in the US allows us to find transferrable lessons that other systems can learn.
The reverse is equally true: organizations in US-style systems can just as easily learn important lessons about delivering coordinated care from others, where collaboration between organizations remains separate.
Whichever model is your destination, it will be vital to develop a clear narrative concerning the transformation. One of the ways that many pioneering organizations have tried to exemplify the big change is by using the example of an individual.
An individual’s story can be a powerful narrative for change, one which simplifies the complex issues that need to be managed and provides a rationale for the transformation that can be applied throughout the process.
Whether seeking to create a single accountable care organization or trying to achieve coordinated care across a whole health system, there will inevitably be a number of different stakeholders involved, each with different priorities.
There are many inspiring examples around the world of successful patient stories being used to galvanize transformations in care. Some organizations choose to use the example of a real patient – perhaps someone who experienced failures in care – while others design a fictional person typical of their patient population and demographics.
Individual’s powerful stories don’t have to only involve patients. The Islington Clinical Commissioning Group in London, UK developed its story of integration around a staff member – Rose – as well as her patient, Maggie. Working with the Young Foundation, they created an animated video about them – We Care Together. This highlights frustrations felt by staff that want to do more for their older patients with complex problems but don’t have the time, resources or support to do it. After becoming a care coordinator, Rose is able to give Maggie much more joined up and personal care using both healthcare services and local voluntary groups. Maggie’s health improves and Rose says she now feels she is doing “what I came into the job for”.
Watch the three minute animated video at vimeo.com and search for Maggie and Rose’s story.
It is important to infuse the narrative throughout every level and stage of the change process. To become crystalized as a symbol for the new ways of working, the story needs to be used often and, over time, be embedded in the culture across the organization.
A good example of one innovative way of doing this comes from Jönköping County in Sweden. Here, staff not only created the story of Esther, an elderly woman with a chronic illness, they even named parts of the patient pathway after her – most visibly the creation of nursing assistants and others as ‘Esther coaches’ to bring the patient perspective into daily practice.