An empowered, interprofessional workforce is one of the key features of successful integrated care for older people living at home. It improves the user/client experience and the use of resources. It also leads to cost savings, motivation of involved care professionals and reduced staff turnover.
These 6 activities are outlined in the Roadmap, a practical representation of the research findings of the European project, SUSTAIN. This collaboration addressed the question, ‘How to improve integrated care for older people in Europe who are living at home?’ Vilans was involved in the research. You can find the extended version of the feature, ‘Empowering an interprofessional workforce’ in book 1 of the Roadmap, ‘Design of integrated care’.
6 activities that empower an interprofessional workforce:
1. Trust and network strengthening – Trust needs time and several interactions, among involved professionals and between professionals and non-professionals providing care. Research findings show that trust has a positive effect on patient experiences and health outcomes. Therefore, it is one of the most valuable investments managers can make.
An example from practice: in West-Friesland, the Netherlands, regular intervision meetings were implemented where professionals met with one another to reflect upon their personal and professional development. These included home care nurses, practice nurses from GP offices, a social worker, case managers, and a ‘social support consultant’ from the municipality. The meetings helped to develop personal relationships and trust. They also increased the awareness of roles, responsibilities and expertise of professionals from other organisations.
2. An interprofessional culture of care – It is important to develop a culture that believes that interprofessionalism truly benefits users and their informal carers. Such a culture values the insights from professionals and non-professionals who together, collaborate and co-create to deliver care. This range of expertise is necessary because older people often develop chronic and complex conditions that are permanent and non-reversible. Furthermore, because integrated care is about meeting the client’s medical, social and emotional needs.
For instance, in the ‘Over 75 service’ at Sandgate Road Surgery, UK, voluntary sector agencies are an integral part of the service. Non-professional staff includes care navigators, health trainers, personal independence coordinators, and carer support workers. By engaging in an interprofessional culture of care, these professionals have been able to decrease social isolation and provide more proactive and preventative care.
3. Continuous interdisciplinary learning – Evidence has shown that the closer learning opportunities are to practical realities, the better the workforce is able to master competencies. Learning should be about promoting reflection, problem solving, self-directed learning, and professional responsibility. Continuous interdisciplinary learning is necessary because SUSTAIN sites have often found that the required skills of new recruits have not been adequately developed during their initial training, and their lessons learned are often out of date.
An example from practice: in Austria, nurses and doctors use case conferencing as a strategy to share their knowledge with one another. Case conferencing is a more formal, planned and structured event separate from regular contacts. In this manner, hospital units have the opportunity to discuss patients with a mental health nurse or psychiatrist, which fosters a more person-centred care approach and supports the staff in their daily work.
4. Leadership opportunities – Some SUSTAIN improvement projects have benefited from a range of leaders who support the change process. Some of these individuals have been officially mandated, others have assumed these roles unplanned, and often these leaders have stepped up on their own initiative. It has been found that when control is delegated to front line staff, carers and even to users, the result is more efficient and effective person-centred care. However, this is only realised in instances where these groups are supported by their managers to effectively utilise structures and systems that promote integrated care delivery.
The improvement project at the Alutaguse Care Centre in Estonia is characterised by a strong leader whose approach involves, among others, a high degree of communication with staff to gather their input and sustained engagement through new roles and responsibilities.
5. Competency-based recruitment and performance management – Competency-based recruitment aims to hire staff with the desired competencies to support integrated care. One way to improve this is to cross-train new staff with different team members and services to ensure that they are familiar with different roles. Competency-based performance management is the continuous process of adressing, measuring and developing staff performance in alignment with the goals of the organisation. In cases where performance management is applied, organisations seem to fare better at retaining their staff.
6. Integrated practice environments – This refers to the physical structures, electronic infrastructure and the non-electronic tools that are part of caring for the user. Take for example co-location of services, direct telephone access to relevant services, IT platforms, and paper documentation. The availability of information and communication technologies that support the management of care makes it easier to ensure continuity and care coordination. Studies have also confirmed that electronic health information positively influences the user’s perception of the continuity of care.
A lesson from practice: in Surnadal, Norway, managers express that it would be beneficial if municipal service units, such as home care services and information technology units were strategically co-located. This might encourage collaboration in goal setting.
In the European project SUSTAIN (Sustained Tailored Integrated care for Older People in Europe) researchers, policy advisors and other partners from eight participating European countries analysed initiatives in the field of integrated care for older people living at home. The Roadmap is their end-product and enables policy and decision-makers to design and improve integrated care in their own community.
The SUSTAIN project was funded under Horizon 2020 – the Framework Program for Research and Innovation (2014-2020).