There is no need for an incremental change in the care landscape – but a transformation, and this needs to take place in several countries at an international level. This becomes clear at multiple conferences where I am invited to speak about integrated care. Whether it is at the ‘Health Community Congress’ in Brussels, or at the recent ‘Sweden’s Patient Safety Conference’ or at conferences of the International Foundation for Integrated Care.
The importance of this transformation was also underlined at the ‘Global Conference on Primary Health Care’, which took place on 25 and 26 October in Astana, Kazakhstan. At the invitation of the World Health Organisation (WHO), I contributed as a speaker and panel member. More than 160 countries were represented with 40 ministers of health. The focus was on reconfirming the ambitious goals of the 40-year-old Declaration of Alma-Ata, which focus on a strong ‘primary health care’. The countries made multiple commitments, including giving enough attention to health promotion and prevention, and no longer accepting fragmented care, unsafe care or poor quality of care.
Difference with Africa
These commitments show that many problems in healthcare occur on every continent, but there are also many differences. For example, there are many young people living in Africa, and infectious diseases play an important role there. While, in the West and countries such as Japan, the issue is mainly about ageing. But whether it concerns young or old: there is a similar need for strong communities to care for people in their own environment and home. This requires in several countries, a redesign of the care landscape that traditionally puts focus (and money) on intramural care and hospital-based cure. It is also about breaking through the silos that no longer meet the needs of people. With silos, I mean the phenomenon in which care professionals work within the boundaries of their own discipline. This stands in the way of demand-oriented care.
This means a challenge for new ways of organising our care. We have to move away from ‘the organisation that must be connected to other organisations’ to achieve better integrated care. Instead, the focus should be on ‘what is needed and where, and which healthcare professional fits in with this? And how can we contribute to what informal care can offer?’ This results in new issues that organisations need to deal with, because the place where care is needed is increasingly at home with citizens. This requires a way of thinking that transcends the organisation’s interests. Organisational boundaries will fade, and in order to provide good care organisations need one another more and more.
Fortunately, there are already many effective initiatives, but these often need further development. For example, in various countries palliative teams are already working. These healthcare professionals are employed by a certain organisation, but the composition of the team itself is cross-organisational. With such an approach, it appears that healthcare professionals can often work very well together on an equal level in the common interest of quality care. However, an organisational and local governance issue still exists behind their actions.
How do you prepare your organisation to meet these needs? What does it mean for an organisation to operate more and more within a network connection and environment? What does this mean for local governance (leadership, accountability, supervision and purchasing care)? The ultimate responsibility also becomes more shared by multiple stakeholders. And what to do when something goes wrong when there is a shared responsibility for the care that is being delivered?
Finally, it requires a different type of leadership with different skills. Optimising your own organisation or even survival of this organisation is no longer the goal. This means that a board may decide to cut down activities based on the realisation that others can simply do it better or cheaper. This creates a feeling of tension because there is also a responsibility for staff, which sometimes makes it complex to aim only for the higher goal.
Is it attainable?
The question is whether such a transformation is attainable. Driving forces such as staff shortages and digitisation could accelerate the process, but more is needed. Governance and leadership must match the overarching goals. Financial incentives to reward or make collaboration possible are needed, because acting beyond one’s own interests is not a human trait that is automatically present. And of course, international exchange of best practices is also valuable. The new declaration, now called the Declaration of Astana, is a relevant and solid fundament for countries to improve their health and social care systems to address the needs of people.