The corona crisis: a pressure cooker for integrated care

As scientists investigate the origin of the COVID-19 pandemic, governments, care providers and agencies are evaluating their response during the different phases and lessons learned. In this blog, published by the Forum for Health Policy, Vilans Dir. Strategy and Development, Prof. Henk Nies and Axel Kaehne, Edge Hill University, UK, review the challenges facing society and healthcare systems as they compete for resources and attention. They also introduce their new book, “How to Deliver Integrated Care: a Guidebook for Managers” which breaks down the main principles governing integrating health, social and long-term care, as well as prevention in a societal context. 

How to Deliver Integrated Care: A Guidebook for Managers
Axel Kaehne, Edge Hill University, UK
Henk Nies, Vrije University,The NetherlandsWith contributions from: Dr. Mirella Minkman; Nick Zonneveld; Elize van Wijk

During the past year our health and social care systems have been challenged as never before. The interdependencies within the systems and in society appeared to be immense. The struggle for survival of patients in intensive care units and in other settings, combatting the risks of widespread contamination, downscaling regular care and services, protecting residents and staff of residential care, rapidly developing vaccines, all these issues competed for being prioritised. The impact on society was and still is also unprecedented. An almost full societal lockdown in most of the countries gave rise to many tensions, affecting schools, shops, restaurants, offices, industry, tourism and in fact the entire economy, as well as social life and family life.We saw – and still see – an immense clash of values and interests and often a lack of understanding of those involved. There are furious debates whether the measures are proportional, the interests of young people aren’t harmed too much (against those of older people), the damage of the economic fallback is more harmful than the virus, and whether acute care is privileged above other types of care, such as primacy care. There are practical and ethical debates about who should be vaccinated first and whether human rights are violated by the measures.

In terms of leadership we saw representatives of public health becoming national celebrities, whereas public health is usually the ‘neglected child’ of health care. In hospitals the virologists gained public esteem, as did the emergency and intensive care specialists, geriatricians and IT specialists. There were rapid developments in the use of digital devices and health technology, as well as consumer technology affecting the health sector. And, also never seen before, ministers of finance played a prominent role in ensuring budgets, both for societal measures as well as for health care services. The Dutch Minister of Finance proclaimed: ‘I have very deep pockets’. There was just one party that poorly voiced their interests: the patients and their relatives.

At this moment national and local authorities, care providers and supervising agencies are evaluating what happened in the various phases of the Corona-crisis. Lessons learned are drawn up. Based on these lessons, the next steps towards implementing good practices and the ‘new normal’ can be created. A lot about this is still unknown, and there are many uncertainties. But we do know the principles of implementing well-integrated systems to deal with the next steps in the pandemic and in health care.

The past year was a pressure cooker for testing the principles of integrating health, social and long-term care, as well as prevention in a societal context.

In our book How to Deliver Integrated Care: a Guidebook for Managers published last month, we present these principles in practice oriented chapters. To mention just a few of these principles: In determining the best financial options, ask yourself: ‘who should be the integrating partner: the government, the care provider or the patient/client?’ And for all choices specific questions need to be answered.

There is not one appropriate funding model, but finances have to be in line with the circumstances and choices to be made. These choices are partly normative choices, guided by values. This also holds for choices about care quality and priorities. Values are held by people, being care professionals, managers, executive boards, policy makers, and patients.

Successful integration is about aligning values and interests, hearing and seeing the other actors. Therefore, implementing integrated care is about people working together, adopting the right leadership style to develop the right services and hearing and engaging those people for whom the services are meant, taking the right implementation steps. As we have seen in the current Corona crisis: we need to move forward by engaging in an incremental process in which we constantly design appropriate and better alternatives, chose the right funding and technology, build the right team at all levels, take care of the social dimensions in collaboration and address the normative and ethical issues openly and – if possible – comprehensively. Policy structures and finances are important but should not blur the human and dimension of organising and arranging the right set of measures. We need to apply the principles that we have learned in the ‘old normal’ in the pressure cooker of integrated care that lies ahead of us.

Forum for Health Policy is a Swedish think tank. It serves as a neutral platform where policymakers, researchers and health care providers meet to discuss and analyse important issues concerning the Swedish health care system. With a strong international perspective and focus on the patient experience, the aim is to stimulate innovation, contribute to new ideas, and assist policymakers and politicians with knowledge and possible policy options.

Axel Kaehne is Reader in Health Services Research, Edge Hill University, Ormskirk, United Kingdom and President of the European Health Management Association.

Henk Nies is Director of Strategy & Development, Vilans and professor of Organisation and Policy Development, Vrije Universiteit, Amsterdam, The Netherlands.

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