Collaboration and Coordination Challenges in Patient-Centered Care

2016. Monica Winge.

Thesis (Doc)

This thesis reports on research focuses on how to deal with the fact that the organization and processesof today’s health and social care are becoming ever more complex as a consequence of societal trends, including an aging population and an increased reliance on care at home. The overall research goal is to suggest ways in which IT-based solutions can enable and leverage collaboration and coordination insituations where a co-morbid patient is subject to care delivered simultaneously by several different professionals and organizations.

Patient-centered care is defined as quality health and social care achieved through a partnership between informed and respected patients, their families, and coordinated health and social care teams who conduct care activities according to jointly determined care plans.

Against a background of several years of research on patient-centered collaborative care using adesign science approach, using techniques such as focus groups, interviews, and document studies, the author of the thesis has further pursued the work in a project named CoCare. Results show that the care required in aging societies is both a social and a technical challenge. Meeting this challenge will require a redesign of today's health and social care processes in order to focus more clearly on patient needs and values, and poses demands on information services allowing to share knowledge of the patient’s health and social situation among involved care providers. An important aspect of the increased complexity is that a single patient may need care from several autonomous care providers in parallel, particularly patients with co-morbidities. This clearly requires effective coordination of care activities, which poses further demands on information services to support this task.

A set of issues involving patient-centered collaborative care is identified and analyzed. The thesis introduces the notions of the Patient-Centered Care Process (PCCP) and a conglomeration of suchprocesses. A conglomeration comprises a set of PCCPs that concern the same patient, that are overlapping in time, and that share the overall goal of improving and maintaining the health and socialwell-being of the patient. The PCCP is inspired by the well-known PDCA cycle and comprises the four phases of assessing the patient situation (ASSESS), planning care activities (PLAN), performingcare activities (DO) and following up care (CHECK) for the patient. Based on a number of key standards, such as HL7, HISA and CONTsys, the thesis introduces a Patient-Centered Information Model (PCIM). A set of information services, together constituting a Coordination Hub, is proposed. The information services aim to help formal as well as informal carers (including the patient) inconducting care according to the PCCP

The thesis contributes to a deeper understanding of care processes and suggests ways to achieve patient-centered collaborative care that better contributes to creating value for the patient as an individual.

The coordination hub

2015. Monica Winge (et al.). Health Informatics Journal 21 (4), 284-305

Article

The organization and processes of today's health and social care are becoming ever more complex as a consequence of societal trends, including an aging population and an increased reliance on care at home. One aspect of the increased complexity is that a single patient may receive care from several care providers, which easily results in situations with potentially incoherent, uncoordinated, and interfering care processes. In order to describe and analyze such situations, the article introduces the notion of a process conglomeration. This is defined as a set of patient-care processes that all concern the same patient, that are overlapping in time, and that all are sharing the overall goal of improving or maintaining the health and social well-being of the patient. Problems and challenges of process conglomerations are investigated using coordination theory and models for continuous process improvement. In order to address the challenges, a solution is proposed in the form of a Coordination Hub, being an integrated software service that offers a number of information services for coordinating the activities of the processes in a process conglomeration.

Understanding Care Work and the Coordination of Care Process Conglomerations

2015. Monica Winge, Erik Perjons, Benkt Wangler. Advances in Conceptual Modeling, 26-37

Conference

Health and social care is becoming ever more complex as a consequence of societal trends, including an aging population and increased reliance on care at home. One aspect of the increased complexity is that a single patient may receive care from several care providers, which easily results in situations with potentially incoherent, uncoordinated, and interfering care processes. In order to describe and analyze such situations, the article introduces the notions of patient-centered care process and a conglomeration of such. The latter is defined as a set of patient care processes that all concern the same patient, are overlapping in time, and are all sharing the overall goal of improving or maintaining the health and social well-being of the patient. The processes are based on a PDCA-cycle comprising phases for assessing, planning, performing and following up the care for the patient independently of health and social care organizations.

Implications of Single Point of Contact

2014. Monica Winge, Ulrika Drougge, Gustaf Juell-Skielse. DSV writers hut

Conference

As more public organizations aim to move to the stage of transformational Government, the need for ‘single point of contact” increases dramatically on local, regional and national government levels. This paper contributes to literature by reporting the findings from three case studies of Swedish local government who has reached, or intend to reach, the transformational stage of e-Government. Using a grounded theory approach, information about the municipalities was collected and analyzed from the perspective of goals, implications and change management. The paper reports on the opportunities aimed for and experienced by the municipalities as well as the organization-al, technical and legal challenges faced by them. Finally we make five prop-ositions, based on the learning from the case studies, on how to manage changes related to implementing single point of contact in local government.

Scenario for a patient at home in health and social care

2014. Monica Winge, Eva Lindh-Waterworth. Journal of Healthcare Leadership (6), 51-66

Article

This paper describes and discusses the situation for a typical patient with multiple illnesses and how his case would benefit from improved coordination, communication, and collaboration among all involved care providers. The paper is built around a patient case presented in a current scenario. The authors identified that for a single patient with several problems and diagnoses and the involvement of several care actors, the common issues concern lack of collaboration, lack of coordination, and awareness of what others have done to assess, plan, perform, and evaluate care. This presumably leads to a lack of care quality and a lack of effective use of care resources. The scenario and the findings are based on a patient-oriented perspective, on an analysis expressed in focus groups, and on interviews with key actors in health and social care. The paper also discusses the fact that an increasing number of patients are treated in their homes by a variety of organizations, and how this fact raises new and more intense demands on the various stakeholders forming the care staff to collaborate and coordinate care. We point to the need for managers in and between organizations to agree on the ways of collaborating at the operational level. Most importantly, by taking a basic set of issues as the starting point for reasoning, we derived a set of related problems and suggest solutions to deal with these. The literature currently lacks scenario descriptions that put the patient's situation into focus with respect to collaboration between health and social care. Finally, the paper presents a future case for collaboration including support by new e-services.

Managing the Process Conglomeration in Health and Social Care

2013. Monica Winge (et al.). HEALTHINF 2013 - Proceedings of the International Conference on Health Informatics, 374-381

Conference

The organisation and processes of today’s health and social care are becoming ever more complex as a consequence of societal trends, including an ageing population and an increased reliance on care at home. One aspect of the increased complexity is that a single patient may receive care from several separate care providers, which easily results in situations with potentially incoherent, uncoordinated and interfering care processes. In order to describe and analyse such situations, the paper introduces the notion of a process conglomeration. This is defined as a set of patient care processes that all influence the same patient, which are overlapping in time, and that all have the goal of improving or maintaining the health and social wellbeing of the patient. Problems and challenges of process conglomerations are investigated using coordination theory and speech act theory. In order to address the challenges, a number of information services are proposed.

Needs, Requirements, and e-Services for Collaborative and Patient-Centered Care

2013. Monica Winge, Benkt Wangler. BIR 2012. Emerging Topics in Business Informatics Research 2012, 75-91

Conference

This paper discusses the fact that more and more patients are treated in their homes by a whole set of organizations, and how this fact places new and more intense demands on health and social care staff to communicate and collaborate. The aim of the paper is to further explore the detailed needs for collaboration between different care units, individuals and professions, and to outline organizational and/or IT-based solutions. The suggested solutions are based on a patient and process oriented perspective and on an analysis of needs and issues expressed in interviews with key actors in a number of research projects focused on collaboration in care. We point to the need for managers in different organizations to agree on ways of communicating and collaborating on the operational level over sectors and units and how this aspect has to be taken into account already during procurement of care services. Most importantly, by reasoning from a basic set of issues, we derive a set of related problems and suggest solutions for how to deal with these. The solutions include suggestions for various e-services aimed at improving coordination and collaboration among care personnel.

Need for a New Care Model - Getting to Grips with Collaborative Home Care

2010. Monica Winge (et al.). MEDINFO 2010, 8-12

Conference

In this paper we discuss the fact that more and more patients are treated in their homes by a set of organizations, sometimes with different ownership, and how this fact places new and severe demands on health care and home service staff to communicate and collaborate. We point to the need for managers in different organizations to agree on ways of communicating and collaborating on the operational level and how this aspect needs to be considered during procurement of home care services. Most importantly, by reasoning around a set of problematic areas, we derive a set of related problems and suggest solutions for dealing with them. The solutions are a mix of organizational/administrative measures and IT support for communication and coordination.

CO-CARE - Collaborative Health and Social Care

2008. Monica Winge (et al.). Proceedings of 13th International Symposium for Health Information Management Research, 113-124

Conference

In this paper we discuss the fact that more and more patients are treated in their homes by a set of organizations, sometimes with different ownership. We explore how this poses new and stronger demands on health care and home service staff, as well as on different managerial and operational levels, to improve their communication and collaboration. We emphasize the need for managers in different organizations to agree on ways and forms of communication and collaboration between the operational levels, and the particular importance of this during procurement of home care services. As a result a number of methodological measures, strategies and IT solutions to support organizational development, coordination and collaboration are suggested.

Monica Winge

About me

Publications

Collaboration and Coordination Challenges in Patient-Centered Care

The coordination hub

Understanding Care Work and the Coordination of Care Process Conglomerations

Implications of Single Point of Contact

Scenario for a patient at home in health and social care

Managing the Process Conglomeration in Health and Social Care

Needs, Requirements, and e-Services for Collaborative and Patient-Centered Care

Need for a New Care Model - Getting to Grips with Collaborative Home Care

CO-CARE - Collaborative Health and Social Care