[Posted on 16 May, 2017 by Nanna Gillberg]
Swedish health care services have a general goal of making health care efforts and care chains more patient-oriented. All care should be based on a comprehensive view of the individual patient’s total needs. Such an approach demands collaboration and coordination across organisational boundaries so that care might be given in a coherent and comprehensible chain. Care and intervention efforts are organised in a decentralised manner, with separate units all trying to optimise according to their own respective budgets and goals, instead of focusing on the needs of the individual patient. This structure leads to practical difficulties with regard to collaboration and also works against obtaining a comprehensive view of the patient’s situation. An example of this presented itself when I was mapping out how investigation and intervention is performed for small children suspected to have autism or some other significant developmental disorder. The chain of investigation and intervention in ordinary care services was compared to a pilot project where this same chain was organised according to a clearly defined collaborative model. This comparison showed significant flaws in how care services are currently organised. The chain of investigation and intervention in regular care services was neither coordinated nor tailored to the child’s symptomatology or life situation. Instead, the various links in the chain were divided among many actors, often geographically scattered and with different systems and goals. Every transition between actors created gaps, extra work and loss of time. They also generated activation of new health care guarantees, which in turn contributed to prolonged wait times. The collaborative model deviated from ordinary procedure primarily in two ways: the entire care and intervention chain was concentrated to one location in the families’ immediate environment, and children and families met with the same caretakers throughout the whole chain. This led to increased continuity and families having to deal with fewer different people throughout the process. The collaborative model thereby created better circumstances for gaining a comprehensive view and increasing flexibility. Intervention measures could be implemented earlier and whenever the need arose rather than when the organisational process allowed it. Moreover, members of the investigation team were able to base their efforts on a complete understanding of the situations facing the respective children and families. Organisation according to the collaborative model had a positive influence on both investigation and intervention efforts, created continuity for both patients and caregivers, and reduced lead times. Collaboration across organisational boundaries thus produced both humanitarian and economic gains at both the individual and societal level. The evaluation of the collaborative model compared to ordinary operations highlights the importance of creating circumstances for coordinated patient-oriented care. To achieve the full picture that care services purportedly strive for, health care must be organised and funded in accordance with a comprehensive view rooted in the patient’s total needs.