A few weeks ago, my best friend told me that her 92-year-old mother had broken her arm. My friend took her to a hospital and had to navigate her way through an array of signs that pointed to different specialized departments. In the Dutch healthcare system, we are very compartmentalized. For every symptom, we have a specialized treatment center, and patients often move from one clinic to another. However, with the rise of healthcare costs, we have become aware that we need to move in a different direction to control expenses and to integrate care.
I recently worked with two organizations in The Netherlands—an organization specializing in nursing homes for elderly people with dementia and a mental healthcare institution—as they joined forces to create a new, integrated center. This case illustrates that to offer optimal care for elderly people, institutions need to work closer together and integrate knowledge and experience into an integrated “care and cure” concept.
Two Organizations, One New Center
The two organizations both work in the field of care for the elderly, but with a different profile. The first, a nursing home organization, cares for elderly people with complex behavioral and psycho-geriatric problems. The second, a mental healthcare organization, provides services for elderly people with psychiatric conditions in combination with severe physical vulnerability. If we look at the partnership from a systemic perspective, it makes sense to create a new center where knowledge and expertise from both organizations can be combined and where patients can easily and seamlessly be transitioned from this center to more permanent housing. Unfortunately, the current financial system does not support this kind of cross-disciplinary collaboration. So, for now, we’ve created a temporary financial solution, which we must make sustainable in time.
The group leading the initiative asked me to serve as a process facilitator to guide the project team through its work. The two organizations evenly split the cost, allowing me to remain neutral and serve the interests of both organizations.
We began by identifying shared goals. In addition to the shared goals, both organizations have their own targets they want to achieve, which they inventoried, shared, and then visualized in a clear drawing. The visualization of the “why” is helpful, because it is an easy and consistent way to communicate the reason this project is being carried out to all of the people who work on it. Whenever we reached a hurdle that seemed too hard to jump over, we looked back at the visualization of the goals and got a renewed sense of why we are in this adventure together.
“Care and Cure”
The team’s shared objective is to realize a truly integrated “care and cure” concept. The project team constantly discusses how to create solutions that are the best of both worlds, a solution with the care component from the nursing home institution and the cure component from the mental healthcare institution. To facilitate this integration, the doctors and nurses who will be working in the new center have been selected from both organizations. In addition, to improve the transition for clients from the current treatment facilities to the new center, the nursing home team received additional training. Learning about ways to support people with mental health issues has provided the entire staff with the much-needed competence to handle any situations that may arise.
Taking an integrated approach is sometimes hard, because it involves challenging the norms and values that are at the core of the different professions.
We learned that, when working with people from two different organizations, it is easy to think that you’re talking about the same thing, but in fact, you’re both making your own interpretations. Reducing the use of jargon helps eliminate this kind of confusion.
A Successful Launch
After a year of preparation, we launched the new facility. The center’s managing team comes from both organizations. This guarantees that leaders consider every decision from both perspectives and come with answers that are the best of both worlds. The conversations about integrating the two ways of working continue to take place.
Why was this process successful? Both organizations felt—and clearly articulated—an urgency to improve the situation for their clients. In addition, the step of making explicit the different individual targets from both organizations made the process open. This openness motivated the team and helped it sail through rough waters.
I hope that when my mother is elderly and needs specialized care, she will not have to move from her nursing home to a clinic and back again, but instead can get the treatment she needs where she is. And I believe that if this is the reality, it will not only be better for my mother, but it will also stop the unnecessary rise of costs in the system.
