Care coordination for chronic and complex health conditions: An experienced based co-design study engaging consumer and clinician groups for service improvement.

Liza Heslop,Trish Burton,Kathryn Cranwell,Sharon Mary Brownie

doi:10.1371/journal.pone.0224380

Liza Heslop, Trish Burton + Show 2 more

Open Access

https://doi.org/10.1371/journal.pone.0224380

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Journal: PloS one	Publication Date: Oct 31, 2019
Citations: 6	License type: CC BY 4.0

Affiliation: Victoria University, James Cook University, Western Health

Abstract

BackgroundEvidence shows that engaging consumers and clinicians in development of health services creates a more responsive, integrated service that better meets the needs of consumers and the community of practice it serves. Further, consumer and clinician participation in service development processes can boost confidence and motivation levels in organisational employees and help foster clinical accountability.ObjectiveTo see where consumers’ care experiences could be improved by better understanding where care coordination organisational systems needed improvement.MethodsExperienced based co-design informed an investigation of consumer and clinician experiences of a care coordination service and involved the sharing of those experiences across service employees in a series of iterative and feedback loops over eighteen months (July 2012-January 2014). Formal participants included care coordination clinicians (n = 13) and consumers. Data from formal participants were collected during September-December 2012, consisting of consumer video-recorded and clinician audio-recorded interviews. Interview transcriptions were analysed to identify service “touch points”, being emotionally significant events related to key service aspects that connect or disconnect consumers and/or clinicians.ResultsResults revealed that consumers highly valued the transdisciplinary skill base of the care coordination workforce, though service improvements were needed for transition support, quality discharge planning and conveying better understandings of care coordination activity both internally and externally.ConclusionIncorporating consumer and clinician view-points about their experiences, including the production of a DVD, facilitated conversations across the entire service about care coordination provision and provided a catalyst for design improvement that may otherwise have been difficult to achieve. Some changes to the service were made such as improved client complaints processes, new roles for the care coordination service, and enlisting clinical staff to undertake motivational interviewing training to promote greater consumer self-management capacity. In this study, the user experience was given a platform within a larger healthcare workforce capability development project.

Highlights

Public health and social services nationally and internationally have noticed an increase in the quantity of older people presenting to health services suffering from long-term, complex multi-morbidity with unique problems, characteristics and needs [1,2]
Results revealed that consumers highly valued the transdisciplinary skill base of the care coordination workforce, though service improvements were needed for transition support, quality discharge planning and conveying better understandings of care coordination activity both internally and externally
Some changes to the service were made such as improved client complaints processes, new roles for the care coordination service, and enlisting clinical staff to undertake motivational interviewing training to promote greater consumer self-management capacity

Summary

Introduction

Public health and social services nationally and internationally have noticed an increase in the quantity of older people presenting to health services suffering from long-term, complex multi-morbidity with unique problems, characteristics and needs [1,2]. Problems identified as commonly experienced by consumers with multi-morbidity include fragmentation and poor coordination of care, polypharmacy, mental health difficulties, functional difficulties, reduced quality of life, and treatment burden—all of which lead to increased healthcare utilisation [3]. The goals of care coordination include: enhancing consumers’ quality of life; management and co-ordination of healthcare services to encourage a continuous service experience for consumers; the provision of quality interventions and; decreasing the fragmentation of care where multiple treatment modalities are involved [6]. Consumer and clinician participation in service development processes can boost confidence and motivation levels in organisational employees and help foster clinical accountability

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Results

Discussion

Conclusion