Citizens as partners in integrated care

Abstract

Introduction : In the Netherlands, citizens increasingly stand up to develop initiatives with each other in the community that attributes to to iving at home longer. One of the ways by which they achieve this, is by organizing health and welfare services themselves, for and by citizens, bases on engagement and reciprocity. Vilans recognized a trend in the rise of these citizens initiatives in (long term) health care, social care and welfare. Since February 2015, the number of citizens’ initiatives in which citizens organise their own welfare and health services rapidly increased from 63, up to a total of 174 initiatives today. What lies underneath this development and these initiatives? How do they work? Are there different perspectives of the involved people about the initiatives? To gain insight into the values of the different stakeholders groups involved around a citizens’ initiative for healthcare and welfare, Vilans has conducted narrative research in 2015 in two sites. Also, Vilans made an inventory of all initiatives in the Netherlands. Theory/methods : Through a qualitative multiple-case study, we conducted narrative research at two different citizens’ initiatives for healthcare and welfare in Lierop (village) and Zoetermeer (city). For each initiative, we collected stories from various stakeholders; 1.) directors/initiators 2.) volunteers/providers 3.) care recipients 4.) external stakeholders such as local authorities or health care professionals. Based on the methodology of narrative research, the stories have been interpreted together with the groups in workshops. The values have been identified and prioritized. In addition, the stakeholders have outlined distinctive characters per citizens’ initiative. Progress report : In our study, 171 stories have been collected at the two citizens’ initiatives. These stories served as inspiration and insight for identifying and prioritizing the values in each group. This has resulted in the three most important values per group per initiative. In addition, the groups have outlined 4 distinctive characters per citizens’ initiative, which provide insight into the perspectives of the stakeholders towards the initiative. The results show the initiatives are relevant and new stakeholders in integrated care, who are only on the starting point of their development. Discussion : The study results show that the two investigated citizens’ initiatives in healthcare and welfare are both different and unique, but the study mainly shows merely similarities concerning key values. The boards of both initiatives have prioritized values which are directed towards stimulation, self-direction? and willingness. No conflicting value types have been named by the different stakeholders within the citizens’ initiatives or between the two initiatives although the initiatives differ in their appearance. The prioritised values of the different groups in both citizens’ initiatives were focussing on growth and development. Citizen initiatives develop and gain new tasks: first experiences with purchasing care and delivering care by the initiatives are running. Conclusion : The role of citizens organizing themselves brings a new dimension in integrated care. As new players their voice of the local people changes collaboration in the health and social care. The initiatives are developing themselves, have common values as health and social care professionals in integrated care and want to collaborate with ‘formal care’. How to do this and which roles to fulfill (for instance purchasing care) are new challenges to discover the coming years in the already 176 initiatives. The narrative research method was an intensive but effective method for collecting experiences in different groups through new collaborations. The respondents were enthusiastic about participation because the research helped them in the conversation and further collaboration with each other. The joint designation of experiences and values by different groups supports new and existing collaborations within the citizens’ initiatives. The found similarities and differences in the values of the initiatives can be further developed and serve as a key content for further cooperation between citizens’ initiatives, local authorities and care and/or welfare organizations.