Organising preventive care and support networks: a need for citizen-centred service delivery

Abstract

Abstract Background There is a growing interest in providing preventive care and support services at a district level (Goodwin, 2014; Kernaghan, 2005) in a citizen-centred way, i.e., accessible, delivered seamlessly, and complying with citizens’ needs and capabilities (King & Meyer, 2006). Currently, those citizens who might need it most are not reached and services provided suffer from a lack of coherence (Kodner, 2009; Stange, 2009). This study aims to examine how local authorities organise more accessible and integrated preventive care and support services against reasonable costs at a district level. Methods An exploratory multiple case study approach was adopted. The unit of analysis was the organisation of the preventive care and support delivery process. Policy documents were analysed and 13 semi-structured interviews were conducted with professionals in four Dutch districts. Results Our findings show that three stages of the delivery process should be distinguished, as within each stage a set of specific key design decisions were taken aiming to contribute to easy access and integrated service delivery. These three stages are (a) entrance, (b) exploration of needs and capabilities, and (c) the development of care and support networks. Each case showed a unique constellation of choices on these key decisions, and explicated their motives for organising it in this way. Examples of these key decisions are: the number and location of access points, the number of different professionals involved (indicating the level of (de)coupled process), and the type of professionals involved. Conclusions The results show that different stages and design decisions could be identified across the four cases. These, as well as clear interfaces between the stages, can be regarded as a constellation of choices through which citizen-centred delivery could be enhanced. Key messages Importance of design decisions in citizen-centred delivery. Focus on multi-faceted issue of organising integration within the different stages.