Quality at all levels – An analysis of the need for change in integrated care pathways for children and youngsters requiring complex and coordinated health services

Abstract

Purpose and background: Better and more coordinated health services for struggling children and youngsters is one of the current priority areas in both national and regional policy in Norway. To fully understand and implement effective managerial strategies necessary to facilitate quality at all levels of the health care system we need to gather experiences, views on challenges and possible problem solutions from each level of the practice field. Objective: The objective of the study was to identify the need for change at each level in the integrated care pathways in the health care system for children and youngsters requiring complex and coordinated health services in a Norwegian setting. Methods: Our study is based on qualitative interviews of key informants from four municipalities in the Northwest of Norway. The included municipalities had 6,208, 2,500, 1,417 and 486 inhabitants in the age range 0 to 19 years, respectively. The study included informants’ from all municipal support and health services for children, youngsters and their families, general practitioner services, nurseries and schools, and specialist health care services for children and youngsters. A total of 63 informants were interviewed, some individually and some in groups. We designed separate interview guides for workplaces within primary and specialist health care services. Results: Our results show that there is still a gap between primary health care services for children and youngsters in the municipalities and specialist health care that lead to fragmented care pathways. This is mainly caused by lack of information about the services provided by the other levels in the pathway, and lack of formal procedures for exchange of information during elucidation and treatment of patients. There is also a need for more evident and formal distribution of responsibility especially at discharge from specialist health care. The informants emphasize managerial strategies for formal procedures regarding information exchange, regular collaborative meetings and mutual competence building for all staff involved in health services for the target group.