Abstract
In 2015, the Belgian Health Ministers launched a plan intended to evolve towards an integrated care system for chronic patients. This plan is implemented through pilot projects involving local actors. Therefore, the researcher raised the following research question: how does the use of pilot projects as implementation instruments structure the collaboration between parties involved in a pilot project? The term “pilot project” refers to a collaborative work method coupled with an experimentation purpose. This is further developed in the paper via a literature study. This qualitative research draws on interviews, focus groups, direct observation, and a documentary analysis. During the two first phases of the process, field workers had to create multidisciplinary local consortia and write an application file describing the project they would implement during the third phase, which raised challenging collaboration issues. Many people learned to work together over time, progressively overcoming the traditional fragmentation of care. They met regularly, understood their respective roles, and dealt with controversies through negotiation to reach an agreement on a common project. In conclusion, the researcher shows that, thanks to its characteristics, the pilot project instrument supports the development of collaborative care networks; in this example of community-based integrated care networks.
Highlights
Launching Integrated Care Pilot Projects: A Phased Process In January 2016, the publication of the guidance leaflet for future integrated care pilot projects by the Belgian authorities marked the beginning of the implementation of the plan, “Integrated care for better health”
The preparation phase and the conceptualisation phase, which are the two phases of the selection procedure, during which field actors designed their projects together; The execution phase, which began in January 2018, which should last for four years, and during which the twelve out of the fourteen selected pilot projects are expected to implement their “loco-regional action plan”; The expansion phase, which will occur after the four-year execution phase, during which the successful pilot projects will have to evolve to cover the entire Belgian population
The political will was to gather a variety of people working with chronic patients so that each consortium properly reflected the care offer of the geographical zone covered by its project
Summary
For the last ten years, numerous pilot projects have been launched in the Belgian health sector, including “therapeutic projects” and “psy 107” projects in the mental health sector, multidisciplinary local networks for diabetics (type 2) and for patients with renal insufficiency, “protocol 3” projects for frail old people, and more recently, integrated care pilot projects for chronic patients. The latter were initiated as part of the “Integrated Care for Better Health” plan targeting chronic patients, which was approved on October 19, 2015.
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