Why and how Flanders wants to roll out goal-oriented, integrated care based on life goals.  A reflection between policymakers and policy organizations.

Abstract

Flanders believes that integrated care can only be achieved by linking medical care, with welfare and social care, creating local government participation and including the voice of the patient and his or her caregiver in local and central policy processes. 
 In order to evolve from fragmented primary care to integrated care, a participatory procedure was mapped out in Flanders: since 2020 existing structures were changed and several tools have been developed to transform the way of care into goal oriented care. 
 The Flemish meso level was thoroughly rearranged: during the covid years population-based approach was rolled out by local care councils.  The care council aims to install integrated, goal-oriented care within the local network of medical care providers, social and welfare providers and local authorities, in cooperation with the patient and his or her caregiver. Together with all these partners, the care council takes care of a population of at least 75,000 people.Finally primary care, and by extension the entire care scene, will evolve towards better goal-oriented, integrated care. This evolution is supported by the implementation of the digital care and support plan which is flanked by a the reform traject of palliative care in Flanders,
 The main goal of in Flanders care organization is putting the patient in the driving seat of the care-process which will be based on life goals
 For policymakers and organizations, this presentation aims to look back at the complex change process, outline future challenges and share lessons learned.
 We show how strategically chosen change management creates connection between welfare, social and medical care.  How, the interaction between patient and caregivers and local authorities try to achieve integrated care in the local communities
 We show our complex challenge of introducing quality thinking and building organizational resilience for future crises within the young care council.
 We discuss the complexity of linking local priorities with global policy objectives and vice versa.