1. Define a clear focus
Clearly demarcate what will, and what will not, be integrated. First: what clinical picture does it involve? How do you deal with comorbidities? Second: which part of the care cycle do you use? For example, do you start with diagnosis, treatment, and follow up? Or do you include prevention from the start as well? Third: is your goal only to improve processes? Or also to modify the forms of funding, or even to integrate organizations (or parts of organizations)?
2. Understand that collaboration is the greatest challenge
Integration of the care process involves not just healthcare-related matters. It is primarily an issue of collaboration between people and parties. Everyone has their own needs and interests. Relationships are not always open or based on trust. To achieve a successful integration, the primary focus must lie on building mutual collaboration and constructive relationships.
3. Involve the right people in the project team
The agreed parameters determine which stakeholders should be involved in the team. Do not take too narrow an approach here: it is essential that the team has the right level of representation. Remember to include patients and caregivers in the primary care process – doctors, nurses, those who deliver care in people’s homes. They are close to patients and form the heart of the team.
4. Make the decision-making process clear
Establish at an early stage who takes decisions, when and how. In order for decisions to be taken quickly, select a small group that represents the various interests so that the decisions are likely to be broadly supported.
5. Make clear agreements with managers and healthcare insurance companies
Make clear agreements with managers and the healthcare insurance company. How are the changes to be funded? How is the better care quality to be rewarded? How will the achieved savings be distributed? And how will the future way of working be funded?
6. Motivate people on the basis of a common goal
Define a clear common goal. Integrating care brings many benefits, but the road leading to it is not an easy one. Without a goal or any persuasion, nobody will act. It is therefore necessary to provide a ‘case for change’; why are the changes important and why are they needed? What will the consequences be if we do nothing?
7. Create a win-win situation
In the process of care integration, some activities will disappear or be relocated to another caregiver. Be aware that this could lead to the creation of ‘winners’ and ‘losers’. You should therefore examine what the common interests are. And look also at how the ‘losers’ can gain some benefit from the integration. If everyone ‘wins’ in some way, you can bring about change successfully together.
8. Do not avoid conflict
Many people prefer to avoid conflict and opposition. This causes a destructive negative undercurrent. Any opposition should therefore be identified as quickly as possible. Encourage others to take this step towards transparency as well. This sounds simple, but it requires leadership and courage.
9. Treat it as a change project
Change costs time, effort, and money. Put a team together whose members have a lot of time, in addition to any day-to-day care duties they may have. Make sure that all the required areas are present (such as medical and business operations), and establish clearly-defined roles. The burdens should also be evenly distributed; each party involved has to commit time and/or financial resources. This also increases ownership.
10. Take time out for analysis and design
Take the time for exploring the current care process (analysis phase) and the design of the future situation. These stages take time, but they are needed in order to determine the right direction and to create support. This will save time later on and increase the likelihood of success.
11. Appoint an independent leader
Appoint an independent leader (person or party) who has the confidence of the various stakeholders. He or she will make sure the above tips are acted upon in order to make the integration a success.
