Noor Heim is an assistant professor who currently works for the University Medical Center in Utrecht. In this blog, she discusses her recent Age & Ageing paper on research she has done in the Leiden University Medical Center.
Integration of treatment and care from multiple disciplines is particularly critical in care for older people. Most older people admitted to a hospital suffer from more than just one (chronic) condition. As a consequence, coherent care for older patients involves more than just one discipline. Furthermore, the fact that patients are discharged from hospital quicker and sicker, with higher demands of care, increases the need for integration of (transitional) care between settings. Given the number of older adults who permanently lose the ability to perform one or more activities of daily living during and after a hospital admission, one has to conclude things need to be improved. However, it has proven challenging to accomplish improvements and maybe even harder to study (and to quantify) the benefits of the efforts taken.
Often, improvement strategies are designed within one setting, for example the hospital, then cooperation partners are sought in other settings and the pre-designed improvement programme is proposed. In our recently published manuscript in Age & ageing, we present the strategies we used to try to improve integrated (transitional) care for older patients. We started off by bringing together all stakeholders in care for older people in the region. They were given a strong voice when creating the agenda of action within our regional programme. The agenda provided a framework in which specific improvement goals could be fit. Our strategy was highly adaptive to differences between organisations and settings and to changes over time. In small committees, professionals of organisations who directly cooperate in the care for older patients pinpointed bottlenecks in their quality of care. They were equal partners in proposing innovations in the care they were involved in. The same professionals joined in managing the implementation of the proposed innovations.
Several advantages of the strategy were experienced throughout the course of the programme. Because the healthcare providers together created the agenda, they were highly motivated to make all necessary efforts to reach the mutual goals of improvement. In the installed committees progress on the agenda was monitored and pace was kept. Making professionals from within the organisations responsible for the implementation of innovations, diminished the risk that innovations were not internalised and therefor stopped when funding and support of the programme ended.
Implementation of predesigned intervention programmes that tell healthcare organisations to improve quality of transitional care according to an uniform protocol might not accomplish its goals. We should bring healthcare providers together to inflame the internal motivation to improve quality of care and supply them with guidance and support. We need to make sure there is a catalyst to start the actions necessary to get it done.
British Geriatrics Society 
‘We need to make sure there is a catalyst to start the actions necessary to get it done’: just what the doctor ordered!