Organising comprehensive care for people is important. In healthcare jargon this is known as ‘multidisciplinary or coordinated care’, but this does not really cover it. Nor is the term ‘integrated care’, which connects different realms of life, entirely suitable. I prefer to use the term ‘integrality’, although the word does not exist in this context, according to the dictionary. Basically, therefore, I need new words to define ideas about new forms of care that go beyond care. The partnerships of the future that realize integrated services will require a new language.
The move towards integrality is logical. One only need consider the problems that can arise in a family requiring youth care services: health problems, debt problems, psychological problems. A broken leg just needs fixing, but the solution is not always that simple, particularly not in our society, with its growing proportion of elderly, and people with multiple needs. They, more than anyone else, need all areas of their life to be connected. This does not mean that organisations should offer their services in a multidisciplinary way, working alongside each other; it all starts with what is important to the client and what he or she needs. We are all trained in our specific field and we all mean well, but somehow or other we overlook this elementary need.
‘To keep providing good care you constantly have to connect with others’
It is not only important that we reorganise care, organisations also need the capacity to adapt to social trends. Our society is rapidly becoming ‘networked’. Dutch leaders and board members of healthcare organizations must be aware that operating in complex partnerships is a vital element of the quality they deliver and of their own performance. An illustration of this is a recent announcement of Radboud University Medical Centre’s that it wanted to evolve into a ‘university medical network’. To keep providing good care you constantly have to connect with others. This of course raises governance issues: what is the role of regulators and advisory boards, should they confer with fellow boards in the network, and how much scope should they have? They should also consider the added value their organisation brings to a networks or collaboration.
The good news is that I expect the networking of our society and of the healthcare sector, combined with digitisation and the demand for real-time knowledge, to bring the processes of care provision and knowledge development closer together. We need a knowledge infrastructure in which providing care and performing research are much more interwoven. The identification of questions arising in practice would then function as direct research programming and input, and applied research would occur together with and in healthcare practice. Healthcare partnerships and knowledge networks would then be able to merge more successfully.
The issues we will face in the future will also be considered at the International Conference on Integrated Care in May 2018, which is being co-hosted by Vilans Center of Expertise for long term care, ZonMw and the National Institute of Public Health and the Environment. It will provide a global platform for the exchange of knowledge on how healthcare and support can cater better for needs, and how integrality can be achieved. Despite some major differences between the healthcare systems of the participating countries, they are all working towards care that is more successfully organised around people. The WHO also acknowledges that we should be moving towards integrated health services delivery.
If we break free of entrenched ideas and old terminology it can help us transform the way we act. Perhaps a new language would bring us closer together, and help us understand each other better. Keep a broad view, and do not lose sight of the people it is all about.
Mirella Minkman is distinguished professor of innovation in the organisation and governance of integrated long-term care at Tilburg University/TIAS, director of research and innovation at Vilans and vice-chair of the Executive Board of the International Foundation for Integrated Care. She is also a member of the ZonMw Pregnancy and Childbirth II programme committee.