Changing perspectives: From care coordination to health coordination

Abstract

Existing health inequalities have been brought to the fore by the COVID-19 pandemic. Investing in the conditions that improve people’s health (i.e., education, employment, housing, social networks, healthy environment) should be an essential part of the COVID-19 recovery for societies. The UK government has set out to ‘level up the nation’s health’. In their briefing ‘A whole government approach to improving health’, Merrifield & Nightingale call for continued action from across the whole of government and beyond. They argue that such action is needed both through how government organizes itself to deliver impact and through pursuing the policies that will make a real difference. Acknowledging that health improvement is the responsibility of a range of departments, not just the Department of Health and Social Care, requires all departments to understand the health implications of the decisions they make and the costings involved. Important lessons regarding policies that will make a real difference as part of this movement could be taken from Miller’s et al. overview of integrated care policy in England from 2010 to 2020. They argue that ‘English health and social care services were simply not designed as a system or with integration in mind.’ In yet another analysis of three national programmes piloting integrated care in England, Lewis et al. question ‘why the debate about how best to integrate health and social care remains unfinished business’. In discussing the ambiguous conceptualization of integrated care, they point out the importance of focusing ‘not on what is done within what organisational construct, but on what patients and carers consider to be needed and what will best support care workers of all sorts to work effectively together’. If some systems are unable to be integrated because they simply do not fit together, then perhaps coordination is a more realistic strategy to level up a nation’s health. Health coordination should become the new standard, with care coordination and integration as supporting strategies, if and where appropriate. By bridging the human and its supporting system, health coordinators make use of what works and are well positioned to identify what hinders health improvement. In this light, narrowly focused approaches such as ‘integrated primary care’ and ‘integrated diabetes care’ do not seem sustainable strategies. A redistribution of resources away from disease-oriented or sector-focused policies in the direction of a broad health ecosystem is urgently needed to make a real impact. In this double issue of the International Journal of Care Coordination, van Tuyl et al. report on a scoping review of international literature about task-shifting expert interviews and in-depth analysis of five task-shifting cases in the Netherlands. They discuss that only when designed to face specific complexities at the workplace and taking into account the balance between specialists and generalists, task shifting may substantially contribute to enhanced quality of care that meets the changing needs of society. In other words, similar to the discussion on integrated and social care, for task shifting to make a real impact its broader implications for health need to be understood. By using interpretive description methodology, Chapman et al. describe clinician communication surrounding initiation and withdrawal of non-invasive ventilation in adults with Motor Neuron(e) Disease. From their study, four important learnings emerged. Both the clinicians’ lack of awareness of international guidelines and the discomfort about discussing the benefits and burdens of non-invasive ventilation and percutaneous gastrostomy tube prior to or at the onset of respiratory symptoms clearly indicate room for improvement. Perhaps most worrisome is the learning that family participants and their relatives with Motor Neuron(e) Disease found clinicians’ communication to be inadequate resulting in seeking for information from less authoritative sources. In our ongoing fight against the COVID-9 pandemic, training of health workers is crucial in promoting pandemic preparedness. Yanti et al. used a cross-sectional study design with an online survey to self-assess knowledge, attitude, behaviour and preparedness of health workers in Aceh Pidie Jaya, a district in Indonesia, against the COVID-19 pandemic. Only half of the health workers report good preparedness indicating the importance of ongoing education and training of health workers. Kokorelias et al. report on the experiences and perceptions of community and hospital healthcare professionals in a seniors’ patient navigator program in Toronto. It was found that the role of patient navigators gets understood inconsistently which leads to uncertainty regarding Editorial