Improving performance intelligence for governing an integrated health and social care delivery network: a case study on the Amsterdam Noord district

Abstract

Background A guiding principle of a successful integrated health and social care delivery network is to establish a governance approach based on learning, grounded in a data and knowledge infrastructure. The ‘Krijtmolen Alliantie’ is a network of health and social care providers with the ambition to realize such a performance intelligence driven governance model in line with the Triple Aim. This study seeks to identify what performance intelligence is available and how it can be improved. Methods This case study was conducted in the district of Amsterdam Noord, the Netherlands, and employed 23 semi-structured interviews with stakeholders in health and social care, a feasibility analysis of available administrative data, and a reflection meeting with board members of the ‘Krijtmolen Alliantie’. Information needs for performance intelligence by the stakeholders were mapped and a data landscape of the district covered by the network was drafted. Finally, in the reflection meeting with board members of the ‘Krijtmolen Alliantie’ the information needs and data landscape were aligned with governing needs, resulting in priority domains around which to strengthen the data infrastructure for governance of the integrated health and social care delivery network. Results The ‘Krijtmolen Alliantie’ encompasses a network of providers with a diverse range of catchment areas. There are indicators on population health and welfare, however they have limited actionability for providers due to a misalignment with their respective catchment areas. There is a barrier in data exchange between health and social care providers. It is difficult to construct one indicator for per capita cost in the Dutch health data infrastructure as health and social care are subdivided in financing siloes. Priority domains for improvement of performance intelligence for the ‘Krijtmolen Alliantie’ are: 1) Per capita and per patient cost data integration that would allow combined accountability through aligning financial incentives to facilitate integrated care, and 2) combined patient experience and outcome measures to reflect network quality of care and patient experience performance. Conclusion Available performance intelligence lacks actionability for the governance of integrated care networks. Our recommendation is to align performance intelligence with the regional governance responsibilities of stakeholders for health and social care delivery.

Social care data and its fitness for integrated health and social care service governance: an exploratory qualitative analysis in the Dutch context

“…Possible explanations and implications on micro, meso and macro levels Our results are characteristic for a fragmented healthcare system (OECD, 2022). 30 In these systems legal and financial silos are a barrier for integrated healthcare, public health and social care provision governance 25 (OECD, 2022). In the Netherlands social care responsibilities have been decentralised from the federal to the municipal level, resulting in variations between municipalities regarding data processing and utilisation.…”

“…The Netherlands has many (N: >450) care partnerships 24. These are often regional initiatives and alliances that are strengthening their provision of integrated health and care services for better outcomes 25. The bandwidth of data-driven action in these collaborations is broad.…”

“…24 These are often regional initiatives and alliances that are strengthening their provision of integrated health and care services for better outcomes. 25 The bandwidth of data-driven action in these collaborations is broad. Some collaborations see it as a need to have, others as a nice to have.…”

Optimising the secondary use of primary care prescribing data to improve quality of care: a qualitative analysis

“…This volume of activity has called into question the extent to which performance indicators are actually used for improvement purposes. Research on the secondary uses of healthcare data has been conducted in the context of Dutch hospitals,24 out-of-hours care25 and integrated care networks 26. In the absence of an overview of routine primary care prescribing data sources, what and how available data is used for learning and improvement purposes across the healthcare system is unclear.…”