Integrated Palliative Care for Nursing Home Residents: Exploring the Challenges in the Collaboration between Nursing Homes, Home Care and Hospitals

Abstract

Introduction: Nursing home residents are a vulnerable and frail segment of the population, characterised by their complex and palliative care needs. To ensure an integrated approach to palliative care for this target group, working on a collaborative basis with multiple providers across organisational boundaries is necessary. Considering that coordinators of palliative networks support and coordinate collaboration, the research question is: ‘how do network coordinators perceive the process of collaboration between organisations in Flemish palliative networks?’ Methods: A dual-phase sequential mixed-methods design was applied. First, the coordinators of each of the fifteen palliative networks in Flanders completed a survey in which they evaluated ten aspects of collaboration for two types of cooperation: between nursing homes and home care, and between nursing homes and hospitals. Next, the survey results thus obtained were discussed to improve understanding in a focus group composed of the above coordinators, and which was analysed on the basis of content analysis. Results: In both forms of cooperation, the ‘formalisation’ and ‘governance’ were the aspects that yielded the lowest mean scores. The coordinators in the focus group expressed a need for more formalised interaction among organisations with regard to palliative care, the establishment of formal channels of communication and the exchange of information, as well as the development of shared leadership. Conclusions: The perspectives of the coordinators on inter-organisational collaboration are a valuable starting point for interventions directed at the stronger integration of palliative care for residents of long term-care facilities.

What Makes Integration of Chronic Care so Difficult? A Macro-Level Analysis of Barriers and Facilitators in Belgium

“…Our study is in line with other analyses of the Belgium context, as well as with similar analyses in other settings. Previous research in the Belgian context has acknowledged the importance of a strong e-health system [32,33], adequate payment systems, such as all-inclusive payments or pay-for-coordination [33][34][35], and the need to involve all stakeholders [33]. Our study added to these the importance of assembling responsibilities at one government level, which becomes more prominent and urgent when policy initiatives at the different levels stumble.…”

“They hold on tight to the healthy eating, we hold on tight to our food safety, and how do we bridge that?”: determinants of successful collaboration between food safety and food security practitioners in British Columbia, Canada

“…This power differential stemming from hierarchical distributions of power within teams of healthcare professionals has been identified with other healthcare professionals (e.g., physicians and palliative network coordinators, Hermans et al, 2019;general practitioners and community pharmacists, Bollen, Harrison, Aslani & van Haastregt, 2019). However, this social system was supported in part by the laws outlining physician responsibility for patient-care (Hermans et al, 2019;Lockhart-Wood, 2000). Here, participants identified power differences as stemming from the legislative system, which was perceived as prioritizing food safety over food security.…”

“…They identified the social system as a source of power differentials between members of the healthcare team, stemming from the typical roles of physicians as decision-maker regarding patient healthcare and nurses as providing care to the patients based on these decisions (Baggs & Schmitt, 1997;Lockhart-Wood, 2000). This power differential stemming from hierarchical distributions of power within teams of healthcare professionals has been identified with other healthcare professionals (e.g., physicians and palliative network coordinators, Hermans et al, 2019;general practitioners and community pharmacists, Bollen, Harrison, Aslani & van Haastregt, 2019). However, this social system was supported in part by the laws outlining physician responsibility for patient-care (Hermans et al, 2019;Lockhart-Wood, 2000).…”

Development and implementation of a transmural palliative care consultation service: a multiple case study in the Netherlands

“…Healthcare professionals working for the consultation service considered national quality frameworks for palliative care [ 29 , 30 ] as facilitating and supportive to substantiate the importance of the initiative. However, it turned out to be difficult to find a shared view on concrete goals and activities of the service, whereas having shared goals and visions is considered to be an important dimension of transmural collaboration [ 31 , 32 ].…”

“…The lack of evidence regarding the effectiveness of transmural consultation services contributed to these doubts. In addition, the care organisations that were involved in the project are participants of a network that has been set up to promote transmural collaboration in palliative care, but in which collaboration and responsibilities are not always formalised [ 31 ]. Our findings show that the unclear ownership of the initiative was a barrier for transmural collaboration.…”