Modular service provision for heterogeneous patient groups: a single case study in chronic Down syndrome care

Abstract

BackgroundService modularity could be promising for organizing healthcare delivery to heterogeneous patient groups because it enables cost reductions while also being responsive towards individual patients’ needs. However, no research on the applicability of modularity in this context exists. To this end, we conducted a qualitative single-case study on chronic healthcare provision for Down syndrome patients, delivered by multidisciplinary pediatric Downteams in the Netherlands, from a modular perspective.MethodsWe conducted six semi-structured interviews with coordinators of multidisciplinary Downteams in six hospitals. In addition, we gathered data by means of observations and analysis of relevant documentation. We transcribed, coded, and analyzed the interviews utilizing the Miles and Huberman approach. The consolidated criteria for reporting qualitative research (COREQ) were applied in this study.ResultsIn all six Downteams studied, the modular package for Down syndrome patients (i.e. the visit to the Downteams) could clearly be divided into modules (i.e. the separate consultations with the various professionals), and into different components (i.e. sub-elements of these consultations). These modules and components were linked by different types of customer-flow and information-flow interfaces. These interfaces allowed patients to flow smoothly through the system and allowed for information transfer, respectively.ConclusionOur study shows a modular perspective is applicable to analyzing chronic healthcare for a heterogeneous patient group like children with Down syndrome. The decomposition of the various Downteams into modules and components led to mutual insight into each other’s professional practices, both within and across the various Downteams studied. It could be used to increase transparency of delivered care for patients and family. Moreover, it could be used to customize care provision by mixing-and-matching components. More detailed research on chronic modular care provision for patients with DS is needed to explore this.

Providing person-centered care for patients with complex healthcare needs: A qualitative study

“…Most healthcare services continue to focus predominantly on single diseases or prioritize medically oriented care (medical outcomes) over socially oriented care (functional outcomes). As a result, these healthcare services do not adequately respond to the complex healthcare needs of people with chronic conditions; current healthcare provision is not optimally tailored to their needs [1,3]. Also from a societal perspective, it is important that healthcare services become more responsive to the complex needs and requirements of these people.…”

“…It allows for the mixing-and-matching principle of modularity: (re)combining components and modules to create individualized modular packages. This principle ensures that each customer can be offered a selection of components and is treated as unique [3,18]. As a result, services can be optimally tailored to the needs and preferences of individual customers.…”

“…Since only a few studies have addressed the applicability of MSA in complex services [13,22,23], there is still ambiguity around how to decompose a service offering into components and how to determine which of these components, alone or together, can be assigned as modules [24][25][26]. Dörbecker & Böhmann [27] have developed questions that can guide the identification of components and modules for the creation of MSA, but these are only applied to a limited extent [3]. In addition, the few studies that do address the applicability of MSA are traditionally conducted from the professional's perspective [13,22,23], which is surprising given the indispensable involvement of the customer in service provision [10,12,28].…”

Elaborating on modular interfaces in multi-provider contexts

“…Moreover, familiarity also assesses the extent to which patients receive outreach, including phone calls and home visits, to ensure appropriate follow-up (Berwick, 2009). Closed-information interfaces are related to continuous familiarity as these interfaces ensure that all professionals have access to the information they need to provide coherent services; interfaces guide and stimulate information exchange about the patients' situation (Fransen et al , 2019). Continuous proactivity enables responsiveness of service providers to incoming requests from patients, and this helps to identify gaps in care.…”

“…A multiple case study into multi-provider contexts in two healthcare contexts was conducted: one representing paediatric Down syndrome (DS) care in the Netherlands, and one representing homecare for the elderly (HCE) in Finland. These contexts were chosen because of the modular nature of the cases, meaning that the cases make use of a structure that enables them to combine a large variety of independently functioning care and service components into customized care packages (Fransen et al , 2019). In this study, the words “patient” and “customer” are used synonymously since theory uses the word customer and patient simultaneously.…”