EFPC congres 2012 Gothenburg 3 September Antoinette de Bont – Marlies Maaijen ‘ Being organized. The experiences of managers and care givers with organizational development on behalf of integrating care

Aim To contrast the perspectives of managers and care givers about how organizational knowledge and practices contribute to integrated care. Question What are the differences in the assumptions of managers and caregivers about the contribution of organizational knowledge and practices to integrated care. And how do they overcome these differences?

Method Definition of a case: a project of the national program Primary Focus Number of cases: 4 completed, 6 in progress Data collection: observations, interviews and document analysis

Dichotomy OD in order to integrate care Organizational management models and tools Day-to-day experiences with organizing and being organized

ORGANIZATIONAL MANAGEMENT MODELS & TOOLS Selection organizational knowledge Search for the best interventions The effects of organizational interventions are known in advance

DAY TO DAY EXPERIENCE: BEING ORGANIZED Being organized according human nature drives organizational development: –Social hierarchies, norms, cultures –Acceptance of disturbances and stubbornness of organizational development (Fineman, S., Sims, D., & Gabriel, Y. 2010)

CHALLENGES OF THE DICHOTOMY Between model and practice Anticipate day-to-day dynamics

DICHOTOMY IN PRACTICE

From implicit and explicit knowledge to mix-plicit From short term and long term to medium term. From population and neighborhood to patients that can be managed

From short term and long term to medium term Plan: to develop care paths and multidisciplinary care protocols for pregnant women at risk proposing uniform, evidence based interventions. Practice: Phones or s with other involved care givers or the client herself discussing the situation of the client from time to time. Crossing the dichotomy: Care paths and protocols are used to set deadlines in day to day care and set limits to patient, insurers and other care givers. Phones and s were used to screen the situation of pregnant women.

From implicit and explicit knowledge to mix-plicit Plan: Risks in the life of elderly people living at home are detected by risk assessment lists and screenings items. Practice: Nurses have informal conversation with elderly at home and see the problems elderly face or will face Crossing the dichotomy: Risk assessment lists are used by care givers to create a multidisciplinary platform to discuss care for vulnerable people. Caregivers mention screenings item indirectly because it helps them to critically consider the situation of the elderly patient.

From population and neighborhood to patients that can be managed Plan: regional cards are discussed to decide upon the care facilities and evidence based care programs that are needed. Practice: Caregivers exchange network information and recommend successful interventions or colleagues in informal talks Crossing the dichotomy: From evidence based care and your best colleague to quick win interventions

Implications Don’ts Do not train caregivers into management models Stop discussing the complexity of daily practice Do’s Observe how caregivers cross the dichotomy between plan and practice and look at: * Medium term * Mix-plicit * Quick wins

Conclusion Use plans in different ways. -Formal plans are introduced in informal situations. -Informal tools are used to realize protocols Policymakers and other change agents are inclined to think in the dichotomy Plans are not used as they should be used: caregivers can not leave in formal things behind. We need different concepts to overcome this dichotomy.