IntegraSarea: developing innovation support networks for implementing People Centred Care across the Basque Health Service

摘要

Introduction: Health organizations are continuously growing in size and complexity as the needs of the populations they serve also increase. The traditional, linear, authoritarian way of identifying and creating new services aiming at satisfying peoples’ needs is no longer valid, nor sustainable. People Centred ways of approaching, understanding and responding to increasingly complex needs are to be identified and put to practice. Description of policy context and objectives: Osakidetza, the public Basque Health Service is comprised of 13 Integrated HealthCare Organizations (IHOs), each one of them holding several Community/Primary Care Centers and one acute/mid-long term hospital. A wide variety of both management as well as clinical practices is found across the 13 IHOs despite the namely similar population health needs they are to respond to and the shared organizational values supposed to traverse all 13 IHOs. Understanding the Integration Process as an opportunity to generate a common People Centred Care (PCC) culture, the Basque Health Service designed, created and developed IntegraSarea: a collaborative network-based innovating method. Targetted population: All 13 IHOs integrating the Basque Health Service were invited to participate. Highlights (innovation, impact, outcomes): IntegraSarea became an on-the-go innovation process making structural integration become true at the care provision level. It was conducted through 3 subsequent innovation cycles: 1- understanding for innovating, which meant the definite integration of the PCC perspective into participants’ views and understandings of the true essence of IntegraSarea in the first place but, more interesting, of healthcare provision in the end, 2- moving from needs and challenges to outcomes, which implied developing and evaluating 5 pilot projects based on prioritized areas (hospital discharge and end-of-life care), 3- magnifying the impact (work in progress), aiming at systematic dissemination, INNOPAL 5D is a network-based movement trying to make the innovative practices previously piloted accessible and easy to use for all 13 IHOs across the Basque Health Service. Different techniques and methodologies were put in place for each one of these 3 cycles: Design Thinking, project seedbed, innovation teams, collaborative meetings, networking…, all of them based on shared values and beliefs: holding sound and solid conversations, shared-leadership, patient’s perspective exploration... Comments on transferability: No big financial costs are associated to incorporating innovative PCC collaborative methods. This approach is neither system-dependant so no large previous changes are to be implemented. The organization is, nevertheless, to be commited to change as well as to provide the resources (time) for these collaborative, network-based methods to facilitate the change process and succeed on finally making the change happen. Conclusions (key findings, discussion, lessons learned): Aiming at implementing PCC-oriented innovation processes within healthcare organizations and systems requires the use of different tools and methods, all of them based on open methodologies, collaborative approaches and innovation teams. People, whether insiders (professionals) or outsiders (users), were found to be the main drivers for change and innovation. It was only their commitment to PCC and innovation that made IntegraSarea possible.