Henk Nies,  Vilans, Centre for Long-term Care in the Netherlands, Vrije Universiteit och Axel Kaehne, Edge Hill University, United Kingdom beskriver i veckans blogg hur vi nu, efter ett år av pandemi, genom utvärdering och eftertanke kan skapa bättre förutsättningar för en integrerad och samskapad vård. De menar att det kräver att vi bygger processer som hela tiden utvecklar nya alternativ utifrån behov, att vi väljer rätt teknik, finansieringsmodell, och bygger team på alla nivåer. Låt dig inspireras och fundera över hur du kan ta tillvara erfarenheterna där du är?


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The corona crisis: a pressure cooker for integrated care

Henk Nies & Axel Kaehne

During the past year our health and social care systems have been challenged as never before. The interdependencies within the system and in society appeared to be immense. The struggle for survival of patients in intensive care units and in other settings, combatting the risks of widespread contamination, downscaling regular care and services, protecting residents and staff of residential care, rapidly developing vaccines, all these issues competed for being prioritised. The impact on society was and still is also unprecedented. An almost full societal lockdown in most of the countries gave rise to many tensions, affecting schools, shops, restaurants, offices, industry, tourism and in fact the entire economy, as well as social life and family life.

We saw – and still see – an immense clash of values and interests and often a lack of understanding of those involved. There are furious debates whether the measures are proportional, the interests of young people aren’t harmed too much (against those of older people), the damage of the economic fallback is more harmful than the virus, and whether acute care is privileged above other types of care, such as primacy care. There are practical and ethical debates about who should be vaccinated first and whether human rights are violated by the measures.

In terms of leadership we saw representatives of public health becoming national celebrities, whereas public health is usually the ‘neglected child’ of health care. In hospitals the virologists gained public esteem, as did the emergency and intensive care specialists, geriatricians and IT specialists. There were rapid developments in the use of digital devices and health technology, as well as consumer technology affecting the health sector. And, also never seen before, ministers of finance played a prominent role in ensuring budgets, both for societal measures as well as for health care services. The Dutch Minister of Finance proclaimed: ‘I have very deep pockets’. There was just one party that poorly voiced their interests: the patients and their relatives.

At this moment national and local authorities, care providers and supervising agencies are evaluating what happened in the various phases of the Corona-crisis. Lessons learned are drawn up. Based on these lessons, the next steps towards implementing good practices and the ‘new normal’ can be created. A lot about this is still unknown, and there are many uncertainties. But we do know the principles of implementing well-integrated systems to deal with the next steps in the pandemic and in health care.

The past year was a pressure cooker for testing the principles of integrating health, social and long-term care, as well as prevention in a societal context. In our book How to deliver integrated care: a guidebook for managers, published last month, we present these principles in practice oriented chapters. To mention just a few of these principles: In determining the best financial options, ask yourself: ‘who should be the integrating partner: the government, the care provider or the patient/client?’ And for all choices specific questions need to be answered. So, there is not one appropriate funding model, but finances have to be in line with the circumstances and choices to be made. These choices are partly normative choices, guided by values. This also holds for choices about care quality and priorities. Values are held by people, being care professionals, managers, executive boards, policy makers, and patients.

Successful integration is about aligning values and interests, hearing and seeing the other actors. Therefore, implementing integrated care is about people working together, adopting the right leadership style to develop the right services and hearing and engaging those people for whom the services are meant, taking the right implementation steps. As we have seen in the current Corona crisis: we need to move forward by engaging in an incremental process in which we constantly design appropriate and better alternatives, chose the right funding and technology, build the right team at all levels, take care of the social dimensions in collaboration and address the normative and ethical issues openly and – if possible – comprehensively. Policy structures and finances are important but should not blur the human and dimension of organising and arranging the right set of measures. We need to apply the principles that we have learned in the ‘old normal’ in the pressure cooker of integrated care that lies ahead of us.


Henk Nies is Director of Strategy & Development, Vilans, Centre of Expertise for Long-term Care, Utrecht and professor of Organisation and Policy Development, Vrije Universiteit, Amsterdam, The Netherlands.
More reading: 
Quality paradigms and innovation – the Dutch case >>>

Axel Kaehne is Reader in Health Services Research, Edge Hill University, Ormskirk, United Kingdom and President of the European Health Management Association.