出版社：Utrecht University, Maastricht University, Groningen University
摘要：In 2013, a 4-year research project on integrated care in Flanders (Belgium) was launched: “Care Organisation: a Re-Thinking EXpedition in search for Sustainability” (CORTEXS). The multidisciplinary research team focuses on the challenge of how to organize care integration. Numerous studies convincingly demonstrate the need for care integration, and several conceptual models and evaluation frameworks have been published. However, far less is known about systematic approaches to organizing care integration. CORTEXS developed a social systems based approach for redesigning care systems. A system consists of components that relate to each other, and has a certain openness to its environment. A care system is a social system, of which the elements are activities. Grouping and linking those activities forms the central focus of redesigning care systems. Splitting up care processes in specialized activities, grouped in specialized sectors, organizations, organizational units and occupations, leads to highly fragmented care systems. The number of interactions and dependencies between the many care processes and activities then becomes so high that delivering integrated care becomes virtually impossible. The mere introduction of additional coordination mechanisms leaves the underlying fragmentation untouched, and risks to increase complexity even more. From a social systems perspective, the far-driven fragmentation of processes and activities itself must be tackled. The ‘law of requisite variety’ (Ashby 1957) posits that variety can only be managed with variety. In other words: the variety a care system offers must be equal to or greater than the variety of care demands. The enormous variety of individual care demands can be reduced to a manageable range of groups of people with comparable care needs. Then, the variety of the care system can be increased by clustering activities in parallel streams for each target group. In order to further reduce the complexity of care systems, it is important to avoid ending up
