标题：The links between co-creation during conception in the restructuring of care organization and appropriate loco-regional network governance? Initial mechanisms identified in Belgian “integreo” projects
出版社：Utrecht University, Maastricht University, Groningen University
摘要：Introduction : Belgium launched a large program (www.integreo.be) to restructure care delivery towards more integrated care. In a first phase, 20 projects have been conceived by loco-regional consortia including health and social care providers with patient representatives. These projects had to plan changes in the care provision through networks (re)structuring at different levels (patient, professionals, and organizations) in geographical areas with a population of around 150,000 people. Projects are now in the phase of selection, to be thereafter implemented. The objective of this communication is to present an analysis of the projects proposals focused on the links between co-creation during conception and future strengthening (or creation) of an appropriate type of loco-regional governance (Tenbensel 2017). Theory – methods : We performed a combination of structured analysis of all the projects submission file, targeted project managers’ interviews and simulation through agent based modelling. The focus was on co-creation during conception and loco-regional governance strengthening. We used the definition of Greenhalgh for co-creation, i.e. aligning priorities and development of all partners via dynamic, locally adaptive community-providers-managers partnerships (Greenhalgh et al. 2016). Concerning governance, we adopt the attributes from Tenbensel, with the idea that there are no ideal form, but a best fit form to a given context (Tenbensel 2017). In the analysis, we tried to identify the three types of mechanisms, as proposed in the Coleman’s diagram (Coleman 1990) through which co-creation could lead to different form of governance. We used an agent based modelling approach to make explicit those possible mechanisms. Results : An initial screening of the proposals shed light on the multiple logics that influenced the proposals content and that may strengthen or hamper further development of loco-regional governance (I.e. power (in)balance; (un)shared vision; sense of ownership; technocratic versus participatory design, to name some). As such different mode of interactions, during conceptualisation phase, between hospitals, primary care and social care organization may influence the readiness of these same organisation (i.e. contextual mechanisms) in embarking in cooperation (formation-action mechanisms). This may lead to new forms of care provisions, reorient adequately financing, and progressively build or strengthen appropriate form of governance (transformative mechanism). Discussion : This is part of the initial phase of a much larger evaluation process. It shed light on key lessons that would merit further discussion. Firstly, the identified mechanisms can be used as a possible frame for the coming implementation evaluation. In the same time, this can serve as a frame to clarify the co-creation process between researchers and implementers and foster appropriated type of governance. Second, the methodological approach combining a theory driven and agent based modelling approach, is particularly promising. Conclusion, lessons learned and future research : This communication will provide key characteristics of a systematic approach in identifying different type of mechanisms explaining development process of integrated care. Lessons learned of our actual approach will be capital in reorienting future evaluation of integrated care and research moving away from an intervention-focus to adopt a system-wide approach.
关键词：restructuring care organization ; co-creation ; loco-regional governance
