Captation, appariement, réseau: une logique professionnelle d’organisation des soins

Bergeron, Henri; Castel, Patrick

doi:10.1016/j.soctra.2010.09.001

Cited by 26 publications

(17 citation statements)

References 18 publications

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“…However, a health worker who sees himself or herself as the care co-ordinator may trigger a conflict when the professional to whom he or she sends the patient sees that as transferring full responsibility for the patient's care to him or her, especially when the two prefer very different treatment methods. 147 Other causes of conflict or delay are that one professional refers 'unsuitable' or 'non-priority' patients to another; different professions or professionals compete for the care co-ordinator role; no one wants to assume overall responsibility for a patient's care; or someone who does not want to is compelled to take such responsibility. 147…”

Section: First-responder Provider Organisationsmentioning

confidence: 99%

“…147 Other causes of conflict or delay are that one professional refers 'unsuitable' or 'non-priority' patients to another; different professions or professionals compete for the care co-ordinator role; no one wants to assume overall responsibility for a patient's care; or someone who does not want to is compelled to take such responsibility. 147…”

Section: First-responder Provider Organisationsmentioning

confidence: 99%

“…The course of many non-cancerous diseases, 144 for instance mental-physical multimorbidity, 152 involves clinical complexity that is hard to predict and difficult for protocolised, routinised or pre-planned health-care processes to accommodate. 12,147 Many of the studies underlying evidence-based guidelines were designed expressly to exclude patients with comorbidities. A perception of receiving 'production-line' treatment may make patients less compliant.…”

Section: Care Plansmentioning

confidence: 99%

“…The consultation model of care co-ordination 133 involves both a 'captant' profession that focuses on the patient's care as a whole, in the round, and a complementary set of professions that focus on more specific tasks. 147 Typically, the captant health worker (classically a GP) transfers or refers patients to other professionals with more 'appropriate' expertise 23,145 who, having made their contributions, return the patient to him or her. This referral pattern can be visualised as a star-like structure with the captant professional at its centre.…”

Section: Care Plansmentioning

confidence: 99%

“…164 Each profession tends to cultivate the habit of other professions referring to them 'good' patients 'appropriate' to their established ways of working. 147 Certain professions see their role as limited to a determinate part of the care pathway; others see it as overseeing the whole patient journey. 147 In such organisations interprofessional demarcations and rivalries, 56,165,166 reflecting 'turf wars' over status and resource control, 33,167 often hinder the creation of common working practices (equated with control from outside the profession).…”

Section: Care Plansmentioning

confidence: 99%

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Integration and continuity of primary care: polyclinics and alternatives – a patient-centred analysis of how organisation constrains care co-ordination

Sheaff

Halliday

Øvretveit

et al. 2015

Health Serv Deliv Res

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BackgroundAn ageing population, the increasing specialisation of clinical services and diverse health-care provider ownership make the co-ordination and continuity of complex care increasingly problematic. The way in which the provision of complex health care is co-ordinated produces – or fails to produce – six forms of continuity of care (cross-sectional, longitudinal, flexible, access, informational and relational). Care co-ordination is accomplished by a combination of activities by patients themselves; provider organisations; care networks co-ordinating the separate provider organisations; and overall health-system governance. This research examines how far organisational integration might promote care co-ordination at the clinical level.ObjectivesTo examine (1) what differences the organisational integration of primary care makes, compared with network governance, to horizontal and vertical co-ordination of care; (2) what difference provider ownership (corporate, partnership, public) makes; (3) how much scope either structure allows for managerial discretion and ‘performance’; (4) differences between networked and hierarchical governance regarding the continuity and integration of primary care; and (5) the implications of the above for managerial practice in primary care.MethodsMultiple-methods design combining (1) the assembly of an analytic framework by non-systematic review; (2) a framework analysis of patients’ experiences of the continuities of care; (3) a systematic comparison of organisational case studies made in the same study sites; (4) a cross-country comparison of care co-ordination mechanisms found in our NHS study sites with those in publicly owned and managed Swedish polyclinics; and (5) the analysis and synthesis of data using an ‘inside-out’ analytic strategy. Study sites included professional partnership, corporate and publicly owned and managed primary care providers, and different configurations of organisational integration or separation of community health services, mental health services, social services and acute inpatient care.ResultsStarting from data about patients’ experiences of the co-ordination or under-co-ordination of care, we identified five care co-ordination mechanisms present in both the integrated organisations and the care networks; four main obstacles to care co-ordination within the integrated organisations, of which two were also present in the care networks; seven main obstacles to care co-ordination that were specific to the care networks; and nine care co-ordination mechanisms present in the integrated organisations. Taking everything into consideration, integrated organisations appeared more favourable to producing continuities of care than did care networks. Network structures demonstrated more flexibility in adding services for small care groups temporarily, but the expansion of integrated organisations had advantages when adding new services on a longer term and a larger scale. Ownership differences affected the range of services to which patients had direct access; primary care doctors’ managerial responsibilities (relevant to care co-ordination because of their impact on general practitioner workload); and the scope for doctors to develop special interests. We found little difference between integrated organisations and care networks in terms of managerial discretion and performance.ConclusionsOn balance, an integrated organisation seems more likely to favour the development of care co-ordination and, therefore, continuities of care than a system of care networks. At least four different variants of ownership and management of organisationally integrated primary care providers are practicable in NHS-like settings. Future research is therefore required, above all to evaluate comparatively the different techniques for coordinating patient discharge across the triple interface between hospitals, general practices and community health services; and to discover what effects increasing the scale and scope of general practice activities will have on continuity of care.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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Section: First-responder Provider Organisationsmentioning

confidence: 99%

Section: First-responder Provider Organisationsmentioning

confidence: 99%