Care Coordination as Imagined, Care Coordination as Done: Findings from a Cross-national Mental Health Systems Study

Abstract

Introduction:Care coordination is intended to ensure needs are met and integrated services are provided. Formalised processes for the coordination of mental health care arrived in the UK with the introduction of the care programme approach in the early 1990s. Since then the care coordinator role has become a central one within mental health systems.Theory and methods:This paper contrasts care coordination as work that is imagined with care coordination as work that is done. This is achieved via a critical review of policy followed by a qualitative analysis of interviews, focusing on day-to-day work, conducted with 28 care coordinators employed in four NHS organisations in England and two in Wales.Findings:Care coordination is imagined as a vehicle for the provision of collaborative, recovery-focused, care. Those who practise care coordination are concerned with the quality of their relationships with service users and the tailoring of services, but limits exist to collaboration and open discussion. Care coordinators describe doing necessary work connecting people and the system of care. However, this work also brings significant administrative demands, is subject to performance management which distorts its primary purpose, and in a context of scarce resources promotes generic professional roles.Conclusion:Care coordination must be done. However, it is not consistently being done in the way policymakers imagine, and in the real world of work can be done differently.

Too Busy to Talk: Examining Service User Involvement in Nursing Work

“…Where participants spoke about involvement in care planning being attempted, we found that it was often reported as an unsatisfying experience by service users. This is perhaps another example of care as imagined in the form of legal and policy requirements, and care as done in the form of what services users actually experience (Hannigan et al, 2018). Bee, Price, Baker and Lovell (2015) note that despite the political rhetoric promoting involvement, many users feel marginalised in the planning of their care.…”

‘In the middle’: A qualitative study of talk about mental health nursing roles and work

“…An alternative position is that co‐ordinating work is very important and demands effort by interpersonally skilled practitioners. According to Hannigan, Simpson, Coffey, Barlow and Jones (), co‐ordinating care is linked to system complexity, and nurses might do well to embrace this key role openly, recognizing the skills and knowledge it requires.…”

Substituting specialist care for patients with severe mental illness with primary healthcare. Experiences in a mixed methods study

“…The scientific knowledge on the topic of care planning and coordination is currently insufficient and care planning is largely dictated by policy (Hannigan et al., ; Jones et al., ). The available knowledge is mostly focused on the start of the care, like for example the Threshold Assessment Grid (Slade et al., ).…”

“…However, more studies are required that focus on the specific care a patient needs at a specific point in his or her recovery, and how to coordinate this care to improve scientific based care planning for patients with SMI (Jones et al., ). This study adds to the topic of referring patients to primary healthcare that are traditionally treated in CMHT's, to help achieve this larger goal of care planning on scientific basis instead of on a mainly policy basis, as is common practice (Hannigan, Simpson, Coffey, Barlow, & Jones, ).”…”