One for All, All for One: A Mixed Methods Case Study into the Role Organisational and Personal Interests Play on Cooperation in Dutch Integrated Dementia Care Networks

Abstract

Introduction:Cooperation is key to provide integrated dementia care. However, different kinds of (personal and organisational) interests will affect collaboration in integrated dementia care (IDC) networks. Hence, it is crucial to understand how interests influence relations in IDC-networks in order to shape future policies. Methods:A sequential mixed methods single case study design was used, in three phases: a Social Network Analysis (SNA) based on data from questionnaires (n = 24-26), explorative interviews with network partners (n = 14) and a focus group with network coordinators (n = 7) to explore the conceptual generalisability of the single case of the IDC-network. Results:The SNA revealed that highly connected organisations were often established care organisations that deliver case management, while smaller care organisations or welfare organisations tend to be less connected. Care-related, strategic, and financial interests influence participation of organisations in the IDC-network, while personal intrinsic motivations determine a representative's contribution to the network. Especially conflicting interests strongly influence the network structure. Discussion and conclusion:We conclude that conflicting interests in IDC-networks stand in the way of reaching the collective goal of an IDC-network, i.e., optimising the wellbeing of people with dementia and their informal caregivers in the region. Thus, IDC-networks should act to manage, resolve and prevent disputes arising from conflicting interests.

Further development needed: models of post-diagnostic support for people with dementia

“…We believe that an integrated model of dementia care should include the process of diagnosis and seamlessly provide support after diagnosis. It is estimated that internationally, 75% of all cases of dementia are undiagnosed [54 ▪ ], including largely unknown proportions in high income countries. An effective model of dementia care needs to support people getting a diagnosis as well as providing ongoing support from diagnosis.…”

“…A whole-system approach is required in designing a dementia model of support to ensure universal equitable access, and timeliness. This would require policy makers, funders and service providers to work across their funding, responsibility and regulatory silos, a known challenge in dementia services [52 ▪ –54 ▪ ]. To the best of our knowledge, regions have only attempted to deliver universal access to short-term support workers, without full success.…”