Interview: an interdisciplinary approach to solving healthcare challenges
|Date:||08 August 2018|
‘Look!’, Manda Broekhuis enthuses, ‘this is exactly what I’m talking about’. At the end of a fascinating conversation about the organisation and coordination of care processes, she points to a lovely glossy roadmap headed ‘Living with Us’. The poster depicts part of the care programme that Broekhuis advised on, based on the best practices of the Espria care facility and its partners.
‘This roadmap gives a step-by-step description of what happens when a client comes to live at Espria permanently. It is not meant to be a set of rules, or a strict protocol, it just describes the process. And it all centres around the question “What do we need to do in the first six weeks to ensure that the client genuinely feels at home here? And how can we get to know the client well enough to discern correctly what he or she wants?”’
Broekhuis was recently appointed Professor of Professional Service Chains within the Faculty of Economics and Business. She is conducting research at Espria into the identification and development of ‘care modules’. These modules focus on groups of clients who have the same care needs when they come to live at Espria, although their backgrounds may be different. They may, for example, be elderly, or physically handicapped, or they may have psychiatric problems. ‘The aim is to optimise certain aspects of the care processes and to link them to efficacy endpoints such as “feeling safe”’ and “feeling at home”, these being two of Espria’s core values. At the end of that six-week period, will people genuinely feel already a bit more at home here? And will they feel safe?’
Shaping their own job
Whilst the scope of Broekhuis’s research is diverse, the focus is always the same: professionals, the service sector, cooperation and coordination. It usually has to do with setting up processes, and managing them, both within an organisation and at inter-organisational levels. ‘In services – public services, care services or the profit sector – the human aspect is, of course, key. The work of professionals often entails a high degree of uncertainty and ambiguity. They operate in an environment in which they are required to render detailed account of their choices and behaviours, whilst increasingly being expected to cooperate with others, both within their own organisation and outside it. I’m fascinated by how individual professionals choose to interpret their responsibilities, and the differences that emerge as a result – and how these choices are influenced by systems or by technology for example. It’s interesting to see how professionals always bring their own nuance to their role.’
Fragmentation and coordination
Broekhuis acknowledges that she has ended up doing research in a field that appeals to her as a person, precisely because of the human aspect. ‘The care sector is extremely highly specialised. You only have to look at how providers are organised. Individual patients or clients almost always find themselves dealing with several different parties. That’s not always ideal. We start by referring them to a specialist, who decides what needs to happen. The resulting fragmentation necessitates the intervention of coordinators, or case managers, who have to try to coordinate all the various aspects of the care. The care sector tends to try to solve problems by creating new structures and jobs, but that is by no means always the best approach.’
In Broekhuis’s opinion, the care sector would benefit greatly from different coordination strategies, such as for instance service modularity. ‘We start by trying to identify a group of clients with more or less the same care needs. Then we look to see if it’s possible to develop a number of modules for that group. This method of operation is often at odds with the care sector’s supply-oriented approach. You can trace that healthcare providers think more in terms of what people want and what they are capable of. First questions they answer are “Which functions or objectives should the care package be making possible?” It’s my ambition to do research into that shift in healthcare and services. This mental shift is an important theme for me. What care is needed, and then who are we going to call on to deliver it, and how to coordinate complex services?’
Independent living in Selwerd
In Selwerd, a district just a stone’s throw away from the Faculty of Economics and Business, Broekhuis will be conducting research over the next few years into the Healthy Ageing community renewal project, an initiative of the municipality of Groningen. Here, too, service modularity plays an important role, but also the question of how formal and informal structures can influence each other. She and fellow professor Kees Ahaus, from the University of Groningen’s Centre of Expertise Healthwise, have been given a grant by ZonMw, a national organization that stimulates research into health and healthcare innovation.
‘We want to look into how we can work together with the service providers to develop modules for local residents with varying levels of independency; for instance modules that will give these people a little more control over their lives. We are not expecting any one specific service provider to meet all their needs. No, the modules are comprised of different components, such as improving a person’s social network, finding them meaningful daytime activities, helping them with financial problems or building their self-confidence through increased physical exercise.’
At the heart of Selwerd’s community renewal project is the Wijkbedrijf (Community Enterprise). The Wijkbedrijf is a residents’ collective devoted to improving the district. Its initiatives include cooking workshops and a legal surgery. ‘From a business-based perspective, we want to investigate the role an informal structure like the Wijkbedrijf can play in social participation and network development’, Broekhuis explains. ‘Can we stimulate reciprocity between informal care and the formal care network? Might the Wijkbedrijf be able to help identify those people who need more care but are not receiving help via the formal channels?’
Innovative and interdisciplinary
This project ties in nicely with Broekhuis’s new role within the Aletta Jacobs School of Public Health. ‘Together with Maarten Postma, I will be coordinating the theme “Prevention: design and evaluation”. So, we’re talking about things like sickness prevention, stimulating a healthy lifestyle, reducing the burden of care … and then in various settings: at home, at work, in the care sector, in the community. Postma brings his expert knowledge of prevention to the table. My focus is more on the organisation and coordination of services and processes. Our main objective is to take an innovative, interdisciplinary approach to tackling the issues linked to this theme.’