ORGANIZATION CHANGE RELATING TO HEALTH SERVICE CARE

Organization Change relating to Health Service Care

Organization Change relating to Health Service Care

Introduction

Declining resources and organizational restructuring distract attention from efforts to develop more client-centred, empowering partnership approaches to health and social services delivery (Falk-Raphael, 1996; Montgomery, 1993; Stewart et al., 2003). Yet in the field of home care, heightened consumer expectations and evaluations of approaches affording clients greater autonomy and voice in their care at home (Alberta Ministry of Health, 1993; Manitoba Ministry of Health, 1994; Saskatchewan Health, 1996) support change in this direction. The limited research evidence suggests that clients demonstrate potential for involvement (Fast and Chapin, 1996), but changing care approaches to empower them as partners in care may be slow (England and Evans, 1992), stressful (Charles et al., 1996) and impeded by organizational barriers (Ferronato, 1999; McWilliam et al., 1994, 2001).

Organization Change relating to Health Service Care

Publicly funded home care programs in Canada currently confront this dilemma. Their services normally are delivered in a brokerage model by a diversity of service providers with varying degrees of client involvement in their care. Providers include case managers, often nurses or social workers by professional background, who assess client needs, and based on their assessments, decide, access, coordinate, monitor and control amounts and timeframes of resources and services. These case managers act as brokers, contracting direct in-home service from other provider groups, including professional nurses, occupational, physical and speech therapists, and social workers, and para-professional personal support workers or homemakers.

In an effort to promote change toward optimizing the involvement of all participants in care, including clients, one Canadian home care program serving approximately 6,000 clients decided to change from its brokerage service delivery approach to “flexible client-driven care” (McWilliam et al., 2003). Premised on previous research indicating its potential for optimizing client health, independence and quality of life (McWilliam et al., 1999), the approach requires all providers, informal caregivers and clients to consciously and conscientiously work as partners. Everyone involved is expected to contribute his/her knowledge about the client's health and health care needs, ability, and right to participate in deciding and implementing a plan of care. The intent is to achieve empowerment (Clarke, 1989) for all involved. The service delivery strategy is flexibly adapted to accommodate the client's self-determined inclination, interest, and potential for involvement as a partner in care management at any one point in time. Thus, partnering efforts might reflect high levels of client autonomy, independence and initiative as partners in their own care management (consumer-managed care). Alternatively, partnering might reflect the client's inclination to work interdependently with all members of the service delivery team to achieve care management (integrated team management of care). A third option permits clients, because of preference or necessity, to have all care management attended to centrally by the case manager as professional expert (brokerage model of case management).

To achieve this change, organizational leaders adopted several strategies elaborated by theorists: vision and goal setting exercises (Baker et al., 2000); recognition and rewards to promote commitment (Mazmanian ...