The ‘Service Transformation Outline’ toolkit to assist in the design, comparison and replication of integrated care programmes

What is it about?

Purpose. We are introducing a toolkit that can assist stakeholders to design, compare and replicate Integrated Care programs, by making explicit their view on the transformations of care and cure services, according to a structured template. Design/methodology/approach. The toolkit is made of two elements: a classification and a template. We adopted a step-wise approach of semantic modelling to work out three layers of a classification in the domain of integration needs related to care and cure services. The third layer consists of 23 non-overlapping classes that fully cover that semantic domain. The classes are used to build a template to elicit the stakeholder’s standpoint about the transformations involved in the deployment of a program. The result is the «Outline» of the program. Research limitations/implications. The objective of the toolkit is not to provide solutions, but to stimulate reflections on the transformations involved in a program and their practical consequences in a precise context. In fact, the Outlines cannot be generalized: they are conceived to reflect the perspective of the stakeholders and thus are intrinsically subjective; in addition, they must be contingent, as they must depend on the local context in the particular timeframe. In case of similar initiatives in other localities, the Outlines must be filled in again by the local stakeholders; however, a subsequent comparison could help to explore similarities and motivated differences. Practical implications. Ideally the stakeholders should use the Outline of the actual transformations in a program as a reference to mediate between the principles and the methodologies provided by the «Models» and «Conceptual Frameworks» in the literature (e.g. Chronic Care Model, Rainbow Model, Development Model of Integrated Care Patient-Centered Medical Home, Maturity Models) and the deeper studies using the specific tools developed in their disciplines (e.g. on information modelling, process modelling, cost-benefit analysis, health technology assessment). The toolkit could have its role also in a multi-annual Roadmap made of a sequence of programs to cope with the urgent challenges on ageing, social changes, technological evolution, in synergy with regulations, budget, context maturity, critical success factors, local priorities. Originality/value. We argue that the approach of the structured Outline is unique, as the scoring mechanism to assess the relevance of the transformation within each class on the overall change brought by the whole programme into the health systems.

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