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Major improvement opportunities for coordinating health care efforts

Published: 20 March 2018

Staff lack knowledge of the process and the persons concerned felt that they could not affect health and care. That shows new research at Luleå University of Technology where studies have been conducted on coordinated individual planning.

– I wanted to find out how people who need a SIP or have a SIP, and their relatives experience the coordinated individual planning process, said Ingela Jobe, PhD student in Nursing at Luleå University of Technology, who conducted two studies focusing on the coordinated individual field.

Coordinated Individual Planning and the Coordinated Individual Plan, SIP, is a right for individuals of all ages with efforts that need to be coordinated from different healthcare and social services actors, such as when a person leaves the hospitals but also for persons living in their own accommodation. There may also be other actors involved in the individual planning, such as the Swedish Social Insurance Agency, the Employment Service and the school.

The first study describes a planning meeting focusing on person-centered interaction between the different parties. The results showed that there are opportunities for improvement in coordinated individual planning and that it is not easy to interact or to work person centred.

In the studied planning meeting, not all parts were met in the planning process, as the staff involved did not have knowledge about the whole process. The participants had different expectations for the meeting and after the meeting it was not clear what had been decided.

– Managers and various staff groups must continuously evaluate how they conduct planning meetings and how they can improve their way of working to increase the individual's and their close relatives' involvement in the planning meeting. It is about looking at the individual's needs and resources, says Ingela Jobe.

In the second study, which has not yet been published, focus group interviews were conducted with 40 elderly people who were active in six different associations, such as PRO, Husmodersföreningen and various patient associations. The participants were between 70-88 years old.

The purpose was to find out how they think about different factors related to the coordinated individual planning.

Participants perceived that they could not influence the care and health care they received without everything being decided in advance, even though they themselves wanted to decide as much as possible. They also felt that relatives had a great responsibility for care and health care and they felt unsafe and worried about what would happen to them when they need health care.

– Most people did not know what SIP was, and those who had their own experience of the coordinated individual planning did not feel it had worked fully. However, many of the participants thought that a plan could be useful to them if they ended up in a situation when they needed one, says Ingela Jobe.

Ingela Jobe is a PhD student in nursing in the project "My Plan", a EU-funded project led by the Norrbotten region, together with the municipalities of Norrbotten, Tieto and Luleå University of Technology. The project will develop new approaches to coordinated individual planning. A new IT support for staff has been developed to facilitate cooperation between the region and the municipalities, and the coordinated individual plan, SIP, will be available to the individual on the internet via 1177.