Building workforce capacity for complex care coordination: a function analysis of workflow activity

Human Resources for Health

Kathryn Cranwell³  Rebecca Power¹  Liza Heslop² 

[1] Strategy, Service Planning and Partnering with Consumers, Royal Victorian Eye and Ear Hospital, 32 Gisborne St, East Melbourne, VIC 3002, Australia;College of Health and Biomedicine, Victoria University, PO Box 14428, Melbourne, VIC 8001, Australia;Community Services Workforce Innovation and Integration Lead, Western Health, 176 Furlong Road, St Albans, VIC 3021, Australia

关键词: Workflow modelling;    Interprofessional teams;    Health workforce reform;    Health care;    Chronic disease management;    Care coordination;   

Others  :  1139386
DOI  :  10.1186/1478-4491-12-52

 received in 2014-04-08, accepted in 2014-09-06,  发布年份 2014

【 摘 要 】

Background

The care coordination workforce includes a range of clinicians who manage care for patients with multiple chronic conditions both within and outside a hospital, in the community, or in a patient’s home. These patients require a multi-skilled approach to support complex care and social support needs as they are typically high users of health, community, and social services. In Australia, workforce structures have not kept pace with this new and emerging workforce. The aim of the study was to develop, map, and analyse workforce functions of a care coordination team.

Methods

Workflow modelling informed the development of an activity log that was used to collect workflow data in 2013 from care coordinators located within the care coordination service offered by a Local Health Network in Australia. The activity log comprised a detailed classification of care coordination functions based on two major categories – direct and indirect care. Direct care functions were grouped into eight domains. A descriptive quantitative investigation design was used for data analysis. The data was analysed using univariate descriptive statistics with results presented in tables and a figure.

Results

Care coordinators spent more time (70.9%) on direct care than indirect care (29.1%). Domains of direct care that occupied the most time relative to the 38 direct care functions were ‘Assessment’ (14.1%), ‘Documentation’ (13.9%), ‘Travel time’ (6.3%), and ‘Accepting/discussing referral’ (5.7%). ‘Administration’ formed a large component of indirect care functions (14.8%), followed by ‘Travel’ (12.4%). Sub-analyses of direct care by domains revealed that a group of designated ‘core care coordination functions’ contributed to 40.6% of direct care functions.

Conclusions

The modelling of care coordination functions and the descriptions of workflow activity support local development of care coordination capacity and workforce capability through extensive practice redesigns.

【 授权许可】

   
2014 Heslop et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Volland PJ, Schraeder CI, Shelton P, Hess I: The transitional care and comprehensive care coordination debate. J Am Soc Aging 2012, 36:13-19.
• [2]Banfield M, Gardner K, McRae I, Gillespie J, Wells R, Yen L: Unlocking information for coordination of care in Australia: a qualitative study of information continuity in four primary health care models. BMC Fam Pract 2013, 14:1-11. BioMed Central Full Text
• [3]Schultz EM, Pineda N, Lonhart J, Davies SM, McDonald KM: A systematic review of the care coordination measurement landscape. BMC Health Serv Res 2013, 13:1-12. BioMed Central Full Text
• [4]Berry LL, Rock BL, Houskamp B: Care coordination for patients with complex health profiles in inpatient and outpatient settings. Mayo Clin Proc 2013, 88:84-194.
• [5]Cipriano P: The imperative for patient, family, and population-centered interprofessional approaches to care coordination and transitional care: a policy brief by the American Academy of Nursing’s Care Coordination Task Force. Nurs Outlook 2012, 60:330-333.
• [6]Seddon D, Krayer A, Robinson C, Woods B, Tommis Y: Care coordination: translating policy into practice for older people. Qual Ageing 2013, 14:81-92.
• [7]Van Houdt S, Heyrman J, Vanhaecht K, Sermeus W, De Lepeleire J: An in-depth analysis of theoretical frameworks for the study of care coordination. Int J Integrated Care 2013, 13:1-8.
• [8]Social Work Leadership Institute: Toward the Development of Care Coordination Standards. An Analysis of Care Coordination in Programs for Older Adults. [http://www.nyam.org/social-work-leadership-institute/docs/care-coordination/N3C-NYS-DOH-SOFA-Care-Coordination-Report-plus-new-york.pdf webcite]
• [9]Naccarella L, Freijser L: Evaluation of Models of Care Coordination Funded by Divisions of General Practice. 2012. [http://www.gpnsw.com.au/__data/assets/aboriginalhealth/20120822_CCEvalFINALREPORT_fin.pdf webcite]
• [10]Gardner K, Yen L, Banfield M, Gillespie J, Mcrae I, Wells R: From coordinated care trials to Medicare locals: what difference does changing the policy driver from efficiency to quality make for coordinating care? Int J Qual Health Care 2013, 25:50-57.
• [11]Banfield MA, Gardner KL, Yen LE, McRae IS, Gillespie JA, Wells RW: Coordination of care in Australian mental health policy. Aust Health Rev 2012, 36:153-157.
• [12]Council of Australian Governments: National Health Reform Agreement. 2011. [https://www.coag.gov.au/node/96 webcite]
• [13]Independent Hospital Pricing Authority: Tier 2 Non-admitted Services Compendium 2013–2014. [http://www.ihpa.gov.au/internet/ihpa/publishing.nsf/Content/tier2-non-admit-services-compendium-2013-14 webcite]
• [14]Chen LM, Ayanian JZ: Care continuity and care coordination: what counts? JAMA Intern Med 2014, 174:749-750.
• [15]Bird SR, Kurowski W, Dickman GK, Kronborg I: Integrated care facilitation for older patients with complex health care needs reduces hospital demand. Aust Health Rev 2007, 31:451-461.
• [16]Leu JD, Huang YT: An application of business process method to the clinical efficiency of hospital. J Med Syst 2011, 35:409-421.
• [17]Davenport TH, Short JE: The new industrial engineer: information technology and business process redesign. Sloan Manage Review 1990, 11-27. CISR WP No.213 WP No. 3190–3190
• [18]Unertl KM, Novak LL, Johnson KB, Lorenzi NM: Traversing the many paths of workflow research: developing a conceptual framework of workflow terminology through a systematic literature review. J Am Med Inform Assoc 2010, 17:265-273.
• [19]Qian SY, Yu P, Zhang ZY, Hailey DM, Davy PJ, Nelson MI: The work pattern of personal care workers in two Australian nursing homes: a time-motion study. BMC Health Serv Res 2012, 12:305. BioMed Central Full Text
• [20]Milosavljevic M, Williams P, Perez G, Dalla T: The results of a pilot time-and-motion study in three Australian hospitals: Where do we spend our time? Nutr Diet 2011, 68:185-188.
• [21]Anderson D, St Hilaire D, Flinter M: Primary care nursing role and care coordination: An observational study of nursing work in a community health centre. Online J Issues Nurs 2012, 17:3.
• [22]Dgedge M, Mendoza A, Necochea E, Bossemeyer D, Rajabo M, Fullerton J: Assessment of the nursing skill mix in Mozambique using a task analysis methodology. Hum Resour Health 2014, 12:5. BioMed Central Full Text
• [23]Stevenson L, Parent K, Purkis ME: Redesigning care delivery in British Columbia. Healthc Manage Forum 2012, 25:16-19.
• [24]Department of Transport, Planning and Local Infrastructure: Victoria in Future 2012. The Victorian Government's official population and household projections. [http://www.dpcd.vic.gov.au/home/publications-and-research/urban-and-regional-research/census-2011/victoria-in-future-2012 webcite]
• [25]Djerriwarrh Health Services Better: Health Plan for the West. 2012. [http://djhs.com.au/fileadmin/…/BHPFTW_13_FINAL_JUNE_2012.pdf webcite]
• [26]Rich E, Lipson D, Libersky J, Parchman M: Coordinating Care for Adults with Complex Care Needs in the Patient-Centered Medical Home: Challenges and Solutions. Rockville, MD: Agency for Healthcare Research and Quality; 2012. [White Paper (Prepared by Mathematica Policy Research under Contract No. HHSA290200900019I/HHSA29032005T). AHRQ Publication No. 12-0010-EF]
• [27]Haas S, Swan BA, Haynes T: Competencies for care coordination and transition management. Nurs Econ 2013, 31:44-49.
• [28]McDonald KM, Schultz E, Albin L, Pineda N, Lonhart J, Sundaram V, Smith-Spangler C, Brustrom J, Malcolm E: Care Coordination Measures Atlas. Rockville, MD: Agency for Healthcare Research and Quality; 2011. [http://archive.ahrq.gov/professionals/systems/long-term-care/resources/coordination/atlas/index.html webcite]
• [29]Ehrlich C, Kendall E, Muenchberger H: Spanning boundaries and creating strong patient relationships to coordinate care are strategies used by experienced chronic condition care coordinators. Contemp Nurs 2012, 42:67-75.
• [30]Hartgerink JM, Cramm JM, Bakker TJ, van Eijsden RA, Mackenbach JP, Nieboer AP: The importance of relational coordination for integrated care delivery to older patients in the hospital. J Nurs Manage 2014, 22:248-256.
• [31]Independent Hospital Pricing Authority (IHPA): National Efficient Price Determination 2014–2015. 2014. [http://www.ihpa.gov.au/internet/ihpa/publishing.nsf/Content/nep-determination-2014-15-html~inscope-ph-services~non-admitted-services webcite]