How to foster an integrated health and social care centred on the individual in a local environment

14 Mar

SUSTAIN is a Horizon2020 European Project related to integrated care for older people that live at home with complex health and social needs. Thirteen initiatives from seven European projects participate in it.

It is a project whose aim is to improve a range of things including the care centred on the individual, the coordination of teams of professionals, the preventive nature of care, safety and efficiency.

In Catalonia, two initiatives (Social and Health Integration of Sabadell Nord and the Programme for complex chronic and advanced patients and the geriatric population of Osona) have participated in the design and development of projects for improvement which have been assessed by AQuAS (you can read the report and article here).

On 23rd January, 2019, professionals involved in the groups that are the driving force of the two local initiatives (Sabadell and Osona) of integrated health and social care – family doctors, workers and social workers, nurses, geriatric and management personnel- met at AQuAS in their first joint meeting.

(SUSTAIN team Sabadell, Osona and AQuAS in Barcelona

The professionals were able to share thoughts on one question: What remains of the SUSTAIN project in the territory?

This was the starting point to identify specific actions that can make the projects sustainable and to also comment on aspects for improvement beyond the projects.

The aim was to identify opportunities within reach of the local initiatives themselves that could serve to generate a more favourable environment for integrated health and social care centred on the individual, both preventive and reactive in nature.

From the brainstorming that was done, a multitude of local actions can be derived with which to drive integrated health and social care centred on the individual. Let’s look at it in detail:

  1. Prioritise at a population level Delimiting a population group for which it is deemed most important to apply the new PIAI method (Individualised Plan for Integrated Care), so that efforts can be concentrated on this group until the context allows for scaling up to the entire population of 65 and older. One possibility would be the older people who live at home with complex health and social needs who at present receive home-based healthcare, or for those cases known by primary healthcare but are not beneficiaries of home-based social care. This would be done in order to eliminate the barrier limiting access to social services or because there is a lack of awareness of these social service
  2. Provide continuity in coordination between sectors, while taking into consideration the suitability of the new PIAI method for each individual case Continuing with periodic meetings of the team of professionals in charge of the multidimensional assessment of needs so as to plan an individualised and integrated health and social care (at least of the triad of primary care, family medicine-nursing-social work). These meetings, held on a monthly basis, would enable the teams to consider who, among those users visited recently (in primary care centres, at home, at local social services, at intermediary care in the case of Osona), would particularly benefit from the integrated and participative approach of SUSTAIN, with the possible introduction of changes or objectives to improve their care and their quality of life.
  3. Inviting professionals that have not participated in SUSTAIN to use the new PIAI method, giving these professionals the necessary tools (time, training) so they can familiarise themselves with the approach of integrated health and social care centred on the individual. With this in mind, there is talk of the importance of “maintaining the spirit of SUSTAIN” and in gradually getting the most reluctant professionals more involved in introducing changes to their way of working.
  4. Carrying out an analysis of the different capacities and responsibilities of each professional in primary care teams (family medicine-nursing-social work-social health work), and sharing out roles and responsibilities ad hoc, which can enhance the skills of each individual. This could mean that professionals who officially occupy the same position (for example, family medicine) would become specialised in one or another type of care (emergency, development of the PIAI, specific pathologies), and it would mean accepting that not all professionals with the same position need do the same: “one-size-only professionals are not needed”.
  5. Enhancing the figure of the spokesperson in a healthcare team, both when dealing with a user as well as an internal coordinator of a team, emphasising that the user has a team with professionals that interact with each other in order to provide solutions to their different needs as quickly as possible. The emphasis is on the opportunity that workers and social workers have in acting as liaison officers between primary care, local social services and community resources while at the same time coordinating actions which are contained in the PIAI.
  6. Analysing how the figure of the social and health worker can best fit in In the case of Sabadell, this figure has only been incorporated very recently. An analysis will need to be carried out with the entire group of professionals that intervene in care but especially with the social workers (under contract with local social services, socio-health workers or social workers specialised in intermediary care). This will be done in order to understand their capacities and perspectives of what function each professional should have bearing in mind their particularities and the specific environments in which they work (for example, specific tools and procedures they can apply, what information systems they have at their disposal or what other professionals they are in direct contact with).
  7. Set up safe and respectful local systems with the LOPD (Spanish personal data protection law) in order to exchange the minimal information necessary to carry out a joint multidimensional assessment and to share the PAIAs among the most important professionals in each case. The example of Integrated System of Health in Osona (SISO) is mentioned, which enables primary care professionals to see which users are admitted in the hospital centres that make up the system, or the mechanism foreseen by the County Council of Osona to enable social health workers employed in health centres to consult the degree of dependency of a user.

We end this post by commenting that this week we participated in the final conference of the project in Brussels.

Representatives of the Osona SUSTAIN team, Sabadell and AQuAS in Brussels

Post written by Jillian Reynolds, Lina Masana, Nuri Cayuelas and Mireia Espallargues.

Less Google® glass and more gender glasses

8 Mar
Esther Arévalo, Marta Millaret

Last week, Barcelona hosted the Mobile World Congress 2019. From AQuAS, we attended the Health and Wellness Summit which takes place within the framework of 4YFN. Very relevant subjects were dealt with regarding technology and digital health putting the spotlight on artificial intelligence, data analytics, aspects of safety, user experience and health systems.

Apart from what was presented, we were able to read about different experiences and news regarding the lack of women among the speakers.

For this reason, today, 8 March, International Women’s Day, we interview Rossana Alessandrello, electronics engineer specialised in bioengineering who works in a world of technology and health, two environments with their own characteristics. Dolores Ruiz Muñoz, epidemiologist and public health technician specialised in gender subjects, conducted the interview.

What are the people you work with like? What responsibilities do women have and what roles do they tend to play in your sector?

Men. I work in a world of men and I would say that there are differences with the roles of women in the ICT. While men are more daring and reckless, women are not. Women provide the element of feasibility and bring ideas down to earth. My feeling is that without women, men would not accomplish anything. We bring everything down to earth in every way. We make work plans operational, from a management, legal and social perspective.

What have your men or women bosses been like?

Men. And I see it as my own limitation. I do not take enough risks. I make things possible but I am not sufficiently audacious. That is my reality, my framework. I provide the creative part but “taking the plunge” is what I lack. I have worked with American, Swedish and Catalan bosses, both in private and public companies. It would not seem to be a coincidence. I am not saying that there are no women technological entrepreneurs, there are some. In my opinion, they have attained leadership positions because they have been able to take advantage of “the plunge” that men take and so jump themselves.

How do you see the future?

I see the future positively. For me, the collaboration between men and women is a very positive collaboration, and it is a necessary synergy. It is just a matter of accepting differences and taking them into account. I consider myself to be an enterprising person. I have built up my professional career which has ranged from offering specific products to managing teams. I have chosen and managed my own career and made my decisions.

In the context of innovation, do you have the perception that there are gender biases? For example, in subjects where innovation is prioritised, the way innovation is done or in any other aspect?

There are no biases. No biases at all. We all want to innovate. Perhaps there is a nuance in the fact that female innovation is always oriented towards improvement and impact. In this respect, I would go so far as to say that there are differences. An example of this would be the case of Bill Gates when he considered creating an operative system without being very sure at the time of the implications it would have in the long run. In my opinion, women on the other hand, work with a creativity that always includes a reason, an end aim or an objective. It is not a paradigm of innovating for innovating’s sake. The other paradigm would be “a challenge as a challenge”.

If we ask the general public whether they can mention the name of a woman known for her contributions to the ICT world, they would probably have considerable difficulty. It is probably because of this that there are international awards and initiatives exclusively for women and that their equivalent does not exist for men. For example, I am thinking about the EU Prize for Women Innovators 2018, Women IT Awards, International Girls in IT Day and Women in Health IT Community.

Most of the projects of public procurement of innovation in which we are working on from the AQuAS were begun by men. We should ask ourselves whether it is because women are not in the appropriate positions or whether it is for other reasons. Similarly, the majority of SMEs that tender for these projects are led by men.

What do you think about quota policies?

I think other things need to be done. There is a real need to train, to educate, to prepare ourselves in equality in the defence of ideas and to encourage this aspect from the time we are very young girls. School has a role in all this and it needs to go a step further and the communications media too.

I have often been “the woman” in meetings and I have been treated differently because of this. Things are constantly happening to me which I do not think would happen to men. Recently, in a meeting I was given a kiss on the forehead as a show of “thanks” for an idea. Further back, in another meeting, I remember that I was pregnant and that they introduced me with the phrase “This pregnant lady, please be kind to her”. I am sure they are experiences which arise from a “naturalness of affection” that I have normalised, as a woman, to be able to move forward professionally. I have many anecdotes like these. I would say that in some sectors, such as in mine which combines ICT and health, things are very much like this at the moment.

Would you like to mention anything that I haven’t asked you about?

Yes. I have had the experience of not having being able to opt for a position of responsibility because of being on maternity leave. It was an American company, at a time of change and fusions. At that time, I experienced firsthand that in the “male world” not being permanently available was not acceptable. I hope things have changed.

Thank you very much, Rossana and Lola!

It has been a year since we published a text by Iria Caamiña from this space about needing to put on our gender glasses. Are we still in the same position?

From AQuAS, we strongly support the incorporation of gender perspective in our day to day and in our work lines. Gender perspective? Yes, absolutely. And also new technologies, research, assessment, data analytics and innovation.

We would like to end this text with this video from EIT Health about women and innovation in health.