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See detailTowards Integrated Care for Chronic Patients in Belgium: The Pilot Project, an Instrument Supporting the Emergence of Collaborative Networks
De Winter, Mélanie ULiege

in Societies (2019)

In 2015, the Belgian Health Ministers launched a plan intended to evolve towards an integrated care system for chronic patients. This plan is implemented through pilot projects involving local actors ... [more ▼]

In 2015, the Belgian Health Ministers launched a plan intended to evolve towards an integrated care system for chronic patients. This plan is implemented through pilot projects involving local actors. Therefore, the researcher raised the following research question: how does the use of pilot projects as implementation instruments structure the collaboration between parties involved in a pilot project? The term “pilot project” refers to a collaborative work method coupled with an experimentation purpose. This is further developed in the paper via a literature study. This qualitative research draws on interviews, focus groups, direct observation, and a documentary analysis. During the two first phases of the process, field workers had to create multidisciplinary local consortia and write an application file describing the project they would implement during the third phase, which raised challenging collaboration issues. Many people learned to work together over time, progressively overcoming the traditional fragmentation of care. They met regularly, understood their respective roles, and dealt with controversies through negotiation to reach an agreement on a common project. In conclusion, the researcher shows that, thanks to its characteristics, the pilot project instrument supports the development of collaborative care networks; in this example of community-based integrated care networks. [less ▲]

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See detailConsidering patients’ empowerment in chronic care management: a multidisciplinary approach
Tilkin, Caroline ULiege; De Winter, Mélanie ULiege; Ketterer, Frédéric ULiege et al

in International Journal of Integrated Care (2018)

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See detailImplementing an Integrated Care System for Chronic Patients in Belgium: a Co-creation Process
De Winter, Mélanie ULiege

in International Journal of Integrated Care (2018)

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See detailPilot projects as public policy instruments : The case of integrated care pilot projects for chronic patients in Belgium
De Winter, Mélanie ULiege

Poster (2018, June)

In October 2015, the Belgian Health Ministers launched the joint plan “Integrated Care for Better Health” (IC4BH) targeting chronic patients (1). Through this plan, they expressed their intention to bring ... [more ▼]

In October 2015, the Belgian Health Ministers launched the joint plan “Integrated Care for Better Health” (IC4BH) targeting chronic patients (1). Through this plan, they expressed their intention to bring about a major transition from a fragmented care system to an integrated care one for such patients. Whilst the authorities knew that they wanted to move towards an integrated care system, they nevertheless did not know how to implement it in the Belgian-specific context. Therefore, they opted for an iterative and incremental implementation. In an original manner, they decided to rule out “top down” solutions and launched a call for multidisciplinary four-year pilot projects to involve field actors and generate “bottom-up” solutions. The Belgian authorities have often used pilot projects in the health sector to test new solutions and new ways of working. For more than ten years, there has been an increasing number of calls for pilot projects in the Belgian health sector (e.g. “protocol 3” projects for frail old people, “psy 107” projects in the mental health sector, home hospitalisation pilot projects, mobile health projects, etc.). However, these new integrated care pilot projects are particular in the sense that they simultaneously target several diseases, encompass larger target groups than the previous ones (thousands of people per project) and cover larger geographic areas. But above all, they involve many more different actors in a phased co-creation process, i.e. policy-makers, civil servants, patients’ representatives, first-line and second-line care actors (hospitals, medical health centres, general practitioners, nurses, etc.) together with non-medical actors (e.g. social and cultural actors). These actors have different and often diverging interests, which raises major inter-organisational and inter-professional collaboration issues. Implementing integrated care challenges usual governance schemes. The authorities aim at developing “loco-regional networks”, viewed as governance modes supporting the transition from a competitive to a collaborative care system (2). In this paper, pilot projects, which Vreugdenhil and Ker Rault see as “…means to establish communication between actors that usually do not cooperate” (3-p.122), are viewed as public policy instruments (4) supporting that kind of transition. Thereby, the researcher addresses the following question, the guiding thread of this paper: how does using multidisciplinary pilot projects as implementation instruments reshape modes of public governance in the Belgian health sector in a context of transition and ongoing devolution? The researcher focuses on how these instruments transform “the relationship between the governing and the governed” (5-p.3), between all the actors of the care production chain who have to learn how to work together, cooperate and collaborate to achieve integrated care in Belgium. This qualitative and inductive research draws on several data collection methods: interviews (N=22), focus groups (N=7), direct observation (109.5 hours), documentary analysis (operational documents) and a literature review. Keywords: pilot projects, policy instruments, policy implementation, governance, integrated care References: 1. Belgian Ministry of Social Affairs and Public Health. Plan conjoint en faveur des malades chroniques: « Des soins intégrés pour une meilleure santé ». [Internet]. 2015. Available from: http://www.integreo.be/sites/default/files/public/content/plan_fr.pdf 2. Buttard A, Santos CD, Tizio S. Networking Healthcare. From a competitive call to a medical cooperation as a guarantee of a found confidence. Recherches en Sciences de Gestion. 2012;6(93):21–43. 3. Vreugdenhil H, Ker Rault P. Pilot Projects for Evidence-Based Policy-Making: Three Pilot Projects in the Rhine Basin. German Policy Studies. 2010;115–51. 4. Lascoumes P, Le Galès P, editors. Gouverner par les instruments. Paris: Presses de la Fondation Nationale des Sciences Politiques; 2004. 370 p. (Gouvernances). 5. Lascoumes P, Le Gales P. Introduction: Understanding Public Policy through Its Instruments? From the Nature of Instruments to the Sociology of Public Policy Instrumentation. Governance. 2007 Jan;20(1):1–21. [less ▲]

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See detailImplementing an Integrated Care System for Chronic Patients in Belgium: a Co-creation Process
De Winter, Mélanie ULiege

Poster (2018, May 24)

• Introduction In October 2015, the Belgian Health Ministers launched a joint plan in favour of chronic patients entitled “Integrated Care for Better Health” [1]. Through this plan, they expressed their ... [more ▼]

• Introduction In October 2015, the Belgian Health Ministers launched a joint plan in favour of chronic patients entitled “Integrated Care for Better Health” [1]. Through this plan, they expressed their intention to move from a fragmented system to an integrated care system for patients with chronic diseases. They decided to implement this plan in a bottom-up way: they launched a call for multidisciplinary four-year pilot projects involving field actors in a co-creation process in order to initiate innovation at the local level. • Methods This qualitative and inductive research draws on several data collection methods: interviews (N=21), focus groups (N=7), direct observation (90.5 hours), documentary analysis (operational documents) and a literature review. The data, pertaining to two aspiring pilot projects, were collected during the “conceptualisation phase”, i.e. the application writing period. • Results According to the authorities ‘guidelines, pilot project consortia had to identify a pilot zone and include a variety of first-line and second-line care actors together with non-medical actors (e.g. social and cultural actors) working in this zone. They were asked to identify the needs of their population and the available/missing resources in their pilot zone. On the basis of this, they had to write a loco-regional action plan in which they outlined their common vision, their strategic and operational objectives and the actions they would implement to achieve these objectives. • Discussions During the conceptualisation phase, different actors, who would probably not have met otherwise, came to work together, overcoming the traditional fragmentation between first- and second-line of care. More than that, by including non-medical stakeholders, the pilot project consortia extended to the community. Multidisciplinarity, coconstruction, cooperation, coordination, targeting a community/defined population in a delimited territory, initiatives “driven by community health needs” [2], sharing goals and resources, all these elements characterising the pilot projects also characterise community health care [3]. • Conclusions Opting for implementation through the use of pilot projects has led local actors to engage in the development of what could become “community health microcosms” in the future. Pilot projects appear to be tools supporting the development of “community-based integrated care” [2]. • Lessons learned Building multidisciplinary projects entails that local actors reach an agreement on their common vision and goals, which is a challenging task. This implies dealing with controversies by meeting, understanding their respective roles, exchanging ideas, negotiating and overcoming their personal interests. Becoming a group, a community aware of its existence is a task in itself, which takes time. Besides, co-designing health care with local actors brings unpredictability to the process: the result of local actors’ reflections can be different from the authorities’ expectations. • Limitations Nineteen pilot projects submitted applications. For practical reasons of feasibility, this research focuses only on two pilot projects and, more specifically, on the application file co-construction process of these pilot projects. • Suggestions for future research The selected pilot projects will implement their loco-regional action plans during the execution phase starting in January 2018. Focusing on the concrete execution of their loco-regional action plans seems to be a logical continuation of this research. Keywords: integrated care, community health, health system, policy implementation, chronic diseases References 1. Belgian Ministry of Social Affairs and Public Health (BE), Plan conjoint en faveur des malades chroniques : « Des soins intégrés pour une meilleure santé ». 2015. 2. Plochg T, Klazinga N. Community-based integrated care: myth or must? International Journal for Quality in Health Care. 2002. 14(2): 91-102 3. Prévost M, L’approche communautaire, un liant interdisciplinaire ? Santé conjuguée. 2016 Mar; 74: 77-82. [less ▲]

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See detailChanger de Paradigme : Vers un Système de Soins Intégrés en Belgique
De Winter, Mélanie ULiege

Scientific conference (2018, April 20)

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See detailInscription, iteration, transformation
De Winter, Mélanie ULiege; Slomian, Cynthia ULiege

Conference (2017, September 09)

In “Knowledge in policy”, Freeman and Sturdy propose a phenomenology with the aim of “knowing knowledge” (Freeman & Sturdy, 2014, p. 2). Knowledge can have different forms called “inscribed”, “embodied” ... [more ▼]

In “Knowledge in policy”, Freeman and Sturdy propose a phenomenology with the aim of “knowing knowledge” (Freeman & Sturdy, 2014, p. 2). Knowledge can have different forms called “inscribed”, “embodied” and “enacted”. This framework is presented as a way to categorize and describe the form, the circulation and the transformation of knowledge in policymaking. In this paper, we intend to focus on inscribed knowledge, and particularly on documents conceived as essential artefacts of public policies (Freeman & Maybin, 2011). Freeman and Sturdy defined inscribed knowledge as “written down in texts, or represented in pictures and diagrams; or it may be incorporated into instruments, tools and machines, among other things”(Freeman & Sturdy, 2014, p. 10). This form of knowledge is particularly “stable”, “easily reproducible” and “highly mobile” so “it can be communicated or made available to many different individuals separated in time and/or space”(Freeman & Sturdy, 2014, p. 10). This statement draws from works in sociology of science and technology. These works, especially Latour’s (1987) studies of the laboratory work and Law's (1986) analysis of control at distance particularly emphasize the power of inscriptions in constraining social action over time and space. Through the analysis of the implementation of two policy plans in the Belgian healthcare sector, we question and put the role of inscriptions in perspective with moments of enactment, by focusing on meetings. We intend to show that some documents are crucial at particular moments and lose value at other moments. In the same vein, we also aim to show the importance of iteration, moments, duration, and rhythms in public action. By doing so, we show how the public policy itself is transformed through time, documents and meetings. We address this issue by drawing on two PhD researches focusing on the devising and implementation of the policy plans mentioned above. By relying on interviews, observations and document analysis, we describe the policy strategies inscribed in documents as well as key moments of both documents’ trajectories. In so doing, we emphasise that documents and meetings articulate with each other in an iterative process that in turn transforms the public policies themselves. [less ▲]

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See detailA Belgian reform towards an integrated care system for chronic patients: the ubiquity of knowledge
De Winter, Mélanie ULiege

Conference (2017, April 27)

Countries all over Europe are currently facing budgetary pressures regarding their health care systems due to scientific progress, population ageing and a sharp rise in chronic diseases. In the European ... [more ▼]

Countries all over Europe are currently facing budgetary pressures regarding their health care systems due to scientific progress, population ageing and a sharp rise in chronic diseases. In the European Union, chronic diseases are now the leading cause of death and the most important item of health expenditures (Schokkaert &Van de Voorde, 2011). In 2015, the Belgian Health Ministers launched a joint public health plan called “Integrated Care for Better Health” (2015) to bring about a transition from an institutional system to an integrated care system for patients with chronic diseases. The authorities are nevertheless uncertain of the solutions to adopt in the Belgian context. Consequently, they have chosen to turn this plan into practice through 4-year pilot projects as part of an iterative and incremental implementation strategy. These iterative and incremental aspects entail a constant production and circulation of knowledge by and between actors involved in the co-construction process, between policy-makers and field actors responsible for policy implementation. As a result, this presentation focuses on concrete practices (preparatory meetings, plenary sessions, recourse to websites and forums, writing documents, etc.) that enact and stabilize knowledge that is produced, transformed and circulated between the different actors of the care production chain. These practices will be identified thanks to the methodological triangulation approach (policy documentary analysis, direct observation, semi-structured interviews). [less ▲]

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