Integrated Care in Australasia
This Journal of Integrated Care ebook comes at a time of rapid change in the delivery of health and social care services across Australasia. Population and patient/client demands are changing rapidly in ways which could not be envisaged even a decade ago. Structural reforms in, and societal expectations of, the health, aged care and disability sectors are re-shaping the way services are funding, staffed and delivered. The converging agendas of client controlled care, co-design, and the broader neo-liberal agenda have resulted in a period which has been described by some critics as an attempt to build an airplane while still in flight (Whalan et al., 2014).
Internationally there are two areas which are highlighted as key elements of integrated care policy. These are patient-centred care, where there is recognition that patient experience and choice along with a focus on the consumer voice are essential to effective care provision, and the requirement for a skilled workforce of healthcare professionals in which to deliver this care (Oliver-Baxter, Brown, et al., 2013; Oliver-Baxter, Bywood, et al., 2013). Planning for future needs is a key element of this. Concurrent calls for integrated, safe and high quality care across all sectors have emerged from the recognition that services have, and continue to, fall short on these principle measures. In order to meet these requirements, new approaches need to be developed. The argument made is that these reforms will result in greater control of care by clients, but whether they will produce either better or more integrated care, or indeed if these will necessarily result in better patient/client outcomes is still under debate (Billot et al., 2016).
In the Australasian region, there is also a growing awareness of the need for the integration of healthcare and other services to ensure that care is organised and delivered in ways that are meaningful to the person receiving the care. As with other nations, countries in the Australasian region have focused efforts to support better integration, responding to what the World Health Organisation (WHO) says is the need “for a fundamental paradigm shift in the way health services are funded, managed and delivered” (WHO, 2015, p.7).
Integrated care must be provided contextually, to reflect the needs of individuals and communities. From the policy context, efforts in Australia and New Zealand to improve care integration are underway, with a view to creating the macro levels of support across jurisdictions (Oliver-Baxter, Brown, & Bywood, 2013; Oliver-Baxter, Bywood, & Brown, 2013).
In this ebook, the authors are looking not so much ’integration’, as at ‘integrating’ in the same way that Amy Edmondson talks about the difference between teams and ‘teaming’ as the dynamic form of collaboration, particularly in environments characterised by uncertainty and ambiguity (Edmondson, 2012). We can similarly interpret integrating care as a never ending process of negotiated or coordinated relationships (Gittell and Douglass, 2012) intended to produce better outcomes for patients and clients.
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