ABSTRACT
Introduction: While the benefits of integrated care are widely acknowledged, its implementation has proven difficult. Together with other factors, financial factors are known to influence progress towards care integration, but in-depth insight in their influence on the envisioned outcomes of integrated care projects is limited. Methods: We conducted a multiple case study of four integrated care projects in the Netherlands. The projects were purposely sampled to be representative of integrated care in its different forms. A total of 29 semi-structured interviews were held with project members, both medical and non-medical staff. In addition, 141 documents were analyzed, including scientific publications and minutes of meetings. Based on elaborate project descriptions we deduced the synergistic influences of financial and other factors on the outcomes of the projects. Results: Financial factors have an important influence on integrated care projects, though this influence is neither deterministic nor isolated. This is because the likelihood of realizing a positive outcome is affected by the degree to which four key conditions are fulfilled: 1) willingness to change, 2) alignment of interests and uniformity goal, 3) availability of resources to change, and 4) effectiveness of management of external actors. Conclusion: Financial factors have an impact on the outcomes of integrated care projects and must be viewed in synergy with interrelated other factors. Crucial for realizing success in integrated care, a balance must be struck between the level of ambition set in a project and the reality of the prevailing key conditions.
ABSTRACT
BACKGROUND: The health care sector is among the most carbon-intensive sectors, contributing to societal problems like climate change. Previous research demonstrated that especially the use of personal protective equipment (e.g., aprons) in critical care contributes to this problem. To reduce personal protective equipment waste, new sustainable policies are needed. AIMS: Policies are only effective if people comply. Our aim is to examine whether compliance with sustainable policies in critical care can be increased through behavioural influencing. Specifically, we examined the effectiveness of two sets of nudges (i.e., a Prime + Visual prompt nudge and a Social norm nudge) on decreasing apron usage in an intensive care unit (ICU). STUDY DESIGN: We conducted a field experiment with a pre- and post-intervention measurement. Upon the introduction of the new sustainable policy, apron usage data were collected for 9 days before (132 observations) and 9 days after (114 observations) the nudge interventions were implemented. RESULTS: Neither the Prime + Visual prompt nudge, nor the Social norm nudge decreased apron usage. CONCLUSIONS: While previous studies have found that primes, visual nudges and social norm nudges can increase sustainable behaviour, we did not find evidence for this in our ICU field experiment. Future research is needed to determine whether this null finding reflects reality, or whether it was due to methodological decisions and limitations of the presented experiment. RELEVANCE TO CLINICAL PRACTICE: The presented study highlights the importance of studying behavioural interventions that were previously proven successful in the lab and in other field contexts, in the complex setting of critical care. Results previously found in other contexts may not generalize directly to a critical care context. The unique characteristics of the critical care context also pose methodological challenges that may have affected the outcomes of this experiment.