Monday, 5 January 2015

Integrated Practice Units: what for?

Hospital medical divisions are based on rigid organizational charts, in accordance with the official medical specialties. This organizational model is quite efficient when you need to provide services to patients with acute pathologies, especially when the derived procedures are more or less standardized. But in any other circumstances, of which there are plenty, the shortcomings found in coordination between medical services often cause frankly disappointing results that leave a lot of room to be improved.

In the fields of Mental Health and Oncology, particularly those sensitive to transversality, long ago instruments designed to overcome the closed compartments (circuit meetings, tumours committees) were created. These organizational models are based on protocols, individualized treatment plans and a lot of intense coordination; and, as a consequence of the positive results of these experiences, we have witnessed the emergence of the Integrated Practice Units, which are often initiatives that want to go beyond simple coordination, although most of them fail to overcome two tough limitations: real management autonomy (can they contract?) and lack of own resources (do they have an attached budget?).

Integrated Practice Units

At the moment, we're seeing many official initiatives aimed at giving legal backing to the establishment of Integratec Practice Units, precisely to overcome the above obstacles and thus get more management autonomy and accountability of clinicians in the management of resources. Even admitting that this new framework is encouraging, the question remains:  Why do we want Integrated Practice Units? Will they bring more value or end up as a new constellation in the firmament of the chaotic management of patients with complex and little standardisable pathologies?

To advance with this line of thought and see if the question “what for?" can be answered, I thought it appropriate to look and see what Michael Porter says in his proposal to reorganize health in Integrated Practice Units.

If I may, I will make an interpretation of Porter's thinking, and to this end I present the basics that I think are essential for creating Integrated Practice Units in Spain:
  1. Characterization of the group (patients) that will access the Unit’s services
  2. Multidisciplinary professional team with well-defined functions
  3. Health education and patient involvement in clinical decisions
  4. Continuity of care beyond the traditional boundaries of different levels (primary, hospital, social care)
  5. Clinical leadership, process definition and development of individualized treatment plans;
  6. Management autonomy and own resources (with a budget)
  7. Evaluation of processes, but especially the evaluation of the clinical results as well as the costs involved in obtaining them
Seeing these requirements, I think that Integrated Practice Units should be promoted when you are aware that for certain groups of patients the new structures will offer services most appropriate to their needs, the clinical outcomes will improve, and that all this will occur at reasonable or even lower costs, when compared to the current organizational model.

Jordi Varela


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