Organisational Structures
Specialised Case or Care Management Centres
access points (referral, counselling, one-stop-shops)
COUNTRY / LOCATION: Switzerland
Keywords: Network, patient orientation, multidisciplinary work, care coordination,
Keywords: Network, patient orientation, multidisciplinary work, care coordination,
Local Integrated Delivery Networks – L’Association “Réseau de la communauté sanitaire de la région lausannoise” (ARCOS)
Summary
The Swiss French-speaking canton of Vaud with its capital Lausanne is divided into four Local Integrated Delivery Networks that correspond to four sanitary regions. Based on the example of the Lausanne region, where the local care network proved to enhance outcomes at the interface between health and social care providers, the cantonal authorities decided to extend the approach to the whole canton.
The networks aim to facilitate multi-professional and inter-agency coordination. One central office for information and orientation as well as liaison nurses act as interfaces to limit gaps between provider organisations within each network. They are also responsible for the coordination between different kinds of services, such as acute care hospitals, home care organisations and care homes as well as intermediate care facilities and rehabilitation services. ARCOS is the network of the Lausanne region. It is an example of a local structure, originally set up by local authorities, which then expanded.
What is the main benefit for people in need of care and/or carers?
The main benefit of this structure is to ensure a better coordination between care organisations to improve the transfer of patients/users along the chain of care.
What is the main message for practice and/or policy in relation to this sub-theme?
The goals of these four networks are to improve collaboration across care providers and to create a public health organisation for all patients of acute, rehabilitation and long term care of the canton.
Why was this example implemented?
The first step of ARCOS was set up in the middle of the nineties. It was developed thanks to a collaboration between the cantonal public health services and the cantonal home care organisation. Its goal was to limit the number of patients in overcrowded hospital emergency wards and to ensure a faster transfer of patients to care institutions services that better responded to their needs. In the meantime, the network system has become a key instrument of the cantonal long term care governance.
In 1998, the canton adopted the ‘New orientations of health policy’ (NOPS) that required the creation of broad regional care networks to ensure better coordination within the LTC system of care. In 2007, the new cantonal law on care networks stipulated that it is compulsory for every care institution subsidised by the canton to take part in one of the four created local networks. The objectives of ARCOS are to promote home care, to limit unnecessary hospitalisations and to improve coordination within the network. It is also to orientate patients and organise their discharge and to improve coordination of care and orientation of users in the health system. Finally, the network aims at promoting inter-institutional collaboration at regional level and at advising the cantonal department on care policy.
Description
ARCOS has the legal status of an association and is promoted by its members (acute care and rehabilitation services, care homes, home care organisations, GPs and districts). Each member group is represented in the governing committee of the association. At individual level, monitoring is ensured across care chains by psychiatric, psycho-geriatric, geriatric services and offices for information and orientation. At the administrative level, there are four skill groups within the network: the project director, a reference group, project teams and project managers.
As all other networks, ARCOS operates as a central office for information and orientation, especially addressed to the care professionals. The liaison nurses of ARCOS have a central role in the network. Some of them work from acute care hospitals and follow patients on the administrative level to ensure pathways. They are in charge of the patients’ discharge management. Other liaison nurses are working directly from the central office with the task of organising the flow of patients, e.g. looking for a vacant place in a nursing home. Their work is based on centralised information about movements of patients/users and available services within the network.
ARCOS is financed by the cantonal public health service and its members. Specifically, the central office for information and orientation is financed by the state (40%), hospitals (42%), nursing homes (12%) and home care services (6%). Cantonal authorities participate by funding operating costs. The federal financing also covers costs for the participation of the network in cantonal programs (e.g. palliative care, HPCI – hygiene, prevention and infections) or specific projects.
What are/were the effects?
Local Integrated Delivery Networks enable the integration of long term care on a systemic level to be addressed and provide better coordination between services and institutions. The example of ARCOS shows that a better integration of services within the care system facilitates cooperation between several stakeholders to improve the structural and procedural organisation of patient pathways across the chain of care, and to assess patient needs according to priorities in a context of a shortage of places in residential care. According to the Director of ARCOS, the liaison nurses make it possible to anticipate discharge of patients, which helps to avoid an increased hospital stay that may be induced by conditions deteriorating. However, no figure is available to prove this.
According to ARCOS, tangible collaboration between members of different services facilitates cooperation and care management on a structural level. This includes managing the lack of available places, creating devices such as global geriatric assessments, aiming at better orientation of patients with complex needs and enhancing fluid discharge management also during weekends, etc (see Activity Report 2009). Mobile teams intervene within the health district as a support for the network. Their aims are to avoid hospitalisations (in particular concerning geronto-psychiatric facilities), to ensure a good transition from hospital to home (concerning adult psychiatry) and to support professional action concerning palliative care.
ARCOS is a sustainable structure as it is an integral part of the LTC organisation on a cantonal level, based on a sound legal framework. While similar initiatives aiming at strengthening cooperation between care facilities in LTC have also been developed in other cantons, the macro-structure created in the canton of Vaud is still unique in Switzerland.
What are the strengths and limitations?
Strengths
- The example of ARCOS is a well-developed network at the institutional level. It helps care services to communicate and to organise the chain of long term care on an administrative level.
Weaknesses
- Ensuring the participation of all members of the network seems to be difficult. For example, the concrete investment of GPs in the common effort of cooperation is limited.
- Interest groups such as associations of professionals, families and patients, as well as volunteer organisations are not represented in the network.
- Moreover, integration of care in the field requires time, a high degree of willingness from professionals to collaborate, and a structure that offers this possibility. The concrete improvement of patients in the field and within integration of services at the individual level can seem more difficult for a wide network than for a more micro regional network.
Opportunities
- The creation of the status of liaison nurses is a step towards a recognition of the work that integration needs.
- According to the model, patients are free to accept whether they want to enter a proposed nursing home within the network.
Threats
- The scarcity of beds compared with the high level of needs tends to limit choice. When a bed is free, the patient has often a limited “choice” to take it or simply not to get a place at all.
Credits
Author: Marion Repetti, Haute Ecole de Travail Social et de la Santé Vaud, http://www.eesp.ch/Reviewer 1: Patrizia Di Santo
Reviewer 2: Kai Leichsenring
Verified by: Dominique Hude, Director of ARCOS, http://www.arcosvd.ch/
Links to other INTERLINKS practice examples
- Coordinating Care for Older People (COPA): Team work integrating health and social care professionals in community care
- Follow-up home visits after discharge from hospital
External Links and References
- ARCOS. (2010) Rapport annuel et statistiques d’activités du BRIO 2009.
- Association "Réseau de la communauté sanitaire de la région lausannoise".
- Bureau régional d'information, d'orientation et de liaison du réseau ARCOS.
- Canton de Vaud. (2010). Services de soins. Réseaux de soins. Les réseaux de soins du canton de Vaud.
- Centre hospitalier universitaire vaudois (CHUV). (2010). Service de gériatrie. Infirmier(ère)s de liaison.
- Nouvelles orientations de politique sanitaire. L’équipe de projet présente les NOPS.
Legal framework
- Law of the 30th January 2007 on The Care Networks, Canton of Vaud
