SQC – Sustainable Quality Coordination: How to Coordinate Governance of Social Services and Health Care for Frail Older Persons

Background

Given the vertical centralization and regulatory reforms of the last decade, the results contribute with new knowledge about sustainable strategic coordination for quality in the governance of social services and healthcare for frail older persons.

Method

The fieldwork included an interview study with stakeholders, a survey in 2019 of the impact of policy change on the collaboration in strategic coordination bodies for older persons compared with 2015, and aggregated register data on coordinated quality 2010-19 and deceased in covid19 in 2020, and the coordination bodies' protocols 2019-22.

Results

The interview study indicated that the vertical restructuring of coordination for older people via market, regulated networks and hierarchy constituted a paradox, as the stakeholders demanded simultaneous centralization and decentralization. The policy change study contributes theoretically with a novel framework for public sector coordination, and empirically with a model for functioning coordination governance on a scale, the Governance of Integrating Care Services Scale (GICS) as well as scales that measure the presence of external and internal political and administrative control and review in the coordination body.

However, external accountability has only been implemented and adapted indirectly: the more external scrutiny, the more internal political check. Instead, the sustainability of collaboration is based unabated on the body's internal administrative check.

Stability over time is particularly noticeable among larger bodies (size): the more internal check, the more effective the coordination governance. What seems to distinguish those who are more successful is that they have since long specialized in coordinating care to older people (time) and have not broadened their assignments to include other groups with complex needs for which the public services are also responsible (scope).

Registry data showed no correlation between the pre-pandemic coordination and covid19 deaths in 2020. However, due to an increased proportion of unplanned hospital readmissions within 30 days among multi-sick and frail older people, quality had generally decreased before the pandemic.

Yet, systematic regional correlation between quality and cooperation capacity due to size, focus and time, make them important keys to the quality improvements required to reduce unplanned readmission levels, and increase health and social equity.