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IT-supported skill-mix change and standardisation in integrated eyecare: lessons from two screening projects in The
Marleen de Mul1, Antoinette de Bont, Marc Berg
1Institute of Health Policy and Management, Erasmus Medical Centre, Rotterdam, The Netherlands. m.demul@erasmusmc.nl
Introduction:
Information Technology (IT) has the potential to significantly support skill-mix change and, thereby, to improve the efficiency and effectiveness of integrated care.
Theory And Methods:
IT and skill-mix change share an important precondition: the standardisation of work processes. Standardisation plays a crucial role in IT-supported skill-mix change. It is not a matter of more or less standardisation than in the 'old' situation, but about creating an optimal fit. We used qualitative data from our evaluation of two integrated-care projects in Dutch eyecare to identify domains where this fit is important.
Results:
While standardisation was needed to delegate screening tasks from physicians to non-physicians, and to assure the quality of the integrated-care process as a whole, tensions arose in three domains: the performance of clinical tasks, the documentation, and the communication between professionals. Unfunctional standardisation led to dissatisfaction and distrust between the professionals involved in screening.
Discussion And Conclusion:
Although the integration seems promising, much work is needed to ensure a synergistic relationship between skill-mix change and IT. Developing IT-supported skill-mix change by means of standardisation is a matter of tailoring standardisation to fit the situation at hand, while dealing with the local constraints of available technology and organisational context.
