bluuebunny/crossref_metadata_2025_split huggingface dataset:
From qualitative reflection to reflexive quality: an intersectoral approach to quality of care
Authors: Boxstaens Johan 
Published: January 2024

Background: All over the continent, organizations in healthcare and welfare are increasingly being challenged to be transparent about what they are doing and to provide evidence regarding the results they achieve. Some organizations choose to develop policy and practice based on a variety of indicators and strictly scientifically based criteria. In this perspective, quality of care is measured against the background of those standardized indicators. Other organizations consider care as a craft or even an art which is impossible to capture in strictly standardized norms and indicators. In such organizations, scientific knowledge is often seen as subordinate to the experiential knowledge of service users and practical knowledge of staff members. Hence, quality of care is measured by – amongst other things – proximity and involvement with service users.
Within Emmaüs vzw, an organization that overarches a variety of facilities in the fields of healthcare and welfare in Belgium, forces were joined to develop a new framework for quality of care in which an effort is made to transcend the contradiction that is outlined above. In order to do so, the experiential knowledge of service users, the practical knowledge of staff and research based knowledge were combined and considered to be equally valuable in tackling issues regarding quality of care.
The project: Building on participatory action research with service users, their social context, staff members, policy makers and academics, we co-constructed a value-driven and intersectoral framework for quality of care that is underpinned by rhizome theory (Guattari & Deleuze, 2014). The ecological approach to quality of care entails an effort to capture and do right by the complexity that characterizes the fields of care and welfare. Furthermore, we connected the concepts of quality and reflexivity in a meta-model that can be used to fuel quality improvement across healthcare en welfare organizations. In our project, service users and staff were involved as respondents and as co-researchers. We use the CAIMeR theory (Blom & Morèn, 2010) as an analytical framework to describe processes of change and to capture effective practice. Although the project is still ongoing, our research shows that the intersectoral framework is widely accepted across organizations in youth care, mental healthcare, elderly care and support of people with disability. Recently also a general hospital expressed their interest in our intersectoral framework and reflexive meta-model.
Presentation: We will present the highlights of our co-constructed framework for quality of care and the reflexive meta-model that is currently piloted in different organizations.
Learning objectives: After this session, participants will be able to:

Understand how participatory action research can help further policy and practice on quality of care across healthcare and welfare organizations.
Understand how the reflexive meta-model we developed can be used in practice.
Barriers and facilitators of the built environment towards social participation, mental and physical health outcomes among seniors residing in a low-income urban community in Singapore: A qualitative study.
Authors: Chua Alyssa Marion 
Published: January 2024

Background and Introduction: Health is complex and multifaceted, comprising domains including but not limited to physical, mental, and psychological health. While the built environment has proven to influence these domains, literature is still lacking in studying the effect of the built environment on social participation, as well as its influence on health outcomes in Singapore’s local context. Given the nation’s rapidly ageing population, rising chronic conditions and increased load in the provision of care, there is an urgent need for effective solutions to improve health. In particular, the built environment holds great potential, offering an opportunity for simple, tangible, and long-lasting interventions.
Objective: This study aims to identify the barriers and facilitators of the built environment, both tangible and non-tangible, that limited or facilitated social participation in communal activities among seniors residing in a low-income urban community in Singapore.
Methods: Photovoice go-along interviews were conducted in addition to semi-structured sit-down interviews with 25 seniors aged 65 and above residing in a low-income urbanised community, Marine Parade. Participants took the interviewer on a journey through their neighbourhood with polaroid cameras, then using the instant photographs, spoke of their thoughts and shared stories related to the aim of study. These interviews focused on elucidating the aspects of the built environment, both tangible and non-tangible, that limited or facilitated social participation and ultimately mental well-being, and physical health outcomes. All in-depth interviews were audiotaped, transcribed, and uploaded into the qualitative software NVivo, and responses were coded with theoretical and emergent themes regarding participants’ perceptions of the built environment. Key conceptual categories were constantly refined until a saturation of categories informed a framework outlining the aspects of the built environment that impacted health outcomes.
Findings: Collectively, 106 categories and 18 broader themes emerged. These preliminary themes reflected concerns of mobility as well as convenience, circulation, visibility, recognisability, and peacefulness of the space. Ideas were shared about how to improve the safety of pathways and routes, linkages to transportation as well as how to leverage on existing unused space to encourage social interaction.
Implications on Ageing and Gerontology: Understanding how the built environment influences social participation could be key to changing health outcomes. As we grow into a Super-Aged Society, we hope to harness the full potential of the built environment towards independent and joyful ageing.
Attentive visitors: developing a training program to support community-based volunteers in their palliative care signposting role
Authors: Van Steenbergen Sabet , Vanderstichelen Steven , Statema Else Given , Deliens Luc , Dury Sarah , Chambaere Kenneth 
Published: January 2024

Background: Community volunteers often notice palliative care (PC) needs that healthcare professionals (HCP) and family caregivers miss, potentially playing an important signposting role. In order to fulfill this role, volunteers need knowledge about PC needs and community resources; and they should have good relational, communication and observation skills. These skills and knowledge can be enhanced through training.
Aims: To develop a training program to support community homecare volunteers in their signposting function.
Methods: Learning objectives were formulated based on the results of a qualitative study in which 7 focus groups (15 community volunteers, 20 HCP’s) and 10 in-depth interviews (6 community residents with PC needs, 4 informal caregivers) were conducted. The content and structure of the training were developed in collaboration with a psychologist trainer, stakeholder organizations and community volunteers.
Results: The training program consists of a didactic workshop (5-6 hours) and a follow-up session (2-3 hours) in which reflection, exchange of knowledge/experiences are central. The workshop aims to achieve learning objectives related to increasing awareness and knowledge of the volunteer role and signposting function, PC needs and signals, community resources, communication with the community resident and communication with HCPs. Case discussions, reflection exercises and role plays are used to enhance volunteers' insights and skills related to recognizing, describing, responding to and communicating patient needs to HCPs. During the follow-up session, participants will be invited to share experiences and reflect on what the didactic workshop has meant for their volunteer work since.
Conclusion: The training responds to existing needs in community homecare and tries to strengthen community volunteers in taking up their signposting function. The training program will be piloted and evaluated Fall 2022-Spring 2023.
Funding: Flemish Cancer Fund
Integrated health and social care with a CALD focus: a service mapping study in Sydney Metropolitan
Authors: Uribe Gabriela , Dronavalli Mithilesh , Katz Ilan , Page Andrew , Wolfenden Susan , Gillespie James , Eastwood John , Huckel Schneider Carmen 
Published: January 2024

Background: Underrepresented and underserved communities such as culturally and linguistically diverse (CALD) groups experience higher reported prevalence and severity of multimorbidity along with unmet social needs and disadvantages in accessing services. Minority populations report higher rates of emergency department presentations globally and nationally and it is understood that services are more frequently accessed on consumer initiative when problems become acute and critical, demonstrating significant barriers for early intervention. In Australia, most of the efforts to reduce over-utilisation of emergency care have focused on developing integrated health and social care approaches for the general population. There is little evidence available on how CALD populations are involved in the design and implementation of integrated care health and social care initiatives and how their needs are identified and addressed.
Methods: A service mapping study informing the development of a framework for comparative analysis of integrated health and social care services targeting CALD populations will be sought. Semi-structured interviews, with key stakeholders and decision-makers representing health and social services, as well as document review, will inform the development of a map of integrated health and social care services available for individuals from culturally and linguistically diverse backgrounds. Core defining elements of the mapped services comprise the basis for the framework that enables comparison of level of integration with a CALD focus, including governance and partnerships, health and social care staff, financing and payment systems, and data sharing and use.
Implications: This study will advance the understanding of how integrated health and social care policies (policy learning) and services are conceptualised, developed, and implemented at a local level (policy implementation) to address the needs of CALD populations. and how they can better respond to the health and social needs of CALD consumers.
The role of Hospice Care at the end of life: perspectives from formal and informal caregivers&nbsp;&nbsp;
Authors: Hermans Kirsten , Dierckx Eva , Wagner Ken , Langenaekens Paula , Verbert Lucretia , Cockx Judith , Vandommele Nele , Declercq Anja 
Published: January 2024

Background: Persons nearing the end of life often prefer to die in their familiar surroundings. Dying at home is, however, not always possible, even when the person is supported by a mobile palliative home care team. As the (complex) care needs increase, informal caregivers are required to be available 24 hours a day and take on a significant portion of clinical care. In some cases, no informal caregiver is available or the informal caregiver(s) are overburdened, leading to hospital admission. As it is often not possible to refer these persons to a palliative unit because of the limited number of places available there, forty percent of deaths occur in acute wards in hospitals. These wards are less specialized in palliative care delivery, resulting in an end-of-life care which is not optimally tailored to the needs of the person and his/her caregiver(s). In order to relieve the burden on informal care, to reduce the high mortality rate in acute hospital wards, and to offer better quality palliative care, hospitals and nursing homes started to collaborate in Flanders (Belgium). Two hospices within nursing homes were created: Hospice “Aulighem” and Hospice “De Klaproos”.
We studied the experiences of (1) health care professionals and (2) relatives/informal caregivers of persons nearing the end of life who reside in these 2 hospices.
Methods: A qualitative study was conducted: (1) two focus groups with a total of 17 care professionals of the respective hospices; and (2) ten individual interviews with relatives of persons who stayed in one of the respective hospices during the past year. Information concerning the experienced hospice care in terms of (1) added value and (2) bottlenecks was gathered.
Results: In terms of added value, the following points emerged: the peaceful atmosphere, the "near-home feeling", the continuous proximity of care professionals and/or volunteers, the strong bond of trust between care professionals, residents and loved ones, the interdisciplinarity of the care (psychological, medical, spiritual and social) and the strong focus on the quality of dying and on aftercare.
The main bottleneck is that these types of hospices currently are not officially recognized nor subsidized by government. As a result, hospices sometimes face staff shortages and a lack of resources, and their future is uncertain. Moreover, the cost for the resident is higher than in case of hospitalization.
Conclusion: This study very clearly shows the added value of hospice care, from the perspective of both formal and informal caregivers. However, structural financing is necessary for the continued existence of these types of hospices, and in order to reduce the cost for residents, to recruit the necessary staff and to provide them with the necessary training.
In future research, also the resident’s perspective should be included.
Towards local health system development in Wallonia: experiences with the HSO toolkit for integrated people centred health systems.
Authors: Scholtes Beatrice , Lambert Anne-Sophie , Macq Jean , Herbaux Denis 
Published: January 2024

Since 2008 Belgium has been developing a more integrated care system. Today, the Belgian healthcare system is undergoing significant reform at national and sub-national levels. In primary care, at the federal level, the New Deal for general practice aims to improve the organisation of general practice and a new inter-federal plan for integrated care is currently under development. At the regional level, there are many initiatives. In Wallonia several projects are working towards greater inter-professional collaboration and clear territorial delimitations in order to cater for the needs of local populations in a more integrated fashion.
The project Proxisanté has been exploring the needs of professionals and patients by conducting consultations and workshops with actors within primary care to feed into a decree which will be presented at the end of 2022. Based on the outcome of this process, actions will be undertaken, starting in 2023, to implement this vision and develop a territorial network of local health systems. Our team is responsible for following and supporting this process of implementation by developing a transdisciplinary and innovative bottom-up methodological approach. For this we intend to rely, among other things, on the Integrated People-Centred Health Systems (IPCHS) Standard developed by the Health Standards Organisation (HSO), as well as the various tools created to facilitate the implementation of this standard.
The presentation will describe the preliminary work done to prepare for concrete support for the creation of local networks starting in 2023. Specifically, we will detail the methodology used to identify the priorities that need to be focused on to ensure successful implementation, Finally, we will present the key messages from meetings with different existing subsystems concerning their strengths and weaknesses, and the inspiring practices identified that will allow us to build a regional learning system dynamic.
Building a digital care and support plan: research as a starting point. A session for policymakers.
Authors: Taelman Bert 
Published: January 2024

In 2018, the idea arose of building a digital care and support plan for primary care. The research on life goals and care goals during the COVID years allowed us to clarify informed choices in the ICT specifications and digital development can start in 2023.
The reform of the primary care in Flanders envisioned a digital capstone. Therefore, a business analysis for a digital care and support plan was prepared in 2018. This digital care plan should:
* facilitate goal-oriented and integrated care,
* give individuals with care and support needs control over their care planning, and
* allow care providers to collaborate interdisciplinary and coordinate their care within the care team.
The scope and associated resources were largely lacking at that time, and the subsequent COVID crisis prevented the project from even starting at all.
We used this pause to engage academia. We asked them what goal-oriented care might look like in practice:
* How do you integrate life goals into care planning?
* Can you create links between life goals and care goals?
* In what ways can you link care goals to existing care scales?
The researchers' recommendations to these questions, gave us a clearer view of the possibilities and scope of our project. This information helped us to:
* Write a clearer ICT specification
* Clearly define the functional requirements
* Propose an evidence-based approach to stakeholders
* Prioritize the different digital modules to be developed
* Engaging academics in a technical debate
Do not underestimate the impact of sound research. Do not rush into an ICT project without fundamentally questioning the content and scope of the project. Consult academics who will work out the concepts in a research context with people in the field. Then build on this input.
The inputs from the research questions are currently being used as a starting point for the digital modules on life goals and care goals. These modules are now being further refined with stakeholders and will serve as a starting point for ICT development this year.
TransForm – Integrated Community Care (ICC) from aspiration to reality
Authors: Vandensande Tinne , Ehrenberg Nieves 
Published: January 2024

Introduction: As we face crises after crises (climate, geopolitical, health, financial), each one increasing inequalities and impacting most on people and communities in vulnerable situations, we need to come up with better ways of living and caring for people and the planet. Most challenges we face today are complex and interrelated and to solve them requires participation from communities and citizens.
As part of this, the mere concept of care needs to be redefined towards a social capacity and activity involving the nurturing of all that is necessary for the welfare and flourishing of life. The current system of care was designed in and for the industrial era and it has reached the limits of what it can achieve. Today’s diseases are chronic and complex and require different responses. We need to reimagine and create a system designed for the problems we face today.
Integrated Community Care (ICC) is a concept that has evolved and is based on a range of important innovations and efforts in the field, such as people centred care, community primary care, integrated care, social determinants of health, goal-oriented care, amongst others. ICC acknowledges that each of these, although important, are not enough on their own and brings them together. In ICC, local organizations, community members, professionals, and policy makers come together in a continuous process of co-developing health, care and social support infrastructures to enhance the quality of life, social cohesion and resilience of a territorially defined community. It is not a prescriptive approach, but rather a set of principles that guide a range of existing practices that are changing the way health and care are organised.
Aim: to inspire and better equip policy makers and practitioners to make ICC the new norm by sharing learnings and experiences of the TransForm community, including defining what ICC is, its benefits and demonstrating how to put the theory into practice.
Audience: Citizens, policy makers, practitioners, academics that realise that the multiple crises we face are an opportunity to create something better. It is for anyone seeking for more effective ways to truly care for, about and with people and communities.
Who did we involve and what we did?
Since 2018, through a series of research activities, international conferences, site visits to ICC initiatives, workshops among experts, activities within a Changemakers Forum, TransForm has developed a learning journey (co-production of knowledge with stakeholders – academics, policymakers, decisionmakers, practitioners, people with lived experience, citizens) that has identified key values – ingredients – challenges- for ICC. An important part of this learning journey is the contribution of ICC changemakers, investing in locally anchored innovation and making the difference again and again in the daily lives of people.
What are the next steps? TransForm will create an open-source collection of knowledge on ICC.
Implementation of change management in a large scale interdisciplinary primary care practice: experiences from Menen.
Authors: Depoot Peter 
Published: January 2024

Background: The ongoing process of Change Management Implementation in the Community Health Center of Menen leads to the provision of integrated care more in line with the quintuple aim model.
Abstract: This presentation describes the process of Change Management Implementation in the Community Health Center of Menen, an interdisciplinary primary care practice in a medium size city in the western part of Flanders funded by a needs based capitation model. In the first 5 years of its existence, the organization knew a vast growth, both in the number of patients (2200 to about 6000) as in the number of staff and different disciplines gathered within the center. This continually challenged the team to reorganize care in line with the Quintuple Aim Model.
Based on a diagnosis of the main health problems within the inscribed population, priorities for change management were identified. The team chose to first focus on both diabetes and shoulder/neck complaints, as they make up a big proportion of the provided care. Subsequently, the team implemented (1) a protocolled follow-up of diabetes patients by specialized nurses and (2) the implementation of a curative and preventative interprofessional approach for back problems (“rugschool”) with a central role for high end training machines .
Concerning the first, all type 2 diabetes patients are proactively contacted twice a year to book a consultation with a specialized nurse. The necessary parameters are checked and necessary care is provided. If needed, the patients are referred to other professionals (dietician, physiotherapist, …) within the team or outside the center. Concerning the latter, the center invested in high end training devices that allow for patients to individually follow a customized training program. Individual contact with the team of physiotherapists are additional to the automatized proportion of the training program.
At the microlevel, both change processes contributed to improvement towards more integrated and high level care and were deemed cost efficient. At the microlevel, improvements are observed in patients outcomes and experiences (compliance, motivation,…..). At the mesolevel, the projects lead to a more efficient use of the available work force. At the macro level, the investments within primary care may lead to a societal cost saving (comparing rehabilitation of patient in the center to the regional hospital).