Cooperation in Care: Integration of care in networks by steering, coordination and learning

Integration of care delivery is a central theme in many Western countries. This is stimulated through various developments in health care and expectations of policy makers, managers, practitioners and researchers. First of all healthcare needs are changing and costs are rising because of an ageing population. Until 2010 major increases (25-60%) are expected in different forms of cancer, cardio-vascular disease (for example stroke), chronic heart failure, diabetes, dementia, asthma, chronic obstructive pulmonary disease, and muscoloskeletal disorders [1]. In general, these are chronic conditions resulting in disabilities influencing daily activities of living. That is why it is said a different organisation of care is needed in which prevention, cure, long-term care and social services are integrated [2] [3]. Secondly, not only needs are changing but also demands. Patients are becoming clients who expect value for money. According to policy advisers patients will demand more, better, faster and coordinated care [1]. Thirdly, it is said that perspectives in health care are broadening from a biological medical model of diagnosis and treatment towards a bio-psycho-social model with a more holistic view of the patient [1] [4]. Patient care is therefore no longer based on ad hoc encounters with individual care professionals but on multi-professional teamwork, usually with professionals working for different care organisations [5] [6]. Furthermore, because of technical innovations there are increasing possibilities to organise specialist care outside the hospital [7]. This also implies that professionals in hospitals need to cooperate more with professionals in other settings. Last but not least, there is increasing scientific evidence suggesting that better coordinated care leads to more effective and efficient care [3] [8].

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