Addressing integration in the organization of palliative care in Belgium: a multilevel ecosystems approach using the analytic hierarchy process (AHP) method
Abstract Background Palliative care is becoming an essential component of healthcare, but there is insufficient research on how integration across different levels of care (micro, meso, and macro) is realized in practice. Without such integration, care may become fragmented, leading to suboptimal pa...
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| Format: | Article |
| Language: | English |
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BMC
2024-10-01
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| Series: | BMC Palliative Care |
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| Online Access: | https://doi.org/10.1186/s12904-024-01585-2 |
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| author | Melissa De Regge Paul Gemmel Leen Ackaert Let Dillen Peter Pype Nele Van Den Noortgate Bert Meijboom Kristof Eeckloo |
| author_facet | Melissa De Regge Paul Gemmel Leen Ackaert Let Dillen Peter Pype Nele Van Den Noortgate Bert Meijboom Kristof Eeckloo |
| author_sort | Melissa De Regge |
| collection | DOAJ |
| description | Abstract Background Palliative care is becoming an essential component of healthcare, but there is insufficient research on how integration across different levels of care (micro, meso, and macro) is realized in practice. Without such integration, care may become fragmented, leading to suboptimal patient outcomes. While many studies have explored palliative care models, there is a gap in understanding how priorities for integrated care align across these levels within healthcare ecosystems. Specifically, it is unclear whether key actions at each level are shared, coordinated, and supported effectively, making it difficult to implement sustainable, cohesive care strategies. Our study aims to explore the extent to which important goals (i.e., priorities) are shared across the micro, meso, and macro levels of the palliative care ecosystem in Flanders, Belgium. Methods We applied a multimethod study using the analytic hierarchy process method (AHP). This consists of three sequential steps: a broad literature search and interviews with Belgian stakeholders (n = 12) to determine the criteria for the organization of integrated care; focus groups (n = 8) with patients, their relatives and caregivers to establish the completeness and relevance of the criteria; and prioritization of the criteria using a questionnaire among 305 Flemish participants (patients, relatives, caregivers and policy makers). Results Our findings revealed that integration is imbalanced, with priorities being most emphasized at the micro level (57%), followed by the meso (29%) and macro (14%) level. Functional enablers dominate at the macro (80%) and meso organizational level (67%), while normative enablers are emphasized at the meso professional (67%) and micro level (75%). Effective palliative care requires vertical coordination of these enablers: for instance, transparent communication with patients at the micro level depends on cross-organizational information exchange at the meso level, supported by a unified data system at the macro level. Conclusion Achieving integrated palliative care requires deliberate alignment of priorities across all levels of the ecosystem. While each level plays a unique role, palliative care is comprehensive and effective only by sharing both functional and normative enablers across micro, meso, and macro level. |
| format | Article |
| id | doaj-art-f24e7a6b541d43308345e0ec1c2b6401 |
| institution | Kabale University |
| issn | 1472-684X |
| language | English |
| publishDate | 2024-10-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Palliative Care |
| spelling | doaj-art-f24e7a6b541d43308345e0ec1c2b64012024-11-17T12:53:46ZengBMCBMC Palliative Care1472-684X2024-10-0123111910.1186/s12904-024-01585-2Addressing integration in the organization of palliative care in Belgium: a multilevel ecosystems approach using the analytic hierarchy process (AHP) methodMelissa De Regge0Paul Gemmel1Leen Ackaert2Let Dillen3Peter Pype4Nele Van Den Noortgate5Bert Meijboom6Kristof Eeckloo7Department of Marketing, Innovation and Organization, Faculty of Economics and Business Administration, Ghent UniversityDepartment of Marketing, Innovation and Organization, Faculty of Economics and Business Administration, Ghent UniversityDepartment of Marketing, Innovation and Organization, Faculty of Economics and Business Administration, Ghent UniversityDepartment of Geriatrics and Palliative Medicine, University Hospital GhentDepartement of Public Health and Primary Care Department, Faculty of Medicine and Health Care, University of GhentDepartment of Geriatrics and Palliative Medicine, University Hospital GhentDepartment Tranzo, Tilburg UniversityStrategic Policy Unit, University Hospital GhentAbstract Background Palliative care is becoming an essential component of healthcare, but there is insufficient research on how integration across different levels of care (micro, meso, and macro) is realized in practice. Without such integration, care may become fragmented, leading to suboptimal patient outcomes. While many studies have explored palliative care models, there is a gap in understanding how priorities for integrated care align across these levels within healthcare ecosystems. Specifically, it is unclear whether key actions at each level are shared, coordinated, and supported effectively, making it difficult to implement sustainable, cohesive care strategies. Our study aims to explore the extent to which important goals (i.e., priorities) are shared across the micro, meso, and macro levels of the palliative care ecosystem in Flanders, Belgium. Methods We applied a multimethod study using the analytic hierarchy process method (AHP). This consists of three sequential steps: a broad literature search and interviews with Belgian stakeholders (n = 12) to determine the criteria for the organization of integrated care; focus groups (n = 8) with patients, their relatives and caregivers to establish the completeness and relevance of the criteria; and prioritization of the criteria using a questionnaire among 305 Flemish participants (patients, relatives, caregivers and policy makers). Results Our findings revealed that integration is imbalanced, with priorities being most emphasized at the micro level (57%), followed by the meso (29%) and macro (14%) level. Functional enablers dominate at the macro (80%) and meso organizational level (67%), while normative enablers are emphasized at the meso professional (67%) and micro level (75%). Effective palliative care requires vertical coordination of these enablers: for instance, transparent communication with patients at the micro level depends on cross-organizational information exchange at the meso level, supported by a unified data system at the macro level. Conclusion Achieving integrated palliative care requires deliberate alignment of priorities across all levels of the ecosystem. While each level plays a unique role, palliative care is comprehensive and effective only by sharing both functional and normative enablers across micro, meso, and macro level.https://doi.org/10.1186/s12904-024-01585-2Palliative careEcosystemIntegrated careAnalytic hierarchy process (AHP) method |
| spellingShingle | Melissa De Regge Paul Gemmel Leen Ackaert Let Dillen Peter Pype Nele Van Den Noortgate Bert Meijboom Kristof Eeckloo Addressing integration in the organization of palliative care in Belgium: a multilevel ecosystems approach using the analytic hierarchy process (AHP) method BMC Palliative Care Palliative care Ecosystem Integrated care Analytic hierarchy process (AHP) method |
| title | Addressing integration in the organization of palliative care in Belgium: a multilevel ecosystems approach using the analytic hierarchy process (AHP) method |
| title_full | Addressing integration in the organization of palliative care in Belgium: a multilevel ecosystems approach using the analytic hierarchy process (AHP) method |
| title_fullStr | Addressing integration in the organization of palliative care in Belgium: a multilevel ecosystems approach using the analytic hierarchy process (AHP) method |
| title_full_unstemmed | Addressing integration in the organization of palliative care in Belgium: a multilevel ecosystems approach using the analytic hierarchy process (AHP) method |
| title_short | Addressing integration in the organization of palliative care in Belgium: a multilevel ecosystems approach using the analytic hierarchy process (AHP) method |
| title_sort | addressing integration in the organization of palliative care in belgium a multilevel ecosystems approach using the analytic hierarchy process ahp method |
| topic | Palliative care Ecosystem Integrated care Analytic hierarchy process (AHP) method |
| url | https://doi.org/10.1186/s12904-024-01585-2 |
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