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The individualized service plan as a clinical integration tool: qualitative analysis in the Quebec PRISMA experiment.

Somme D, Hébert R, Bravo G, Blanchard F, Saint-Jean O - Int J Integr Care (2007)

Bottom Line: Case managers felt uncomfortable with the individualized planning task and expected a tool more adapted to their needs.Although a majority of the case managers' charts contained an individualized service plan, implementation of this tool seems tenuous.Because of the discrepancy between the potential usefulness expected by case managers and their actual use, a working committee was created to develop proposals for modifying the instrument.

View Article: PubMed Central - PubMed

Affiliation: Hôpital Européen Georges Pompidou, Service de Gériatrie, Paris, France.

ABSTRACT

Introduction: One aspect of clinical integration involves case managers' tools and particularly the individualized service plan.

Methods: We examined individualized service plan content and use in the PRISMA experiment. We analyzed 50 charts, and conducted and recorded interviews regarding individualized service plan use with all the case managers concerned (n=13).

Results: Delays between starting case management and writing the individualized service plan were long and varied (0-596 days, mean: 117 days). During the interviews, the individualized service plan was described as the 'last step' once the active planning phase was over. The reasons for formulating plans were mainly administrative. From a clinical viewpoint, individualized service plans were used as memoranda and not to describe services (842 interventions not mentioned in the plans) or needs (694 active problems not mentioned). Case managers felt uncomfortable with the individualized planning task and expected a tool more adapted to their needs.

Conclusion: Although a majority of the case managers' charts contained an individualized service plan, implementation of this tool seems tenuous. Because of the discrepancy between the potential usefulness expected by case managers and their actual use, a working committee was created to develop proposals for modifying the instrument.

No MeSH data available.


Illustration of the cognitive ergonomics scheme of analysis 21 compared to a more traditional view.
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fg001: Illustration of the cognitive ergonomics scheme of analysis 21 compared to a more traditional view.

Mentions: Our analysis of the individualized service plan is based on the conceptual framework of cognitive ergonomics [21], where the focus is on the discrepancies between what is prescribed, said, and done. Traditionally, a task has to be performed as prescribed by managers and if this is not the case, a deficiency in training or management must be found. In contrast, cognitive ergonomics research is based on the assumption that users have specific (but not necessarily the best) knowledge on how and why an activity is to be done during their work (Figure 1). Studies in cognitive ergonomics develop an analysis framework to take into account the prescribed task and the performed task. To understand the discrepancies, the performed task has to be assessed in a real situation (not a simulation or a ‘performance’ test), and in parallel an assessment of cognitive activities linked to the task has to be done, usually by users' comments on this task. This approach is pragmatic and aims to develop recommendations that meet both organizational needs and reflect professional reality. In our research on individualized service plans, the prescribed task (case managers have to develop individualized service plans in order to achieve clinical integration) was compared to the task actually performed (individualized service plan production and use) and what the case managers had to say about it (which reflects both their knowledge about the task prescribed and performed, and their expectations). The discrepancies between the task prescribed and performed, and what the case managers had to say are not viewed here as deficiencies. Indeed, as we have said, knowledge about the need for individualized service plans for integration was vague. Accordingly, we will discuss these discrepancies as a source of information about the work done by the case managers related to individualized service plans and as a source of potential information about the usefulness of these plans in terms of integration.


The individualized service plan as a clinical integration tool: qualitative analysis in the Quebec PRISMA experiment.

Somme D, Hébert R, Bravo G, Blanchard F, Saint-Jean O - Int J Integr Care (2007)

Illustration of the cognitive ergonomics scheme of analysis 21 compared to a more traditional view.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2690906&req=5

fg001: Illustration of the cognitive ergonomics scheme of analysis 21 compared to a more traditional view.
Mentions: Our analysis of the individualized service plan is based on the conceptual framework of cognitive ergonomics [21], where the focus is on the discrepancies between what is prescribed, said, and done. Traditionally, a task has to be performed as prescribed by managers and if this is not the case, a deficiency in training or management must be found. In contrast, cognitive ergonomics research is based on the assumption that users have specific (but not necessarily the best) knowledge on how and why an activity is to be done during their work (Figure 1). Studies in cognitive ergonomics develop an analysis framework to take into account the prescribed task and the performed task. To understand the discrepancies, the performed task has to be assessed in a real situation (not a simulation or a ‘performance’ test), and in parallel an assessment of cognitive activities linked to the task has to be done, usually by users' comments on this task. This approach is pragmatic and aims to develop recommendations that meet both organizational needs and reflect professional reality. In our research on individualized service plans, the prescribed task (case managers have to develop individualized service plans in order to achieve clinical integration) was compared to the task actually performed (individualized service plan production and use) and what the case managers had to say about it (which reflects both their knowledge about the task prescribed and performed, and their expectations). The discrepancies between the task prescribed and performed, and what the case managers had to say are not viewed here as deficiencies. Indeed, as we have said, knowledge about the need for individualized service plans for integration was vague. Accordingly, we will discuss these discrepancies as a source of information about the work done by the case managers related to individualized service plans and as a source of potential information about the usefulness of these plans in terms of integration.

Bottom Line: Case managers felt uncomfortable with the individualized planning task and expected a tool more adapted to their needs.Although a majority of the case managers' charts contained an individualized service plan, implementation of this tool seems tenuous.Because of the discrepancy between the potential usefulness expected by case managers and their actual use, a working committee was created to develop proposals for modifying the instrument.

View Article: PubMed Central - PubMed

Affiliation: Hôpital Européen Georges Pompidou, Service de Gériatrie, Paris, France.

ABSTRACT

Introduction: One aspect of clinical integration involves case managers' tools and particularly the individualized service plan.

Methods: We examined individualized service plan content and use in the PRISMA experiment. We analyzed 50 charts, and conducted and recorded interviews regarding individualized service plan use with all the case managers concerned (n=13).

Results: Delays between starting case management and writing the individualized service plan were long and varied (0-596 days, mean: 117 days). During the interviews, the individualized service plan was described as the 'last step' once the active planning phase was over. The reasons for formulating plans were mainly administrative. From a clinical viewpoint, individualized service plans were used as memoranda and not to describe services (842 interventions not mentioned in the plans) or needs (694 active problems not mentioned). Case managers felt uncomfortable with the individualized planning task and expected a tool more adapted to their needs.

Conclusion: Although a majority of the case managers' charts contained an individualized service plan, implementation of this tool seems tenuous. Because of the discrepancy between the potential usefulness expected by case managers and their actual use, a working committee was created to develop proposals for modifying the instrument.

No MeSH data available.