Working together to improve the care of older people: A new framework for collaboration

Aim: This paper is a report of a study identifying the care issues experiencedby older people in the acute setting that could be improved through acollaborative approach to action.

Background: Actively involving consumers in thegovernance of healthcare organizations is viewed positively, although there isless agreement on how to do this. Co-operative inquiry is a useful approach toinvolve consumers and clinicians in structured dialogue about understanding andchanging care, whereas traditional quality improvement methodologies are oftensingular in their dimensions of change.

Method: Using a co-operative inquiry approach, five workshops were facilitatedover a 4-month period in 2008 with four volunteer older people, four cliniciansand three facilitators (n-=-11). All participants were actively involved ingenerating ideas and actions using a range of facilitation techniques and datacollection methods.

Findings: There was increased awareness, understanding and acceptance ofclinicians' and consumers' experiences and expectations of care. The complexitybehind changing so-called simple care (providing warm drinks, appetizing food),which were the key concerns for consumers, relied on the active management andbroader transformation of the system, including teamwork, communicationprocesses and organizational and individual values and beliefs.

Conclusion: Consumers and clinicians put differentemphasis on perspectives related to improving care of older people in the acutehospital setting. The disconnect between what consumers viewed as 'simple'organizational behaviours to change and what the clinicians viewed as complex,led to a recognition that the approach to organizational change needs to bereconceptualized.