Guiding principles including strategies, contexts and mechanisms underlying collaboration to improve pharmaceutical care
| Guiding principles: specific strategies per guiding principle | Enabling (+) or constraining (−) contextual factors that influence the likelihood of guiding principles to be effective | Mechanisms by which these guiding principles operate |
|---|---|---|
| 1. Create agreement and commitment based on a long-term vision | ||
| a. Engage a small number of stakeholders within the care domain | + Prior mono-disciplinary approaches with little effect on improving pharmaceutical care | Induces a sense of urgency to work together to achieve improvements on pharmaceutical care |
| + Dissatisfaction with competition among care providers in regional market | Induces readiness for multidisciplinary approach in the regional market based on a long-term vision | |
| b. Facilitate joint development of a business plan pharmaceutical substitution | + Increased pressure based on a growing sense of urgency to improve inefficient pharmaceutical care | Induces feelings of problem ownership |
| − Internal organizational matters such as reorganizations, reallocation of capacity | Consideration of substantive, strategic and financial arguments whether to agree and commit to a small-scale project Balancing the degree of importance with regard to agreement and commitment to pharmaceutical substitution | |
| 2. Foster cooperation and representation at board level | ||
| a. Create opportunities that will stimulate multidisciplinary collaboration to improve pharmaceutical care | + Introduction of shared savings: awaiting positive results | Generates safety to show that interdisciplinary cooperation works Generates safeguarding of a financial buffer for future projects Generates motivation to put PHM initiatives “on the map” |
| b. Install the right people at the right time in the right place | + or − Representation of pharmacists on the board level – or in a legal entity or steering group/project group pharmaceutical care | Representation of pharmacists on the board level or regional legal entity generates safeguarding of more involvement in other projects and in the development of pharmaceutical policy in the region Representation of pharmacists in a separate pharmaceutical steering committee/project group or legal entity generates safeguarding of more investment of time and more in-depth pharmaceutical knowledge |
| 3. Use the layered governance structure | ||
| a. Conscious use of information within the layered governance structure for escalation and facilitation purposes | + Need to solve problems that hinder the progress of the pharmaceutical project | Generates commitment to modify behavior and working processes in line with the agreed upon protocol |
| b. Conscious use of skills and influencing power of PHM managers and experts within the layered governance structure for escalation and facilitation purposes | + History of working together | Generates motivation to modify behavior without harming working relationship |
| + Differences in interests and commitment | Generates feeling of insight into differences in interest and commitment Generates confidence in launching off the pharmaceutical project | |
| 4. Create awareness at all levels | ||
| a. Organize informed interaction and communication | + Development of a toolkit pharmaceutical care – pharmaceutical formulary using data | Generates reconsideration of pharmacotherapies Generates taking into account different medical guidelines Generates adapting to a new structured way of working in accordance with the jointly developed pharmaceutical protocol |
| b. Stay in line with/make use of existing consultation situations between medical specialists, general practitioners, pharmacists, physician assistants and patients | + Pre-existing quality of consultations between medical specialist, general practitioners, pharmacists, physician assistants and patients | Induces a safe situation for confrontation and awareness |
| c. Develop patient information and/or make it available to patients | Induces awareness Generates reduction of mistrust regarding new drug efficacy | |
| 5. Enable interpersonal links at all levels | ||
| a. Join existing consultation situations between professionals | + Increasing collaboration within primary care and between primary and secondary care | Induces trust, recognition and acknowledgment of each other’s contribution and (scientific) knowledge brought into the project to improve pharmaceutical care |
| b. Organize regional multidisciplinary meetings to share best practices/pharmaceutical protocol | ||
| c. Invest in relationships between different professions | ||
| 6. Create a learning environment | ||
| a. Organize adequate data input and tool development | + or − At the start of the project, decisions made within the patient-doctor relationship were based on lack of the right information (quality, timing and level of feedback of the data) | Influences motivation of professionals to engage in the feedback loop |
| b. Create capacity and knowledge regarding data technology, analysis and synthesis to support the plan-do-check-act cycle | + or − At the start of the project, insufficient capacity and knowledge regarding data technology, and analysis and synthesis of data | Induces pressure to establish either internal or external (organizations outside the population health management initiative) capacity and knowledge |
| 7. Organize shared responsibility | ||
| a. Organize new incentive design fitting regional multidisciplinary responsibility | + Separate financial incentives did not fit the new regional agreement on multidisciplinary responsibility to improve pharmaceutical care + A growing sense of urgency to improve inefficient pharmaceutical care + Expectation that shared savings prevent shifts in responsibility − Differences between professionals and organizations regarding the design of the accountability model | Induces exploration mechanisms with regard to new incentive designs taking into account differences in cut of values and scores, setting benchmark etc |
| b. Organize an adherence design strongly based on social forces (peer reviewing in a multidisciplinary context) | + Dissatisfaction with historically higher % prescription expensive drugs and mono-disciplinary responsibility +Positive experiences with the plan-do-check-act cycle | Induces a shift to multidisciplinary accountability resulting in higher market mobilization than mono-disciplinary accountability Induces a strong motivation for achieving better integrated performance |
| 8. Adjust financial strategies to the market context | ||
| a. Take into account market factors and trends regarding pharmaceutical products in the regional market | + Market situation of pharmaceutical products differ for specific populations | Induces focus on efficiency and/or quality in order to influence price fixing |
| b. Organize financial insight ranging from an individual to a regional level | + Strive for optimization of care conform accountable care principles better health, quality of care and reduction of costs growth | Induces deliberate use of financial outcomes and combining this data with clinical data and patient preferences |
| 9. Organize mutual gains | ||
| a. Focus on low-hanging fruit’ to gain quick wins | + Discussions in society at large (among others discussions about the bonus culture of banks and the influences op the pharmaceutical industry) | Induces focus on distribution of gains |
| b. Put population health management initiatives “on the map” | + Pressure within the population health management initiative to work toward a comprehensive regional program | Induces focus on achieving quick wins |
| 10. Align regional agreements with national policies and regulations | ||
| a. Indicate at the earliest possible moment where existing policies and regulations pinches implementation of new regional agreement | − The preferential policy of the health care insurers | Experiencing risk factors both at the level of the treatment relationship and at the level of the population health management initiative itself |
| − Existing walls between sectors and disciplines regarding funding systems | Induces unraveling of multidisciplinary agreements to meet current funding system | |
| b. Pursue freedom of contracting by health care insurers | − Regulations regarding contracting by health care insurers | Wish for clarity or “a go” of the non-preferred health care insurer to follow the contract of the preferred health care insurer at the earliest possible stage of the development of the regional agreements |
| Guiding principles: specific strategies per guiding principle | Enabling (+) or constraining (−) contextual factors that influence the likelihood of guiding principles to be effective | Mechanisms by which these guiding principles operate |
|---|---|---|
| a. Engage a small number of stakeholders within the care domain | + Prior mono-disciplinary approaches with little effect on improving pharmaceutical care | Induces a sense of urgency to work together to achieve improvements on pharmaceutical care |
| + Dissatisfaction with competition among care providers in regional market | Induces readiness for multidisciplinary approach in the regional market based on a long-term vision | |
| b. Facilitate joint development of a business plan pharmaceutical substitution | + Increased pressure based on a growing sense of urgency to improve inefficient pharmaceutical care | Induces feelings of problem ownership |
| − Internal organizational matters such as reorganizations, reallocation of capacity | Consideration of substantive, strategic and financial arguments whether to agree and commit to a small-scale project | |
| a. Create opportunities that will stimulate multidisciplinary collaboration to improve pharmaceutical care | + Introduction of shared savings: awaiting positive results | Generates safety to show that interdisciplinary cooperation works |
| b. Install the right people at the right time in the right place | + or − Representation of pharmacists on the board level – or in a legal entity or steering group/project group pharmaceutical care | Representation of pharmacists on the board level or regional legal entity generates safeguarding of more involvement in other projects and in the development of pharmaceutical policy in the region |
| a. Conscious use of information within the layered governance structure for escalation and facilitation purposes | + Need to solve problems that hinder the progress of the pharmaceutical project | Generates commitment to modify behavior and working processes in line with the agreed upon protocol |
| b. Conscious use of skills and influencing power of PHM managers and experts within the layered governance structure for escalation and facilitation purposes | + History of working together | Generates motivation to modify behavior without harming working relationship |
| + Differences in interests and commitment | Generates feeling of insight into differences in interest and commitment | |
| a. Organize informed interaction and communication | + Development of a toolkit pharmaceutical care – pharmaceutical formulary using data | Generates reconsideration of pharmacotherapies |
| b. Stay in line with/make use of existing consultation situations between medical specialists, general practitioners, pharmacists, physician assistants and patients | + Pre-existing quality of consultations between medical specialist, general practitioners, pharmacists, physician assistants and patients | Induces a safe situation for confrontation and awareness |
| c. Develop patient information and/or make it available to patients | Induces awareness | |
| a. Join existing consultation situations between professionals | + Increasing collaboration within primary care and between primary and secondary care | Induces trust, recognition and acknowledgment of each other’s contribution and (scientific) knowledge brought into the project to improve pharmaceutical care |
| b. Organize regional multidisciplinary meetings to share best practices/pharmaceutical protocol | ||
| c. Invest in relationships between different professions | ||
| a. Organize adequate data input and tool development | + or − At the start of the project, decisions made within the patient-doctor relationship were based on lack of the right information (quality, timing and level of feedback of the data) | Influences motivation of professionals to engage in the feedback loop |
| b. Create capacity and knowledge regarding data technology, analysis and synthesis to support the plan-do-check-act cycle | + or − At the start of the project, insufficient capacity and knowledge regarding data technology, and analysis and synthesis of data | Induces pressure to establish either internal or external (organizations outside the population health management initiative) capacity and knowledge |
| a. Organize new incentive design fitting regional multidisciplinary responsibility | + Separate financial incentives did not fit the new regional agreement on multidisciplinary responsibility to improve pharmaceutical care | Induces exploration mechanisms with regard to new incentive designs taking into account differences in cut of values and scores, setting benchmark etc |
| b. Organize an adherence design strongly based on social forces (peer reviewing in a multidisciplinary context) | + Dissatisfaction with historically higher % prescription expensive drugs and mono-disciplinary responsibility | Induces a shift to multidisciplinary accountability resulting in higher market mobilization than mono-disciplinary accountability |
| a. Take into account market factors and trends regarding pharmaceutical products in the regional market | + Market situation of pharmaceutical products differ for specific populations | Induces focus on efficiency and/or quality in order to influence price fixing |
| b. Organize financial insight ranging from an individual to a regional level | + Strive for optimization of care conform accountable care principles better health, quality of care and reduction of costs growth | Induces deliberate use of financial outcomes and combining this data with clinical data and patient preferences |
| a. Focus on low-hanging fruit’ to gain quick wins | + Discussions in society at large (among others discussions about the bonus culture of banks and the influences op the pharmaceutical industry) | Induces focus on distribution of gains |
| b. Put population health management initiatives “on the map” | + Pressure within the population health management initiative to work toward a comprehensive regional program | Induces focus on achieving quick wins |
| a. Indicate at the earliest possible moment where existing policies and regulations pinches implementation of new regional agreement | − The preferential policy of the health care insurers | Experiencing risk factors both at the level of the treatment relationship and at the level of the population health management initiative itself |
| − Existing walls between sectors and disciplines regarding funding systems | Induces unraveling of multidisciplinary agreements to meet current funding system | |
| b. Pursue freedom of contracting by health care insurers | − Regulations regarding contracting by health care insurers | Wish for clarity or “a go” of the non-preferred health care insurer to follow the contract of the preferred health care insurer at the earliest possible stage of the development of the regional agreements |
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