Web-based collaboration in individual care planning challenges the user and the provider roles – toward a power transition in caring relationships

Abstract

Background and objective

The Individual Care Plan (ICP) was introduced in Norway to meet new statutory requirements for user participation in health care planning, incorporating multidisciplinary and cross-sector collaboration. A web-based solution (electronic ICP [e-ICP]) was used to support the planning and documentation. The aim of this study was to investigate how web-based collaboration challenged user and professional roles.

Methods

Data were obtained from 15 semistructured interviews with users and eight with care professionals, and from two focus-group interviews with eight care professionals in total. The data were analyzed using systematic text condensation in a stepwise analysis model.

Results

Users and care professionals took either a proactive or a reluctant role in e-ICP collaboration. Where both user and care professionals were proactive, the pairing helped to ensure that the planning worked well; so did pairings of proactive care professionals and reluctant users. Proactive users paired with reluctant care professionals also made care planning work, thanks to the availability of information and the users’ own capacity or willingness to conduct the planning. Where both parties were reluctant, no planning activities occurred.

Conclusion

Use of the e-ICP challenged the user–professional relationship. In some cases, a power transition took place in the care process, which led to patient empowerment. This knowledge might be used to develop a new understanding of how role function can be challenged when users and care professionals have equal access to health care documentation and planning tools.

Keywords:

• integrated care
• patient participation
• empowerment
• role transition
• system testing
• web-based collaboration
• Norway

Acknowledgments

We thank the participants testing the e-ICP tool, especially the members of the regional project group. The Hospital Trust (CNRHA) represented by the ICT manager, Arild Pedersen, made the project possible and provided additional funding. Thanks are also due to the Masters’ students who participated in the project and to Margaret Forbes for improving the language of the article. Finally, our warm thanks go to Ragnhild Hellesø, the reflective supervisor of the first author.

Disclosure

Jorunn Bjerkan was employed part-time by the Central Norwegian Regional Health Authority (CNRHA) as project manager during testing and implementation of the e-ICP, which was the period of this study. The research and the student’s PhD studies were financed and governed by a university grant. Additional funding was received from the CNRHA and Nord-Trøndelag University College to support preparation of this paper. The authors report no other conflicts of interest in this work.