An investigation of the challenges to coordination at the interface of primary and specialized palliative care services in Switzerland: A qualitative interview study

ABSTRACT

Good coordination of healthcare services is vital for ensuring health cost efficiency and high-quality care for patients. It is especially important in the context of palliative care as services are often highly fragmented due to a combination of diverse professional groups, organizations, and approaches to care. However, the coordination of services in this field is often evaluated as insufficient. Little is known about the challenges to coordination in this sector in Switzerland. The present study addresses this gap in research by investigating the challenges to coordination at the interface of palliative care services in Switzerland. Interviews (n = 24) with 38 healthcare practitioners working in palliative care in four cantons (Basel-City, Lucerne, Ticino, and Vaud) form the basis for this investigation. The selected cantons not only represent French, Italian, and German language regions of Switzerland but also represent diverse rural, urban, and historical contexts. Expert interviews are analyzed using structural content analysis. Three clusters of challenges to coordination were identified in the data: (1) organizational challenges to coordination, which relate to explicit forms of coordination; (2) relational challenges to coordination; and (3) structural challenges to coordination, which relate to implicit forms of coordination. The study reveals a need for better financial support for coordination in palliative care and a stronger focus on interprofessional coordination in educating professionals in palliative care. Future research on how to further foster good team coordination practices between primary and specialized palliative services merits further investigation. Since these findings are indicative of areas for improvement for coordination at the interface of Swiss palliative care services, they are of particular interest for healthcare practitioners, policymakers, and researchers involved in the evolution of coordinative practice.

KEYWORDS:

• Primary palliative care
• specialized palliative care
• care coordination
• integrated care
• Switzerland
• qualitative study

Acknowledgements

The authors wish to thank Mrs. Eveline Degen from the Fachhochschule Nordwestschweiz for her helpful contributions to the research and extend their gratitude to the professionals who took part in this study.

Declaration of interest

The authors declared no conflicts of interest with respect to the research, authorship, or publication of this article.

Additional information

Funding

This research was funded by the Swiss National Science Foundation (SNF), NRP 74 “Smarter Health Care” www.nrp74.ch; Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung.

Notes on contributors

Emily Reeves

Emily Reeves holds a Bachelors of Science degree in Psychology from Queen's University Belfast and a Masters of Science degree in Health Psychology from Kings College London. She is a PhD candidate at the University of Basel, Switzerland at the department of Psychology and an associate researcher on the NRP 74 project: “Smarter Healthcare” (2017-2020, project ID:407440_167345). The project is entitled: “Coordination and collaboration in palliative care: Palliative Care Networks in Switzerland𠇒 and is funded by the Swiss National Science Foundation.

Reka Schweighoffer

Reka Schweighoffer holds a Bachelors of Science degree in Psychology and a Masters of Science degree in Clinical Psychology and Neuroscience from the University of Basel, Switzerland. She is a PhD candidate at the University of Basel at the department of Psychology and an associate researcher on the NRP 74 project: ”Smarter Healthcare“ (2017-2020, project ID: 407440_167345). The project is entitled: Coordination and collaboration in palliative care: palliative care networks in Switzerland” and is funded by the Swiss National Science Foundation.

Brigitte Liebig

Dr. Prof. Brigitte Liebig studied psychology, sociology and anthropology at Goeth University, Frankfurt and completed her Habilitation at the faculty of Philosophy and History at the University of Basel, Switzerland. She is a professor at the School of Applied Psychology at the Fachhochschule Nordwestschweiz (FHNW), Switzerland and teaches privately at the University of Basel's Department of Sociology.  She is the lead of the project “Coordination and collaboration in palliative care: Palliative Care Networks in Switzerland; Swiss National Science foundation (NRP 74, 'Smarter Healthcare' Project ID: 407440_167345).