IT-supported skill-mix change and standardisation in integrated eyecare: lessons from two screening projects in The Netherlands

• Main Authors: Marleen de Mul, Antoinette de Bont, Marc Berg
• Format: Article
• Language: English
• Published: Ubiquity Press 2007-05-01
• Series: International Journal of Integrated Care
• Subjects: skill-mix; information technology; standardisation; integrated care; eyecare
• Online Access: http://www.ijic.org/articles/189

<b>Introduction:</b> Information Technology (IT) has the potential to significantly support skill-mix change and, thereby, to improve the efficiency and effectiveness of integrated care.<br><br> <b>Theory and methods:</b> IT and skill-mix change share an important precondition: the standardisation of work processes. Standardisation plays a crucial role in IT-supported skill-mix change. It is not a matter of more or less standardisation than in the ‘old’ situation, but about creating an optimal fit. We used qualitative data from our evaluation of two integrated-care projects in Dutch eyecare to identify domains where this fit is important.<br><br> <b>Results:</b> While standardisation was needed to delegate screening tasks from physicians to non-physicians, and to assure the quality of the integrated-care process as a whole, tensions arose in three domains: the performance of clinical tasks, the documentation, and the communication between professionals. Unfunctional standardisation led to dissatisfaction and distrust between the professionals involved in screening.<br><br> <b>Discussion and conclusion:</b> Although the integration seems promising, much work is needed to ensure a synergistic relationship between skill-mix change and IT. Developing IT-supported skill-mix change by means of standardisation is a matter of tailoring standardisation to fit the situation at hand, while dealing with the local constraints of available technology and organisational context.