/ Doktorat
Nathalie Möckli successfully defended her thesis on 22 June 2023
Nathalie Möckli’s dissertation is entitled “Quality and coordination in home care: A national cross-sectional multicenter study – SPOTnat” and is embedded in the SPOTnat study. The overall goal of the dissertation was to deepen our understanding of the homecare sector regarding care coordination and quality. Nathalie Möckli’s PhD was funded by the Stiftung Pflegewissenschaft Schweiz.
Homecare services include a wide range of medical treatments and therapies, basic care (e.g., personal hygiene), domestic services (e.g., household support) and social services. However, it has been neglected in most countries compared to hospitals and nursing homes, especially regarding healthcare research. As a result, while many countries see high-quality, sustainable care at home as a high-value goal, there are many knowledge gaps in the homecare setting. For agencies, challenges include an increasing demand combined with a workforce shortage, constant cost pressure, and issues with both care coordination and care quality.
So far, large-scale studies that consider macro-, meso-, and micro-level factors and incorporate multiple perspectives and measurements to capture coordination and quality of care are rare. More importantly, no studies so far have examined which factors are associated with care coordination in the homecare setting. Moreover, no clear, accepted concept was available to define care coordination, not only for home care but for health care in general. This gap is taken up by the SPOTnat study (Spitex Koordination und Qualität - eine nationale Studie (homecare coordination and quality – a national study)).
This dissertation first clarifies the concept of care coordination in the homecare setting and describes the various financial and regulatory mechanisms operating in the Swiss homecare setting. It then explores how those factors relate to homecare agencies’ structures, processes, and working environments, how system and agency factors are related to care coordination, and ultimately how care coordination is related to quality of care.
Within this dissertation we established a theoretical basis for care coordination and explain how the concept of coordination can be understood and measured. Our newly-constructed COORA (care coordination) framework differentiates clearly between coordination as a process—i.e., tasks people perform to coordinate versus coordination as a state, i.e., the desired outcome of the coordination process. Applying this distinction to both measurement and interpretation of results helps avoid misleading conclusions.
The results of the analyses show that coordination processes such as role clarity, mutual trust, respect, common understanding, predictability and accountability, as well as communication are crucial factors for better coordination. In addition, the results also show that improved care coordination is related to improved quality of care regarding two measures: self-reported quality (from the perspective of homecare staff and clients); and healthcare service use by clients. Results such as these emphasize the importance of choosing meaningful quality-of-care outcomes, i.e., quality-of-care outcomes that can truly be influenced by coordination.