Introduction: In order to tackle the challenges many care systems worldwide are faced with, care delivery needs to become a shared outcome of the deployment of several actors. The question raised is then how information, resources, activities and the skills of those different sovereign and unique organizations, independent care providers, informal care givers, and patients can be combined to achieve a result that none of the parties concerned can achieve independently. While much is known already about ways to improve care integration within single organizations, and a growing body of knowledge is being developed on care integration within organizational networks, far less is known on how to move the larger constellation of actors towards a more integrated care delivery, across organizational and network boundaries.
Research questions to tackle are then:
- How can we define care ecosystems?
- Is designing ecosystems different from designing organizations and networks?
- How do we understand ecosystem viability?
Theory/Methods: Our theoretical framework is Socio-Technical Systems STS Design, which is a comprehensive and effective framework for designing complex systems. STS Design is about joint optimization of organizational performance and quality in people's work lives. We conducted an analysis of the literature on organizational care ecosystems, leading to a draft note on ecosystem definition and design. Next, we organized two sets of three online deliberation sessions with academics, consultants and practitioners, all of whom are engaged to write chapters on care ecosystem design cases and approaches from across the globe for a 2018 Springer book, entitled “Designing Integrated Care Ecosystems”. In total we had 30 individual participants. Additional discussions were held in a private LinkedIn group with 25 members.
Results: A care ecosystem is a collection of actors which each are involved in some aspect of delivering care for a certain target group, and in which the collected actors are co-producing a result that none of the actors can achieve independently. Ecosystem design is seen as more complex in comparison to organization or network design. Since all ecosystems already exist, the design will be about creating a sociotechnical infrastructure which enables actors to more easily create innovations in the collaborative delivery of integrated care. If we define designing as the intentional creation of a desired future, designing ecosystems would imply having actors co-create shared purpose across new constellations and new ways of working among ecosystem actors, thus enhancing the viability of the whole ecosystem.
Lessons learned: The ecosystem concept could help to better understand and improve care integration across networks, organizations and individual actors.
Limitations: The results are based on a first scan of the relevant literature, two rounds of deliberations, and LinkedIn discussions.
Next steps: The people involved in the deliberations are currently writing chapters on their respective experience with, and vision on designing care ecosystems. Simultaneously, we are performing an extensive literature review. We aim to gain a deeper understanding of the concept of care ecosystems and possibilities for their design. Evidently, further testing and validation of the proposed definition and design approach will be needed.