Consumers' views of coordination, their transition experiences, and health system performance

Restructuring health service organizations into vertically integrated systems is a national and international trend. In Alberta, a regional structure for the delivery of health services was introduced in June 1994. A major challenge in planning and evaluating services in a health care region is to first conceptualize the region as a system. "Systems thinking" requires an understanding of the links and interrelationships among different parts of the system, as well as its specific elements.;Coordination, which is one means of linking sectors, has been identified in the literature as a critical organizational attribute. Despite its importance, there are very few studies about coordination, and no previous empirical work that examines what coordination means to consumers, who are key stakeholders in the health care system.;In this qualitative, exploratory study, 33 consumers who experienced the transition from an acute care hospital into the Home Care Program of the Calgary Regional Health Authority were interviewed. They were asked to describe their transition experience and to identify what aspects of coordination were important to them. Interviews were recorded, and analyzed using constant comparison. The coding and retrieval of information was facilitated by the computer software program Nud*ist.;The present study is the first to identify what coordination means to consumers including terms and components. A very significant finding to emerge from the data is the crucial organizational role that consumers play in coordination. Five types of activities that consumers undertake as part of this coordination role are identified. The study also identifies what aspects of health care system support are important to consumers for preparation to return home, and identifies the elements of a successful transition between hospital and home. The study has produced the only model--grounded data from interviews with consumers--that proposes how coordination contributes to a successful transition.;These findings contribute to understanding and evaluating how to manage both the boundaries between sectors in a vertically integrated health care system, and the transition process for those who use the system. This information has significant implications for assessing the performance of integrated health care delivery systems.