Modular health services: a single case study approach to the applicability of modularity to residential mental healthcare

摘要

Background The Dutch mental healthcare sector has to decrease costs by reducing intramural capacity with one third by 2020 and treating more patients in outpatient care. This transition necessitates enabling patients to become as self-supporting as possible, by customising the residential care they receive to their needs for self-development. Theoretically, modularity might help mental healthcare institutions with this. Modularity entails the decomposition of a healthcare service in parts that can be mixed-and-matched in a variety of ways, and combined form a functional whole. It brings about easier and better configuration, increased transparency and more variety without increasing costs. Aim: this study aims to explore the applicability of the modularity concept to the residential care provided in Assisted Living Facilities (ALFs) of Dutch mental healthcare institutions. Methods A single case study is carried out at the centre for psychosis in Etten-Leur, part of the GGz Breburg IMPACT care group. The design enables in-depth analysis of a case in a specific context. This is considered appropriate since theory concerning healthcare modularity is in an early stage of development. The present study can be considered a pilot case. Data were gathered by means of interviews, observations and documentary analysis. Results At the centre for psychosis, the majority of the residential care can be decomposed in modules, which can be grouped in service bundles and sub-bundles; the service customisation process is sufficiently fit to apply modular thinking; and interfaces for most of the categories are present. Hence, the prerequisites for modular residential care offerings are already largely fulfilled. For not yet fulfilled aspects of these prerequisites, remedies are available. Conclusion The modularity concept seems applicable to the residential care offered by the ALF of the mental healthcare institution under study. For a successful implementation of modularity however, some steps should be taken by the ALF, such as developing a catalogue of modules and a method for the personnel to work with this catalogue in application of the modules. Whether implementation of modular residential care might facilitate the transition from intramural residential care to outpatient care should be the subject of future research.