Case-mix system as a boundary object: the case of home care services

Governments worldwide face the challenges of an ageing population. New models of health services are being established to support older people to continue living in their homes with timely access to quality health services. Health care provision for older people, however, involves multiple stakeholders, who represent different views on health care, while working towards a common goal. This study presents an action-oriented collaborative process between funders, service providers and clinicians that showcases the development of a client classification (case-mix) system for home-based support service provision in New Zealand. In doing so, this study draws on the concept of boundary objects and develops a unique framework that explicitly showcases the process of aligning diverse stakeholder interests to reach a consensus. This study demonstrates how different manifestations of a single boundary concept-object can effectively bridge all knowledge boundaries and thus develops a new way of using boundary objects for creating effective collaborations.

Chinese abstract世界各国都面临着人口老龄化的挑战。业界正努力建立医疗服务新模式，以支持老年人继续在自己家中生活，同时可及时获得高品质的医疗服务。然而，老年人的医疗护理涉及到多个利益方，在实现共同目标的过程中，各个利益方对医疗护理都有不同的意见。本文为资助方、服务提供商和医生提出一套以行动为导向的合作流程方案，为新西兰的家居护理服务提出了一套客户分类(案例混合)系统。因此，本文借鉴边界对象概念，制定了一套独特框架，详细地展示一套如何平衡多个利益方的利益从而达成共识的工作流程。这项研究向读者展示，单个边界对象的不同表现形式可以如何有效地消除所有知识边界，从而利用边界对象来找到新的途径，实现有效的合作。