Description of the 12 dimensions of the SCIROCCO tool
| Dimensions | Objectives |
| Readiness to Change | Providing a more integrated set of services by creating new roles, processes and working practices, as well as new systems to support information sharing and collaboration across care teams. |
| Structure and Governance | Multiyear programmes with efficient change management, funding and communication, and the power to influence and mandate new working practices needed to deliver integrated care at a regional or national level. |
| eHealth Services | Building on existing eHealth services, connecting them in new ways to support integration, and augmenting them with new capabilities (enhanced security and mobility) will enable continuous collaboration, measuring and managing outcomes, and citizens will take a more active role in their care. |
| Standardisation and Simplification | Simplification of the number of different systems in use and the formats in which they store data by consolidating data centres, standardising on fewer systems and agreeing on what technical standards will be used across a region or country. |
| Funding | Initial investment and funding are required to change systems of care so that they can offer better integration. To ensure that the initial and ongoing costs can be financed, a full range of mechanisms from regional/national budgets to ‘stimulus’ funds, public–private partnerships and risk-sharing mechanisms need to be used. |
| Removal of Inhibitors | Funded programmes and good eHealth infrastructure can face barriers (legal issues with data governance, resistance to change from individuals or professional bodies, cultural barrier to the use of technology, perverse financial incentives and lack of skills), which need to be recognised early in order to develop a plan to deal with them and to minimise their impact. |
| Population Approach | Integrated care can be developed to benefit citizens who are not thriving under existing systems of care, in order to help them manage their health and care needs in a better way, and to avoid emergency calls and hospital admissions and reduce hospital stays. That way, the citizens can maintain their health for longer and be less dependent on care services as they age. |
| Citizen Empowerment | Easy-to-use services, such as appointment booking, self-monitoring of health status and alternatives to medical appointments, need to be available to citizens, as they are willing to do more to participate in their own care, as suggested by evidence. This means providing services and tolls that enable convenience, offer choice, and encourage self-service and engagement in health management, considering the need to address the risk of health and social inequalities. |
| Evaluation Methods | Evidence-based investment is required, meaning that the impact of each change is evaluated. Health technology assessment is an important method here and can be used to justify the cost of scaling up of integrated care to regional or national level. |
| Breadth of Ambition | Integrated care includes many levels of integration, such as integration between primary and secondary care, of all stakeholders involved in the care process, or across many organisations. The long-term goal should be fully integrated care services, which provide a complete set of seamless interactions for the citizen, leading to better care and improved outcomes. |
| Innovation Management | Managing the innovation process to get the best results for the systems of care and ensuring that good ideas are encouraged and rewarded, is necessary. Innovations from clinicians, nurses and social workers need to be recognised and scaled up to provide benefit across the system as well as taking into consideration universities and private sector companies, which are increasingly willing to engage in open innovation in order to develop new technologies, test process improvements and deliver new services that meet the needs of citizens. There is also value in looking outside the system to other regions and countries that are dealing with the same set of challenges, to learn from their experiences. |
| Capacity Building | Capacity building is the process by which individual and organisations obtain, improve and retain the skills and knowledge needed to do their jobs competently. New roles will need to be created, new skills developed and the systems of care need to become ‘learning systems’ that are constantly striving to improve quality, cost and access, so that they become more adaptable and resilient. Ensuring that knowledge is captured and used to improve the next set of projects, leading to greater productivity and increasing success, is needed. |
SCIROCCO, Scaling Integrated Care in Context.