A man of 79 goes home after a heart failure admission. In his first week home, his daughter makes these calls:
The pharmacy, because one new prescription needs the insurer’s approval before it can be filled
The cardiology office, because the discharge medicine list and the cardiologist’s list disagree on one dose
The home health agency, to move the first nurse visit to a day she can be there
The primary care office, to book the follow-up visit the discharge papers ask for
The home care agency, to pass along the physical therapist’s instructions for the aide
None of those calls is part of any one organization’s service. Each call joins one organization’s work to another’s.
What coordination cost is
Coordination cost is the time and effort it takes to make separate organizations’ work fit together for one person: carrying information from one to the next, settling disagreements between their instructions, and lining up their schedules. In the example, the hospital, the pharmacy, the cardiologist, the home health agency, the primary care office, and the home care agency each did their own work. The daughter did the joining.
Why it falls to the family
Each organization’s job is defined by its license, its contracts, and what it is paid to do. Those definitions describe work inside the organization. The space between two organizations sits outside both definitions, so neither one is assigned the work that happens there.
The work still has to be done for the person to stay safe. It goes to the party who cannot decline it. Often that party is the family. When no family member can do it, the work may go undone, and the gap can show up later as a missed dose or a missed visit.
Five steps that move some of it back
Count the handoffs. Before discharge or a change in care, list every organization involved and every point where information must pass from one to another.
Name an owner for each handoff. Write a person’s name, not a department, next to each one.
Ask the family about last week. “How many calls did you make about your father’s care?” The answer shows how much coordination the family is already carrying.
Send the facts the next organization needs. OPA’s guide to what a home care agency needs from discharge to staff the first shift lists them for home care.
Treat a family that cannot coordinate as a risk in the plan. A family member who works full time or lives out of state may not be able to make five calls a day. Plan for that before the person goes home.
Further reading
The Invisible Architecture: A Story About Senior Care as a System is the second book in the series. The Space Between examines coordination costs directly.
To refer a client to OPA for care at home, see how care starts at OPA.
