Despite the need for holistic approaches to complex problems, there are several practical barriers that prevent effective care coordination between services. These include structural barriers, geographic barriers (e.g., working with rural/remote services), difficulty reconciling treatment approaches between services, lack of clear communication, and competition between traditionally separate services, all of which make collaboration difficult [612, 613]. Moreover, both primary care providers and insurers currently identify the lack of a viable financial model as one of the major barriers to widespread coordinated care [614].
With coordinated approaches requiring the involvement of services and service providers in working partnerships, there is the potential for a lack of clarity regarding roles and responsibilities of different stakeholders [615, 616], making communication between services even more important. Further, the nature of competitive tendering arrangements between services to determine government funding, and focus on occupied bed days, creates tension and competition between agencies who must work together to provide collaborative health care [605]. For some services, this working environment may foster creativity; others may find their collaborative efforts stifled, and the associated difficulties overwhelming [605].
An additional barrier that may prevent effective collaboration between services is the lack of an existing model to follow [617]. Some common principles that can be incorporated into care coordination include [389, 600, 607, 618, 619]:
- Cross-disciplinary training and involvement of external service providers in case review meetings.
- Effective communication between services and service providers.
- Culturally responsive practices.
- Clear roles and accountability within and across services and service providers.
- Shared respect for the client and their health needs, and a common work culture that incorporates collaboration as a key aim.
- Routine evaluation of client care outcomes, including adherence.
- Centralised access to care, including designating a single point of contact to coordinate care for clients. If a single point of contact is not possible, clear communication with the client about who to contact for varying aspects of their care.
- Recognition that co-location alone does not result in effective service coordination or increase communication.
- Recognition of barriers to referral pathways, which include staff turnover, client confidentiality, and competition between services and service providers, which in turn requires dedication and commitment to overcome.