Readiness for integrated care in Switzerland: results of a nationwide survey using the SCIROCCO tool

Introduction In 2017, the Swiss survey on integrated care identified 162 initiatives, an increase compared to previous data. Despite these encouraging results, Switzerland may fall behind other European countries in terms of integrated care development. The main objective of this study was to assess the readiness of the Swiss healthcare system for integrated care; the secondary aim was to explore whether the Swiss readiness was varying according to several variables. Methods Study design: A Swiss national electronic survey (November 2019) Population: Persons being on the list of stakeholders of the integrated care unit of the Swiss Federal Office of Public Health and of the fmc, the Swiss Forum for integrated Care, and those representing cantonal public health departments, were invited to participate. Measures The outcome was the readiness for integrated care of the Swiss healthcare system, measured using French, German and Italian versions of the SCIROCCO tool. The latter comprises 12 dimensions assessed by 12 questions rated on a 6-point scale (from 0 -  “not fulfilled”, “not present/available” to 5 - “fully fulfilled”, “totally present/available”). We also collected the following stratifying variables: respondent’s age, gender, working linguistic region, healthcare profession, main domain of professional activity, implication in integrated care, attitude towards integrated care and the Swiss healthcare system. Analyses We described the respondents and responses to the questionnaire, and performed stratification to find out whether readiness varied according to the levels of several variables. Results Mean age of the 642 respondents was 53 years, 42.5% were women, 60.0% and 20.7% worked in the German and French-speaking parts of Switzerland, respectively. Overall, the readiness of the Swiss healthcare system was rather low. On a 0-5 point-scale, means ranged from 1.0 (SD 1.0) for the “Funding” dimension to 2.7 (SD 1.1) for the “Digital infrastructure” one. Results did not vary across strata except for the working linguistic region.  Discussion These results highlight a limited readiness of the Swiss healthcare system for integrated care, as evaluated at a national level by a large and varied number of healthcare stakeholders. Conclusions These results represent key information for the further development of integrated care in Switzerland. They are particularly timely since more coordination is one of the 16 lines of action of the Swiss health2030 policy strategy. In fact, they should help identify areas requiring attention for a successfull transformation of the Swiss healthcare system towards integrated care. Lessons Learned Up to now, the Scirocco tool has been used at regional levels by small groups of stakeholders. To our knowledge, this is the first study using it for a national survey. Limitations The main limitation of this study is the use of an electronic-only version of the Scirocco tool, precluding the consensus reaching process of the instrument’s use; this limitation should be counterbalanced by the large sample size.  Suggestions For Future Research These results could be consolidated using a consensus-like method, leading to results usable both to identify areas of improvement and to accompany the development and implementation of integrated care in Switzerland.