Every child has the right to optimal care, appropriate to the wishes and life of the child and family

To ensure that this care runs as smoothly as possible, the Medical Child Care Cooperation (MKS) working method has been developed. We spoke to Meggi Schuiling-Otten, director of the Knowledge Center for Palliative Care for Children and one of the creators of the MKS about the long-term strategy. 'In 2026, all children with care needs must go home, according to MKS.'

The starting point of MKS is that all professionals and institutions involved organize the care together with each other and with the child and family, both inside and outside the hospital. Four steps are taken for this: 1) the referral tree, 2) the help needs scan, in which a family indicates what it needs, 3) the overarching care plan and 4) the decision tree. This not only takes into account the medical care needs, but also the social circumstances, the development of the child and his or her safety. 'We want children and parents to know what is going to happen and to be in control where they can. We aim to create a network around the child and family, to ensure that they receive the right care in the right place and that the quality of care and life increases.'

Not system, but cooperation

MKS has been around for a while. It was set up in 2014 in close collaboration with the Ministry of Health, Welfare and Sport, by the Child & Hospital Foundation, the forerunners of the INtegrale KindZorg Branche (BINKZ), the Knowledge Center for Pediatric Palliative Care, the Dutch Pediatric Association (NVK) and the Professional Association of Nurses and Caregivers for Child Nursing (V&VN). Kinderververzorging.nl will be connected in 2022. 'Professionals inside and outside the hospital did not cooperate sufficiently, so that the child and family in their own environment did not always receive tailor-made care. MKS had to change that.' The previous name: Medical Childcare System, has caused obstacles. 'The term system led to 'cuts in the sand'. That is actually not true, because it is mainly a working method that is essentially about cooperation. That's why we changed the name. In the coming years, we must draw much more attention to the Medical Childcare Collaboration working method to ensure that this working method is implemented everywhere.'

'Extramural, within primary care almost everyone works successfully with these instruments.'

Extramurally, almost everyone works according to MKS

Much has been achieved in recent years. For example, an unambiguous framework has been developed for nursing care for sick children with various instruments, such as criteria for good care, an experience monitor, a nursing quality and information standard and a Handreiking Indicatieproces Kindzorg (HIK). 'Extramurally, within the first line at nursing nurseries, nursing homes for children and children's home care, everyone successfully works according to the MKS method with the associated instruments.' Because the method has been developed for all children with care needs - from children with a single, nursing demand to children who need palliative care - the way in which it is applied differs. 'In the latter group, other, often ethically complex issues concerning quality of life and quality of death play a role, and in line with the social domain, spiritual care is often also discussed. 'In order to ensure that good agreements are made about all these care aspects, the Individual Care Plan has been developed for them, in line with the MKS. Now we want the care plan to be made available to all families, even those with less demanding care needs. In this way we make maximum use of the possibilities together.'

All healthcare organizations

The aim is to organize the care for all children with the help of MKS by 2026. Various (sub)objectives are described in this regard in the long-term MKS strategy . One of the objectives is that all healthcare organizations will then work according to the ideas and working methods of MKS. That also means all hospitals. 'We're not there yet. Implementing this new working method requires time and staffing, while the healthcare sector is currently facing growing staff shortages.' What also makes implementation difficult is that medical child care is a very small but complex target group. Less than 1% of the care within district nursing concerns children and within the hospitals this is also a fairly small group. 'Especially the children's wards in general hospitals are often small. On the other hand, the impact of caring for a child on his or her environment is great, especially when it comes to pediatric palliative care. We see this in the Children's Comfort Teams (KCTs), which have already implemented MKS to a large extent and for whom performing an aid needs scan and writing a care plan are already familiar. 'The positive experiences of the KCTs can help to draw more attention to the working method within hospitals'.

Cost reduction

One of the arguments for getting started with MKS is how much working according to the MKS method not only benefits children and families, but also hospitals. The cost-benefit analyzes carried out on behalf of the MKS Partners show this. 'And yes, as always, the costs outweigh the benefits, so as a hospital you will have to invest first. For example, embedding the needs scan and care plan in ICT or training. Gaining insight into the return will be an extra motivation for hospitals. Especially now that we are dealing with a major national austerity order in a time of scarcity.'

Matching the current zeitgeist

'In order to realize the implementation of this method in intramural care as well, we will enter into talks with all kinds of parties in the near future, including the Dutch Association of Hospitals (NVZ) and the Dutch Federation of University Medical Centers (NFU).' The partners will also enter into discussions with health insurers and the Dutch Healthcare Authority. 'What helped in the first line is that working according to MKS has been included in the purchasing conditions of the health insurers. Our ambition is to arrange this for hospitals as well. The current zeitgeist with a focus on transmural medicine and the Integral Care Agreement can help with this. In political The Hague, it is increasingly important that everyone with a care need can be at home more and longer, with good care. The MKS working method fits in seamlessly with the realization of this vision. In that respect, medical child care is a forerunner of current developments.'

To work?

Do you want to get started with MKS as a healthcare organization? We're happy to help. Until the end of this year, a team is ready to support you with the implementation. You can register via academy@kindenziekenhuis.nl

MKS afternoon symposium

Knowing more? Then come to the MKS afternoon symposium 'Their lives, our care' on 20 April! Click here for more information or to register.