MAIA Method

If the MAIA method is originally top-down, the deployment is left to the initiative of the MAIA pilot: this approach requires a bottom up process because the priorities and drivers of actions, which enable this method to be implemented, must emerge from the partners themselves. The MAIA system requires the commitment and the co-empowerment of stakeholders of the health, medico-social and social sectors. However, this co-empowerment is not spontaneously developed, especially in the context of instability of the ARS teams. In the MAIA system, the value is created by the whole set of professional partners who participate to the working groups to create common communication tools (e.g. orientation forms), who also try to articulate and adjust the existing committees with the tactical table. For example, the development of an integrated, one-stop service, can only be done with the partners (meetings, training). The value is created by all the stakeholders. They create the final value for the benefit of the user (through training, tool sharing, but also by transmitting information about dysfunctions of the system or transferring information about elderly people in precarious situation). They also use the MAIA framework themselves to find contacts and to orient patients towards case managers.

The MAIA method is more a social innovation, rather than digital transformation, which seeks to transform the health system by implementing new forms of organization of collective work.   Nevertheless, it implies a digital innovation related to MAIA’s three communication tools. (a) A shared Multidimensional Analysis Form (used by professionals from the one-step services) and the multidimensional assessment tool (used by case managers). (b) The Individualized Service Plan (PSI). It is a case management tool used to define and to plan in a consistent manner all the interventions provided to the elderly in a complex situation. (c) Shared information systems (it gathers information from the one-stop service, from the MAIA pilot, and from the case managers …). It requires the development of a common shared information system and action-steering tools, to create a directory database to identify local resources, and to be able to create the integrated, one-stop service.

One of the main value creations of the MAIA method is the improvement of the accessibility to services by providing an adapted answer to a problem. The aim is to avoid the bad quality of answers given to users, user’s family and caregivers. Thus, monitoring indicators have been developed and used during the implementation stage of the MAIA method especially to assess the number of contacts a senior must have established to access to the right resource. The result is that the integration of orientation counters into a one-step services simplifies people’s pathway and substantially reduce the number of contacts. At the local level, the impact in terms of organization is measured in different ways, such as the participation rate of partners at the tactical table, or the territorial distribution of seniors being managed for the case management. Regarding the participation rate of partners, the results indicate that the participants to the tactical tables are always the same volunteers, actors who encounter difficulties in their daily practice do not often wish to participate (as this could be viewed as failure) and general practitioners are rarely part of the table.

Before the denomination of “Method of action for the integration of healthcare and support services in the field of autonomy”, the acronym MAIA was used for “House for autonomy and integration of Alzheimer disease”. The use of the first denomination of « MAIA » as a « House » resulted in a misunderstanding of the method.   Beyond the misunderstanding of the denomination, the notion of integration is not well understood by a lot of actors. Actors are often seeking for interstitial measures, such as accommodation solution after hospitalization, Psychogeriatric mobile team, night nurse, etc. But these interstitial measures are clinical solutions instead of an integration system. Moreover, the MAIA method needs time to be implemented, because trust and relationships between actors take time to appear. Another barrier comes from the competition between the MAIA project and other national projects from which objectives are close to the MAIA method. On the top of that, there is a problem with the choice of the territory. The MAIA pilot must first choose the geographical territory that will be affected by the method and within which professionals will be contacted. This choice is important because it has to correspond to Regional Health Authorities, which are coordinating the project. The result of the experimental phase showed that the private actor as a holder of the project is not appropriate because it could lead to conflict of interest. It also poses a problem of data confidentiality.  

The MAIA method is transferable. MAIAs were tested on 17 sites in France to refine tools, work procedures, and training content for case managers. Following this experiment, the method was extended on the French territory. Currently, the MAIA method is a public policy institutionalized in the Family and social action code.  

The MAIA method as social innovation led to a methodological and organizational method: The MAIA project is a working method disseminated all over the territory so that the healthcare, social and medico-social actors of local territories work better collectively. Therefore, it leads to organizational local innovation: various stakeholders innovate together in order to find corrective measures to organizational dysfunctions observed on the local territory. This method promotes the mutual adjustment of each other actor’s missions. Otherwise, the actors may ignore each other by lack of legibility of the system, or may feel in competition with each other.  

A partially unexpected result is about the role of private partners and the data privacy issue raised by the concept of integration. The integration process implies the participation of private partners. The private partners could be the holder of the MAIA project. During the experimental phase, the “Private holder” management did not work for reasons of conflict of interest, which results in a problem of credibility of the (private) holder. The other professionals of the territory do not accept the holder and its practices. This lack of credibility is compounded with the problem of confidentiality of patient data. The private holder may use this data to charge services or may not protect these data enough.