159 General discussion Considering the above, the developments within the action program Solid Start at national level appear to align with the principles of Population Health Management (PHM). The conceptualization and definition of PHM are subject to ongoing refinement, yet PHM typically refers to efforts aimed at integrating services across the public health, social and medical sector. The overarching goal is to enhance health equity, patient experiences, provider well-being and population health, while reducing costs (known as the quintuple aim) (10-12). Regularly, studies appear that describe various elements of PHM initiatives, offering valuable insights into their design, implementation and evaluation (6, 13-16). These elements include population segmentation, risk-stratification, understanding populations’ strengths and needs, and monitoring and evaluating population-tailored strategies (10, 16, 17). In the context of the action program Solid Start and specifically the local coalitions, the extensive literature on Learning Health Systems (LHS) is also relevant (18-21). LHS emphasizes a cycle of continuous learning to improve care, using elements such as data-linkage and sharing. Further exploration of both PHM and LHS literature can provide valuable insight into the interpretation of the findings presented in this thesis. Drawing upon our research findings and in light of recent scientific literature, we provide multiple lessons learned. These insights may guide future endeavours related to the action program Solid Start, and may also be relevant in the adoption and monitoring of other cross-sectoral initiatives. The lessons learned are structured alongside the components of the main research objective, namely the adoption of the action program Solid Start, monitoring and cross-sectoral collaboration. Lessons learned in the adoption of the action program Solid Start The adoption of the action program Solid Start encountered both facilitators and barriers and seemed to be a continuous learning process, but it showed overall progress. Chapter 5 outlined numerous program-elements and developments that may have contributed to the adoption of the action program Solid Start. Based on these findings, we draw two lessons learned. 1. The adoption was facilitated by a unifying narrative and dedicated champions at all levels Having a unifying narrative that not only sets a clear societal goal but also resonates with stakeholders at different levels and sectors was instrumental in facilitating the adoption of the action program Solid Start. This narrative, emphasizing the importance of the first thousand days and the imperative for cross-sectoral collaboration, extends beyond immediate issues to build a foundation for long-term improvements. By creating common ground and instilling a sense of urgency, the narrative prompts a shared commitment to the idea that ‘we are in the same boat’ for the future, thereby laying a solid base for collaboration. These interrelated factors of a shared vision, commitment and societal urgency align with previous literature on cross-sectoral collaboration (9, 22-26) and are influential in initiating and sustaining integrated programs and partnerships. 6
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