Practice-integrated care teams – learning for a better future

2015 ◽  
Vol 23 (2) ◽  
pp. 74-87 ◽  
Author(s):  
Angela Beacon
Keyword(s):  
General Practice ◽  
Integrated Care ◽  
Secondary Care ◽  
Social Care ◽  
Cost Savings ◽  
Building Blocks ◽  
Urgent Care ◽  
Recent Experience ◽  
Content Type ◽  
Health And Social Care

Purpose – The purpose of this paper is to present a case study of one element of the integrated work which has taken place in Central Manchester, the development of multi-disciplinary Practice-Integrated Care Teams (PICT). The paper will show how working together has become a practical reality for members of these teams, and is forming the building blocks for further integration across neighbourhoods. Design/methodology/approach – This paper draws on the author’s experience of working in the PICT project from 2012 to 2014. The report will draw on the evaluation work which took place during the project, and will include reflections from others involved in the project and members of the teams. Findings – The integrated care teams which have been developed in Central Manchester have started to make significant changes to the ways that professionals work together, to the experience that patients have and to the costs of urgent care provision. Whilst there is still a long way to go, there has been significant learning from the PICT. This includes improved patient outcomes and experience. There has been an overall reduction in secondary care activity for patients the teams have been working with, with the largest reduction being in emergency admissions. Alongside this, patient feedback has reinforced the value of this personalised approach and increased overall satisfaction with the care and advice received from health and social care professionals and an improved professional experience. Evaluation has demonstrated that amongst professionals involved in the team there is a strong commitment to the principles of integrated care and that the confidence, skills and capacity of the teams have strengthened since this way of working has been introduced. As monitoring of financial impact continues to develop, cost savings from secondary care, particularly around emergency unplanned care, are encouraging. Originality/value – This paper draws on the recent experience of designing and delivering integrated care across a range of multi-agency, multi-professional partners. The model which has been developed centres around the role of general practice, and has enabled primary care to take a key role in the development of an out-of-hospital integrated care system. This has enabled community professionals such as nurses and social workers to build a much stronger relationship with general practice and enable system linkages which will be essential to the delivery of joined-up health and social care in the future. The project has been accompanied by thorough and ongoing evaluation to support the validity of the learnings which have been reported.

A logic model of the implementation of a regional workforce strategy in positive behavioural support

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Steve Noone ◽  
Alison Branch ◽  
Melissa Sherring
Keyword(s):  
Large Scale ◽  
Social Care ◽  
Building Blocks ◽  
Logic Model ◽  
Competency Framework ◽  
Health Staff ◽  
Content Type ◽  
Behavioural Support ◽  
Health And Social Care ◽  
Wide Range

Purpose Positive behavioural support (PBS) as a framework for delivering quality services is recognised in important policy documents (CQC, 2020; NICE, 2018), yet there is an absence in the literature on how this could be implemented on a large scale. The purpose of this paper is to describe a recent implementation of a workforce strategy to develop PBS across social care and health staff and family carers, within the footprint of a large integrated care system. Design/methodology/approach A logic model describes how an initial scoping exercise led to the production of a regional workforce strategy based on the PBS Competence Framework (2015). It shows how the creation of a regional steering group was able to coordinate important developmental stages and integrate multiple agencies into a single strategy to implement teaching and education in PBS. It describes the number of people who received teaching and education in PBS and the regional impact of the project in promoting cultural change within services. Findings This paper demonstrates a proof of concept that it is possible to translate the PBS Competency Framework (2015) into accredited courses. Initial scoping work highlighted the ineffectiveness of traditional training in PBS. Using blended learning and competency-based supervision and assessment, it was possible to create a new way to promote large-scale service developments in PBS supported by the governance of a new organisational structure. This also included family training delivered by family trainers. This builds on the ideas by Denne et al. (2020) that many of the necessary building blocks of implementation already exist within a system. Social implications A co-ordinated teaching and education strategy in PBS may help a wide range of carers to become more effective in supporting the people they care for. Originality/value This is the first attempt to describe the implementation of a framework for PBS within a defined geographical location. It describes the collaboration of health and social care planners and a local university to create a suite of courses built around the PBS coalition competency framework.

Partnership working across sectors: a multi-professional perspective

2019 ◽  
Vol 27 (4) ◽  
pp. 328-345 ◽  
Author(s):  
Nancy El-Farargy
Keyword(s):  
Integrated Care ◽  
Workforce Development ◽  
Social Care ◽  
Third Sector ◽  
Adult Health ◽  
Content Type ◽  
The Third ◽  
Health And Social Care ◽  
Professional Perspective ◽  
The Third Sector

Purpose The Public Bodies (Joint Working) (Scotland) Act 2014 set the framework for the integration of adult health and social care services. Teams, organisations and sectors are now required to work in partnership and interdependently to deliver shared outcomes for the people they serve. The purpose of this paper is to explore any features, practices and behaviours that could influence effective partnership working across sectors. Design/methodology/approach A questionnaire was designed and distributed to a range of stakeholders working in health, social care and the third sector. With reference to the changing health and social care reform agenda, the aims of the survey were to gather views, experiences and perceptions of working across sectors, and any workforce development needs. Findings The majority of respondents were from the NHS (80.3 per cent, 118/147), and experiences were largely drawn from those working with the third sector. The utility of working with the third sector was positively highlighted; however, there were limited opportunities to fully engage. Whilst formal education and training was welcomed, workforce development needs were mostly related to fostering relationships and building mutual trust. Originality/value This paper highlights views, perceptions, enablers and barriers to integrated care in Scotland. Whilst the Scottish integration landscape is currently not fully fledged, insights into prevailing attitudes towards integrated care, by a cohort of the Scottish health and care workforce, are offered. In particular, reflections by the NHS workforce to working with third sector services are discussed.

scholarly journals The Digital House of Care: information solutions for integrated care

2016 ◽  
Vol 24 (5/6) ◽  
pp. 237-248 ◽  
Author(s):  
Andrew Muirhead ◽  
Derek George Ward ◽  
Brenda Howard
Keyword(s):  
Large Scale ◽  
Social Care ◽  
Care Delivery ◽  
Service Planning ◽  
Recent Experience ◽  
Organisational Development ◽  
Digital Tool ◽  
Content Type ◽  
Health And Social Care ◽  
Care Information

Purpose The purpose of this paper is to describe the development of a digital tool in an English county striving towards a vision of integrated information that is used to underpin an increasingly integrated future of health and social care delivery. Design/methodology/approach It discusses the policy context nationally, the origins and implementation of the initiative, the authors’ experiences and viewpoint highlighting key challenges and learning, as well as examples of new work undertaken. Findings In all, 12 health and care organisations have participated in this project. The ability for local commissioners and providers of services to now understand “flow” both between and within services at a granular level is unique. Costs are modest, and the opportunities for refining and better targeting as well as validating services are significant, thus demonstrating a return on investment. Key learning includes how organisational development was equally as important as the implementation of innovative new software, that change management from grass roots to strategic leaders is vital, and that the whole system is greater than the sum of its otherwise in-silo parts. Practical implications Data linkage initiatives, whether local, regional or national in scale, need to be programme managed. A robust governance and accountability framework must be in place to realise the benefits of such as a solution, and IT infrastructure is paramount. Social implications Organisational development, collaborative as well as distributed leadership, and managing a change in culture towards health and care information is critical in order to create a supportive environment that fosters learning across organisational boundaries. Originality/value This paper draws on the recent experience of achieving large-scale data integration across the boundaries of health and social care, to help plan and commission services more effectively. This rich, multi-agency intelligence has already begun to change the way in which the system considers service planning, and learning from this county’s approach may assist others considering similar initiatives.

Integrated care communities: putting change theory into practice

2014 ◽  
Vol 22 (4) ◽  
pp. 132-141 ◽  
Author(s):  
Elizabeth Bradbury
Keyword(s):  
Integrated Care ◽  
Complex Adaptive Systems ◽  
Adaptive Systems ◽  
Large Scale ◽  
Social Care ◽  
Content Type ◽  
North West ◽  
Health And Social Care ◽  
Capability Building ◽  
Complex Adaptive

Purpose – The purpose of this paper is to reflect on the experience of the Advancing Quality Alliance's (AQuA) regional Integrated Care Discovery Community created to translate integrated care theory into practice at scale and to test ways to address the system enablers of integrated care. Design/methodology/approach – Principles of flexibility, agility, credibility and scale influenced Community design. The theoretical framework drew on relevant complexity, learning community and change management theories. Co-designed with stakeholders, the discovery-based Community model incorporated emergent learning from change in complex adaptive environments and focused bespoke support on leadership capability building. Findings – In total, 19 health and social care economies participated. Kotter's eight-step change model proved flexible in conjunction with large-scale change theories. The tension between programme management, learning communities and the emergent nature of change in complex adaptive systems can be harnessed to inject pace and urgency. Mental models and simple rules were helpful in managing participant's desire for a directive approach in the context of a discovery programme. Research limitations/implications – This is a viewpoint from a regional improvement organisation in North West England. Social implications – The Discovery Community was a useful construct through which to rapidly develop multiple integrated health and social care economies. Flexible design and bespoke delivery is crucial in a complex adaptive environment. Capability building needs to be agile enough to meet the emergent needs of a changing workforce. Collaborative leadership has emerged as an area requiring particular attention. Originality/value – Learning from AQuA's approach may assist others in structuring large-scale integrated care or complex change initiatives.

Space, time and demographic change

2017 ◽  
Vol 25 (1) ◽  
pp. 39-48 ◽  
Author(s):  
Hamish Robertson
Keyword(s):  
Integrated Care ◽  
Social Care ◽  
Care Service ◽  
Population Ageing ◽  
Social Care Service ◽  
Content Type ◽  
Care Integration ◽  
Health And Social Care ◽  
Geographical Perspective ◽  
Practical Implications

Purpose The purpose of this paper is to explore the potential value of applying spatial science and technology to the issue of care integration across what are the often fragmented domains of health and social care provision. The issue of focus for this purpose is population ageing because it challenges existing information and practice silos. Better integration, the author proposes, needs to adopt a geographic approach to deal with the challenges that population ageing present to health and social care as they currently function in many countries. Design/methodology/approach The approach utilised here explores the role that could be played by enhancing spatial perspectives in care integration. Spatial and temporal strategies need to be coordinated to produce systems of integrated care that are needed to meet the needs of growing numbers of older people. Findings The author’s premise is that, with some rare exceptions, geographies of care are needed to address important shifts in demography such as population ageing and their epidemiological consequences. The rising intersection between the ageing and disability concepts illustrates how the fluid nature of health and social care client groups will challenge existing systems and their presuppositions. Health and medical geography offer a theoretical and practical response to some of these emerging problems. Research limitations/implications This is a brief conceptual piece in favour of integrating geographic concepts and methods in the context of changing demography and the social, economic and service implications of such changes. It is limited in scope and a more detailed explanation would be required for a proof of concept. Practical implications Practically we know that all human services vary across space as do both healthcare and related social services and supports. Issues of quality and safety are numerous in these policy domains generally, with aged care evidencing a growing number of problems and challenges. Being able to inquire on significant challenges in health and social care through a spatial lens has the potential to provide another, highly practical, kind of evidence in this field of work. This lens is, the author contends, very poorly integrated into either health or social care at present. However, doing so would have a variety of useful outcomes for monitoring and intervening on real problems in care integration. An example could be “frequent flyers” in emergency departments as has been done in Camden, New Jersey through patient mapping. Social implications The author’s position in this paper is that the challenges we face in providing integrated care to ageing and increasingly disabled (including both physical and cognitive impairments) populations will only grow in the face of variable governmental responses and increasingly complex funding and service provider arrangements. Without a geographical perspective and the concepts and tools of spatial science the author does not see an adequate response emerging. The shift to community-based care for many groups, including the aged, means that location will become more important rather than less so. This is a societal concern of major proportions and the very concept of integrated care requires of us a geographical perspective. Originality/value This is a short but, the author believes, conceptually rich piece with a variety of potential practical implications for health and social care service provision. Issues of equity, quality, safety and even basic access can only grow as population ageing progresses and various forms of chronic disease and disability continue to grow. Knowing where the most affected people and their social and service connections are located will support better integration. And better integration may resolve some of the financial and related resource problems that are already evident but which can only continue to increase. In this context, the author suggests that the integrated care of the future needs to be geographically informed to be effective.

Knowing me, knowing you

2015 ◽  
Vol 23 (2) ◽  
pp. 62-73 ◽  
Author(s):  
Catherine Mangan ◽  
Robin Miller ◽  
Carol Ward
Keyword(s):  
General Practice ◽  
Social Work ◽  
Focus Groups ◽  
Social Care ◽  
Work Teams ◽  
Interprofessional Collaboration ◽  
Current Evidence ◽  
Content Type ◽  
Health And Social Care ◽  
Interprofessional Working

Purpose – The purpose of this paper is to report on the findings of the first stage of a project seeking to improve interprofessional working between general practice and adult social care teams. It develops the current evidence base through findings from focus groups and reflects on the implications of the findings for interprofessional collaboration. Design/methodology/approach – The project involved running seven focus groups with general practice staff and adult social work teams to explore their perceptions and understanding of each other. Findings – The focus groups highlighted that the negative aspects of interprofessional working outweighed the positives. Negatives included perceptions of different value bases, a lack of knowledge about each others’ roles and responsibilities which resulted in resorting to stereotypes, poor interprofessional communication and a sense of an unspoken professional hierarchy with general practitioners (GPs) at the top leading preventing a culture of appropriate challenge. Research limitations/implications – The research has only been conducted with four GP practices and three social work teams that had expressed an interest in improving their interprofessional working. Therefore the findings may not be generalisable. Practical implications – The case study suggests that there is a lack of effective interprofessional working between social care teams and general practice. With the current health and social care agenda focused on integration, this suggests there should be a greater focus on this area. Originality/value – This paper illustrates that despite many years of policy makers promoting better integration, the quality of the interprofessional collaboration between social care teams and general practice remains poor.

scholarly journals Integrated care: mobilising professional identity

2018 ◽  
Vol 32 (5) ◽  
pp. 726-740 ◽  
Author(s):  
Stephanie Best ◽  
Sharon Williams
Keyword(s):  
Professional Identity ◽  
Integrated Care ◽  
Social Care ◽  
Healthcare Systems ◽  
Cross Sectional Study ◽  
Key Factors ◽  
Cross Sectional ◽  
Content Type ◽  
Health And Social Care ◽  
The Uk

Purpose Integrated care has been identified as essential to delivering the reforms required in health and social care across the UK and other healthcare systems. Given this suggests new ways of working for health and social care professionals, little research has considered how different professions manage and mobilise their professional identity (PI) whilst working in an integrated team. The paper aims to discuss these issues. Design/methodology/approach A qualitative cross-sectional study was designed using eight focus groups with community-based health and social care practitioners from across Wales in the UK during 2017. Findings Participants reported key factors influencing practice were communication, goal congruence and training. The key characteristics of PI for that enabled integrated working were open mindedness, professional trust, scope of practice and uniqueness. Blurring of boundaries was found to enable and hinder integrated working. Research limitations/implications This research was conducted in the UK which limits the geographic coverage of the study. Nevertheless, the insight provided on PI and integrated teams is relevant to other healthcare systems. Practical implications This study codifies for health and social care practitioners the enabling and inhibiting factors that influence PI when working in integrated teams. Originality/value Recommendations in terms of how healthcare professionals manage and mobilise their PI when working in integrated teams are somewhat scarce. This paper identifies the key factors that influence PI which could impact the performance of integrated teams and ultimately, patient care.

scholarly journals Early findings from the evaluation of the Integrated Care and Support Pioneers in England

2017 ◽  
Vol 25 (3) ◽  
pp. 137-149 ◽  
Author(s):  
Bob Erens ◽  
Gerald Wistow ◽  
Sandra Mounier-Jack ◽  
Nick Douglas ◽  
Tommaso Manacorda ◽  
...  
Keyword(s):  
Integrated Care ◽  
Social Care ◽  
Hospital Admissions ◽  
Early Stage ◽  
Qualitative Interviews ◽  
Long Term Conditions ◽  
Content Type ◽  
Health And Social Care ◽  
Local Actors ◽  
Barriers To Integration

Purpose Integrating health and social care is a priority in England, although there is little evidence that previous initiatives have reduced hospital admissions or costs. In total, 25 Integrated Care Pioneers have been established to drive change “at scale and pace”. The early phases of the evaluation (April 2014-June 2016) aimed to identify their objectives, plans and activities, and to assess the extent to which they have overcome barriers to integration. In the longer term, the authors will assess whether integrated care leads to improved outcomes and quality of care and at what cost. The paper aims to discuss these issues. Design/methodology/approach Mixed methods involving documentary analysis, qualitative interviews and an online key informant survey. Findings Over time, there was a narrowing of the integration agenda in most Pioneers. The predominant approach was to establish community-based multi-disciplinary teams focussed on (older) people with multiple long-term conditions with extensive needs. Moving from design to delivery proved difficult, as many barriers are outside the control of local actors. There was limited evidence of service change. Research limitations/implications Because the findings relate to the early stage of the 5+ years of the Pioneer programme (2014-2019), it is not yet possible to detect changes in services or in user experiences and outcomes. Practical implications The persistence of many barriers to integration highlights the need for greater national support to remove them. Originality/value The evaluation demonstrates that implementing integrated health and social care is not a short-term process and cannot be achieved without national support in tackling persistent barriers.

scholarly journals Can health and social care integration make long-term progress? Findings from key informant surveys of the integration Pioneers in England

2019 ◽  
Vol 28 (1) ◽  
pp. 14-26
Author(s):  
Bob Erens ◽  
Gerald Wistow ◽  
Nicholas Mays ◽  
Tommaso Manacorda ◽  
Nick Douglas ◽  
...  
Keyword(s):  
Integrated Care ◽  
Large Scale ◽  
Social Care ◽  
Community Health Services ◽  
Content Type ◽  
Barriers To Change ◽  
Health And Social Care ◽  
Wide Range ◽  
Key Informant ◽  
Care Systems

Purpose All areas in England are expected by National Health Service (NHS) England to develop integrated care systems (ICSs) by April 2021. ICSs bring together primary, secondary and community health services, and involve local authorities and the voluntary sector. ICSs build on previous pilots, including the Integrated Care Pioneers in 25 areas from November 2013 to March 2018. This analysis tracks the Pioneers’ self-reported progress, and the facilitators and barriers to improve service coordination over three years, longer than previous evaluations in England. The paper aims to discuss these issues. Design/methodology/approach Annual online key informant (KI) surveys, 2016–2018, are used for this study. Findings By the fourth year of the programme (2017), KIs had shifted from reporting plans to implementation of a wide range of initiatives. In 2018, informants reported fewer “significant” barriers to change than previously. While some progress in achieving local integration objectives was evident, it was also clear that progress can take considerable time. In parallel, there appears to have been a move away from aspects of personalised care associated with user control, perhaps in part because the emphasis of national objectives has shifted towards establishing large-scale ICSs with a particular focus on organisational fragmentation within the NHS. Research limitations/implications Because these are self-reports of changes, they cannot be objectively verified. Later stages of the evaluation will look at changes in outcomes and user experiences. Originality/value The current study shows clearly that the benefits of integrating health and social care are unlikely to be apparent for several years, and expectations of policy makers to see rapid improvements in care and outcomes are likely to be unrealistic.

Integrated care nursing in Canterbury, New Zealand

2016 ◽  
Vol 24 (3) ◽  
pp. 150-160 ◽  
Author(s):  
Lynne Wigens
Keyword(s):  
Integrated Care ◽  
Social Care ◽  
Health Care Systems ◽  
Positive Culture ◽  
Content Type ◽  
Nurse Leadership ◽  
Care Services ◽  
Health And Social Care ◽  
Care Systems ◽  
Travel Scholarship

Purpose – The purpose of this paper is to outline how nursing has contributed to the development of integrated care in an internationally recognised centre of excellence (Timmins and Ham, 2013). Design/methodology/approach – During a three-week travel scholarship the author undertook interviews, focus groups and observation and has reflected on this through three themes. These are: system working, nursing leadership and examples of integrated care in action. Findings – Elements of the Canterbury approach could have implications for other health care systems, e.g. New Care Models within England. Time was spent on developing the vision, involving many staff. Stability in the senior leadership team allowed decisions to be made in a collective, transformational way. Nurse leadership authenticity meant nursing staff saw integrated decision making being role modelled at a senior level and this appeared to empower them to operate in a similar way. Time was invested in redesign. Creating a positive culture where innovation was tried, without staff feeling the risks and challenges would not be supported by their leaders. Originality/value – This system worked most effectively where there was cohesion between health and social care, and strong relationships developed between leaders and staff working for different providers. The reflection includes practice examples of integrated care services in action. There is potential to inform integrated care developments within other health and social care systems, e.g. Vanguards within England.

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