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.

Achieving integrated care through CAS thinking and a collaborative mindset

2015 ◽  
Vol 23 (3) ◽  
pp. 108-119 ◽  
Author(s):  
Lars Edgren ◽  
Keith Barnard
Keyword(s):  
Integrated Care ◽  
Complex Adaptive Systems ◽  
Adaptive Systems ◽  
Conceptual Analysis ◽  
Research Review ◽  
Intended Audience ◽  
Content Type ◽  
Health And Social Care ◽  
Complex Adaptive ◽  
Key Aspects

Purpose – The purpose of this paper is to contribute to knowledge by exploring and distilling how providers in health and social care who have adopted complex adaptive systems thinking (CAS thinking) and have a collaborative mindset are in a better position to achieve integrated care than those who adopt reductionist approaches. Design/methodology/approach – This paper is a research review and a conceptual analysis of key aspects drawn from the literature on CAS thinking and collaborative mindset applied to integrated care. By choosing this approach the authors intend to promote understanding and efforts made to put it into action. The intended audience comprises managers responsible for addressing the problem of fragmentation and the research community challenged by the task of supporting those managers. Findings – Specialization of knowledge and skill has increased the risk of fragmentation. It is possible to reduce that risk and hence to foster integrated care when providers with different specializations stimulated by a collaborative mindset develop an understanding of how they connect with others in a CAS. The essence of CAS thinking applied to integrated care is the readiness to connect. This readiness is facilitated by adopting a collaborative mindset. Originality/value – Literature on CAS thinking and collaborative mindset have evolved independently of one another. The study points at the importance of connecting the two concepts to produce effective action.

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.

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.

Strategy in the era of “swans”: the role of strategic leadership under uncertainty and unpredictability

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Henry Adobor ◽  
William Phanuel Kofi Darbi ◽  
Obi Berko O. Damoah
Keyword(s):  
Mental Models ◽  
Complex Adaptive Systems ◽  
Adaptive Systems ◽  
Strategic Leadership ◽  
Content Type ◽  
Complexity Leadership ◽  
Complex Adaptive ◽  
Strategic Leaders ◽  
Impact Events

PurposeThe purpose of this conceptual paper is to explore the role of strategic leadership under conditions of uncertainty and unpredictability. The authors argue that highly improbable, but high-impact events require the upper echelons of management, traditionally the custodians of strategy formulation to offer a new kind of strategic leadership focused on new mindsets, organizational capabilities, more in tune with high uncertainty and unpredictability.Design/methodology/approachDrawing on strategic leadership, and complexity leadership theory, the authors review the literature and present a conceptual framework for exploring the nature of strategic leadership under uncertainty. The authors conceptualize organizations as complex adaptive systems and discuss the imperatives for developing new mental models for emergent leadership.FindingsStrategic leaders have a key role to play in preparing their organizations for episodic disruptions. These include developing their adaptive capabilities and building resilient organizations to ensure their organizations cannot only bounce back after a disruption but have the capacity for transformation to new fitness levels when necessary. Strategic leaders must engage with complexity leadership by seeing their organizations as complex adaptive systems, reconfigure their leadership approaches and organizations to build strategic adaptive capability.Research limitations/implicationsThis is a conceptual paper and the authors cannot make any claims of causality.Practical implicationsOrganizational leaders need to reconfigure their mental models and leadership approaches to reflect the new normal of uncertainty and unpredictability. Developing the strategic adaptive capability of organizations should prepare them for dealing with high impact events. To assure business continuity in the face of disruptions requires building flexible, adaptable business models.Originality/valueThe paper focuses on how managers can offer strategic leadership for a new normal that challenges some of our most cherished leadership and strategic management paradigms. The authors explore the new mental models and leadership models in an era of great uncertainty.

scholarly journals Smallholder value chains as complex adaptive systems: a conceptual framework

2018 ◽  
Vol 8 (1) ◽  
pp. 14-33 ◽  
Author(s):  
Alastair Orr ◽  
Jason Donovan ◽  
Dietmar Stoian
Keyword(s):  
Conceptual Framework ◽  
Complex Adaptive Systems ◽  
Value Chain ◽  
Adaptive Systems ◽  
Initial Conditions ◽  
Sudden Change ◽  
Value Chains ◽  
Limited Attention ◽  
Content Type ◽  
Complex Adaptive

Purpose Smallholder value chains are dynamic, changing over time in sudden, unpredictable ways as they adapt to shocks. Understanding these dynamics and adaptation is essential for these chains to remain competitive in turbulent markets. Many guides to value chain development, though they focus welcome attention on snapshots of current structure and performance, pay limited attention to the dynamic forces affecting these chains or to adaptation. The paper aims to discuss these issues. Design/methodology/approach This paper develops an expanded conceptual framework to understand value chain performance based on the theory of complex adaptive systems. The framework combines seven common properties of complex systems: time, uncertainty, sensitivity to initial conditions, endogenous shocks, sudden change, interacting agents and adaptation. Findings The authors outline how the framework can be used to ask new research questions and analyze case studies in order to improve our understanding of the development of smallholder value chains and their capacity for adaptation. Research limitations/implications The framework highlights the need for greater attention to value chain dynamics. Originality/value The framework offers a new perspective on the dynamics of smallholder value chains.

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.

How can a municipal government continue operations during megadisasters? An analysis of preparedness using complex adaptive systems

2020 ◽  
Vol 29 (5) ◽  
pp. 779-792
Author(s):  
Masahiko Haraguchi
Keyword(s):  
Public Sector ◽  
Complex Adaptive Systems ◽  
Local Governments ◽  
Adaptive Systems ◽  
Municipal Government ◽  
Theory And Practice ◽  
Content Type ◽  
The Public ◽  
Continuity Planning ◽  
Complex Adaptive

PurposeThis paper aims to examine how government continuity planning contributes to strengthening the public sector's emergency preparedness, resulting in enhanced resilience of the public sector. Government continuity plans (GCPs) are a recently focused concept in disaster preparedness, compared to business continuity plans (BCPs) in the private sector. The need for BCPs was widely recognized after the 2011 Great East Japan Earthquake (GEJE) and the 2011 Thailand Floods. However, recent disasters, such as the 2016 Kumamoto Earthquake in Japan, have revealed that local governments without effective GCPs were severely affected by disasters, preventing them from quickly responding to or recovering from disasters. When the GEJE occurred in 2011, only 11% of municipal governments in Japan had GCPs.Design/methodology/approachThe paper analyzes basic principles of government continuity planning using complex adaptive systems (CAS) theory while summarizing recent developments in theory and practice of government continuity planning.FindingsThis research investigates the Japanese experience of GCPs using self-organization, one of the concepts of CAS. A GCP will complement regional disaster plans, which often focus on what governments should do to protect citizens during emergencies but fail to outline how governments should prepare for an emergency operation. The study concludes that GCPs contribute to increased resilience among the public sector in terms of robustness, redundancy, resourcefulness and rapidity.Practical implicationsThis paper includes implications for the development and improvement of a GCP's operational guideline.Originality/valueThis research fulfills an identified need to investigate the effectiveness of a GCP for resilience in the public sector and how to improve its operation using concepts of CAS.

scholarly journals The viable decision maker for CAS survival: how to change and adapt through fitting process

2017 ◽  
Vol 27 (5) ◽  
pp. 1006-1023 ◽  
Author(s):  
Luca Carrubbo ◽  
Francesca Iandolo ◽  
Valentina Pitardi ◽  
Mario Calabrese
Keyword(s):  
Decision Making ◽  
Decision Maker ◽  
Complex Adaptive Systems ◽  
Adaptive Systems ◽  
Organizational Design ◽  
Decision Making Process ◽  
Theoretical Frameworks ◽  
General Process ◽  
Content Type ◽  
Complex Adaptive

Purpose The purpose of this paper is to investigate the decision-making process in the management of the complex adaptive systems (CAS), particularly focusing on the dimensions that affect the individual decision maker (DM) when passing from decision to behavior in fitting processes. Although the importance of the general process of fitting in terms of organizational design has been highlighted in earlier studies, a closer focus on the DM perspective is required. Design/methodology/approach Starting from the theoretical frameworks of viable systems approach (vSa) and addressing the evolving concepts of change and adaptation in CAS, the work takes the DM perspective and investigates the dimensions involved in the paths that lead complex decisions into behaviors, when referring to fitting processes. The paper reviews the vSa and the concept of CAS, deepening the decision making in fitting processes. Then, the paper proceeds to discuss the schemes and the categories that affect, at different levels, the decision and behavioral choices by proposing an interpretative framework. Findings The paper proposes a general framework useful to recognize/identify which are the elements/dimensions that have to be considered when organizations change in pursuing survival. The findings of the paper also show how adopting a vSa as a meta-model can be insightful to the understanding of service systems and useful in fully comprehending decision-making processes and behavior in complex adaptive system. Originality/value The originality of this paper lies in exploring the decision making process in CAS, adopting a closer perspective on the single DM through the lens of the vSa.

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.

The Dynamics of Risk

2019 ◽  
Author(s):  
Louise K. Comfort
Keyword(s):  
Complex Adaptive Systems ◽  
Seismic Risk ◽  
Adaptive Systems ◽  
Large Scale ◽  
Complex Societies ◽  
Complex Adaptive ◽  
Shared Awareness ◽  
Response And Recovery ◽  
Global Threat ◽  
Post Disaster

Earthquakes are a huge global threat. In thirty-six countries, severe seismic risks threaten populations and their increasingly interdependent systems of transportation, communication, energy, and finance. This book provides an examination of how twelve communities in nine countries responded to destructive earthquakes between 1999 and 2015. And many of the book's lessons can also be applied to other large-scale risks. The book sets the global problem of seismic risk in the framework of complex adaptive systems to explore how the consequences of such events ripple across jurisdictions, communities, and organizations in complex societies, triggering unexpected alliances but also exposing social, economic, and legal gaps. It assesses how the networks of organizations involved in response and recovery adapted and acted collectively after the twelve earthquakes it examines. It describes how advances in information technology enabled some communities to anticipate seismic risk better and to manage response and recovery operations more effectively, decreasing losses. Finally, the book shows why investing substantively in global information infrastructure would create shared awareness of seismic risk and make post-disaster relief more effective and less expensive. The result is a landmark study of how to improve the way we prepare for and respond to earthquakes and other disasters in our ever-more-complex world.

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