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.

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.

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.

Elephant in the room

2019 ◽  
Vol 27 (1) ◽  
pp. 64-72 ◽  
Author(s):  
Martin William Fraser
Keyword(s):  
Social Care ◽  
Care Delivery ◽  
Care Staff ◽  
Professional Collaboration ◽  
Care Needs ◽  
Content Type ◽  
Health And Social Care ◽  
Joint Health ◽  
Collaborative Working ◽  
Integration Strategies

Purpose The purpose of this paper is to report on the findings of the first stage of a project seeking to evaluate and overcome inter-professional barriers between health and social care staff within a single, co-located, integrated community team. The project seeks to answer the following questions: first, Do inter-professional barriers to integrated working exist between health and social care staff at the interface of care delivery? Second, If inter-professional barriers exist, can joint health and social care assessments help to overcome them? The paper develops the current evidence base through findings from a staff questionnaire and the initial findings of a pilot study of joint health and social care assessments aimed at overcoming inter-professional barriers to integration. Design/methodology/approach The first stage of the project involved running an anonymous, online questionnaire with health and social care staff within a single, co-located community adult health and social care team. The questionnaire aimed to explore staffs’ perceptions of inter-professional collaboration when assessing the health and care needs of service users with a high degree of complexity of need. The second element of the study presents the initial findings of a small pilot of joint health and social care assessments. A second staff survey was used in order to provide a “before and after” comparative analysis and to demonstrate the effect of joint assessments on staffs’ perceptions of inter-professional collaboration at the interface of care delivery. Findings Health and social care staff value joint working as a means of improving quality of care. However, they also felt that inter-professional collaboration did not occur routinely due to organisational limitations. Staff members who participated in the pilot of joint assessments believed that this collaborative approach improved their understanding of other professional roles, was an effective means of enabling others to understand their own roles and helped to better identify the health and care needs of the most complex service users on their caseloads. Initial findings suggest that joint assessments may be a practical means of overcoming inter-professional barriers related to a lack of communication and lack of understanding of job roles. Practical implications The questionnaires highlighted the need for integration strategies that are aimed at facilitating collaborative working between staff of different professions, in order to achieve the aims of integration, such as a reduction in duplication of work and hand-offs between services. Originality/value To date, few studies have explored either staff perceptions of collaborative working or the effectiveness of joint assessments as a means of overcoming inter-professional barriers. This paper adds new data to an important area of integration that legislators and researchers increasingly agree requires more focus. Although the findings are limited due to the small scale of the initial pilot, they provide interesting and original data that will provide insight into future workforce integration strategies.

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.

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.

Going round in circles? Joint working between primary health and social care

2015 ◽  
Vol 23 (2) ◽  
pp. 53-61 ◽  
Author(s):  
Anna Coleman ◽  
Caroline Glendinning
Keyword(s):  
Social Services ◽  
Early Development ◽  
Large Scale ◽  
Social Care ◽  
Well Being ◽  
Early Years ◽  
Content Type ◽  
Care Groups ◽  
Health And Social Care ◽  
Operational Activities

Purpose – The purpose of this paper is to examine research evidence on collaboration between primary and adult social care in strategic, rather than operational, activities at two different time points, following large-scale changes within the health and social care environments; and discuss the prospects for the future. Design/methodology/approach – This paper reports evidence from two substantial longitudinal studies (Dowling and Glendinning, 2003; Checkland et al., 2012) which followed the development of Primary Care Groups and Trusts (PCG/Ts) and Clinical Commissioning Groups (CCGs), respectively. Each used a combination of national surveys and local in-depth case studies to trace the early development of new structures and ways of working following major changes in the NHS and local government. Findings – PCG/Ts had limited success in collaborating with adult social care partners. Health and Well-being Boards offer a new overarching organisational framework for collaborative strategic working between GP-led CCGs and adult social care services. Mandated joint strategic needs assessments also provide a shared framework within which commissioning decisions by both CCGs and social services are made. However, there remains evidence of long-standing barriers, particularly differences in geographic boundaries and in organisational and professional cultures. Research limitations/implications – Evidence from both studies is based on the early years of the respective new organisations; later evidence may have yielded a different picture. Originality/value – This is the first paper reflecting on developments in strategic relations between primary and social care from researchers involved with two longitudinal investigations of the early development of PCG/Ts (1999-2002) and CCGs (2011-ongoing).

scholarly journals Can we mandate partnership working? Top down meets bottom up in structural reforms in Scotland and Norway

2018 ◽  
Vol 26 (2) ◽  
pp. 109-119 ◽  
Author(s):  
Guro Øyen Huby ◽  
Ailsa Cook ◽  
Ralf Kirchhoff
Keyword(s):  
Performance Management ◽  
Large Scale ◽  
Social Care ◽  
Structural Reforms ◽  
Top Down ◽  
Bottom Up ◽  
Content Type ◽  
Care Organisation ◽  
Health And Social Care ◽  
Local Levels

Purpose Partnership working across health and social care is considered key to manage rising service demand whilst ensuring flexible and high-quality services. Evidence suggests that partnership working is a local concern and that wider structural context is important to sustain and direct local collaboration. “Top down” needs to create space for “bottom up” management of local contingency. Scotland and Norway have recently introduced “top down” structural reforms for mandatory partnerships. The purpose of this paper is to describe and compare these policies to consider the extent to which top-down approaches can facilitate effective partnerships that deliver on key goals. Design/methodology/approach The authors compare Scottish (2015) and Norwegian (2012) reforms against the evidence of partnership working. The authors foreground the extent to which organisation, finance and performance management create room for partnerships to work collaboratively and in new ways. Findings The two reforms are held in place by different health and social care organisation and governance arrangements. Room for manoeuvre at local levels has been jeopardised in both countries, but in different ways, mirroring existing structural challenges to partnership working. Known impact of the reforms hitherto suggests that the potential of partnerships to facilitate user-centred care may be compromised by an agenda of reducing pressure on hospital resources. Originality/value Large-scale reforms risk losing sight of user outcomes. Making room for collaboration between user and services in delivering desired outcomes at individual and local levels is an incremental way to join bottom up to top down in partnership policy, retaining the necessary flexibility and involving key constituencies along the way.

A journey towards integrated person-centred care: a case study of a mental health perspective in the voluntary sector

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Louise Kermode
Keyword(s):  
Mental Health ◽  
Best Practice ◽  
Care Delivery ◽  
Voluntary Sector ◽  
Assessment Tools ◽  
Valuable Insight ◽  
Physical And Mental Health ◽  
Content Type ◽  
Health And Social Care

PurposePerson-centred care is a fundamental component of any service. This case study aims to explore the delivery of person-centred care in the voluntary sector, discussing how integrating support can be achieved to benefit individuals. It identifies challenges, best practice and learning that can be applied across sectors and promotes further enquiry.Design/methodology/approachThis case study is the result of a service audit at a mental health charity. The findings are a blend of reflections, observations and examples from service delivery, synthesised with national policy to provide evidence of best practice and processes that enable person-centred care.FindingsA focus on need not diagnosis, creating accessible and inclusive services, employing dual trained practitioners, having a varied skill mix along with holistic self-assessment tools are all enablers for integrated person-centred support. Multi-agency assessment frameworks, collaboration across services, cross-agency supervision and a shared vision for integration and person-centred care support services to coordinate more effectively. Barriers to integrated person-centred support include complex physical and mental health needs and harmful risk and safeguarding. The diversity of the voluntary sector, a lack of resources along with complex and competitive funding also hinder integration.Originality/valueThis case study provides a valuable insight into the voluntary sector and shares its findings to enhance best practice. It aims to promote interest and invites further research into health and social care delivery by the voluntary sector. As this delivery continues to increase, it is vital to examine the interface between the voluntary and statutory sector. Through better understanding and further research across all sectors, the author can identify how they can achieve person-centred outcomes and deliver the national policies.

Is co-production working well in recovery colleges? Emergent themes from a systematic narrative review

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Karen Louise Bester ◽  
Anne McGlade ◽  
Eithne Darragh
Keyword(s):  
Mental Health ◽  
Lived Experience ◽  
Social Care ◽  
The Body ◽  
Bibliographic Databases ◽  
Service Users ◽  
Content Type ◽  
Practitioner Attitudes ◽  
Health And Social Care ◽  
The Impact

Purpose “Co-production” is a process in health and social care wherein service users and practitioners work in partnership. Recovery colleges (RCs) are educational establishments offering mental health education; a cornerstone feature is that courses are designed and delivered in parity by both mental health practitioners and “peers” – people with lived experience of mental illness. This paper aims to consider, through the identification of key themes, whether co-production within RCs is operating successfully. Design/methodology/approach The paper is a systematic review of qualitative literature. Relevant concept groups were systematically searched using three bibliographic databases: Medline, Social Care Online and Scopus. Articles were quality appraised and then synthesised through inductive thematic analysis and emergent trends identified. Findings Synthesis identified three key themes relating to the impact of co-production in RCs: practitioner attitudes, power dynamics between practitioners and service users, and RCs’ relationships with their host organisations. As a result of RC engagement, traditional practitioner/patient hierarchies were found to be eroding. Practitioners felt they were more person-centred. RCs can model good co-productive practices to their host organisations. The review concluded, with some caveats, that RC co-production was of high fidelity. Originality/value RC research is growing, but the body of evidence remains relatively small. Most of what exists examine the impact of RCs on individuals’ overall recovery and mental health; there is a limited empirical investigation into whether their flagship feature of parity between peers and practitioners is genuine.

Trauma-informed servant leadership in health and social care settings

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Daryl Mahon
Keyword(s):  
Servant Leadership ◽  
Conceptual Model ◽  
Social Care ◽  
Large Body ◽  
Well Being ◽  
Service Users ◽  
Content Type ◽  
Starting Point ◽  
Health And Social Care ◽  
Trauma Informed

Purpose Practitioners, organisations and policy makers in health and social care settings are increasingly recognising the need for trauma-informed approaches in organisational settings, with morbidity and financial burdens a growing concern over the past few years. Servant leadership has a unique focus on emotional healing, service to others as the first priority, in addition to the growth, well-being and personal and professional development of key stakeholders. This paper aims to discuss Trauma Informed Servant Leadership (TISL). Design/methodology/approach A targeted review of the servant leadership and trauma-informed care literature was conducted. Relevant studies, including systematic review and meta-analysis, were sourced, with the resulting interpretation informing the conceptual model. Findings Although there are general guidelines regarding how to go about instituting trauma-informed approaches, with calls for organisational leadership to adapt the often cited six trauma-informed principles, to date there has not been a leadership approach elucidated which takes as its starting point and core feature to be trauma informed. At the same time, there is a paucity of research elucidating trauma outcomes for service users or employees in the literature when a trauma-informed approach is used. However, there is a large body of evidence indicating that servant leadership has many of the outcomes at the employee level that trauma-informed approaches are attempting to attain. Thus, the author builds on a previous conceptual paper in which a model of servant leadership and servant leadership supervision are proposed to mitigate against compassion fatigue and secondary trauma in the health and social care sector. The author extends that research to this paper by recasting servant leadership as a trauma-informed model of leadership that naturally operationalises trauma-informed principles. Research limitations/implications A lack of primary data limits the extent to which conclusions can be drawn on the effectiveness of this conceptual model. However, the model is based on robust research across the differential components used; therefore, it can act as a framework for future empirical research designs to be studies at the organisational level. Both the servant leadership and trauma-informed literatures have been extended with the addition of this model. Practical implications TISL can complement the trauma-informed approach and may also be viable as an alternative to trauma-informed approaches. This paper offers guidelines to practitioners and organisations in health and social care on how to operationalise important trauma-informed principles through leadership. Social implications This conceptual model may help reduce the burden of trauma and re-traumatisation encountered by practitioners and service users in health and social care settings, impacting on morbidity. Originality/value To the best of the author’s knowledge, this is a novel approach, the first of its kind.

Sign in / Sign up

Export Citation Format

Share Document