AimTo understand what contextual influences, mechanisms and outcomes affect the implementation and use of localised, online care pathways (HealthPathways) in primary and secondary care.Design and procedureMixed-measures design. Quantitative data included number of page views and conditions viewed. Qualitative data from semistructured interviews and focus groups were gathered over a 6-month period, and analysed using NVivo software.SettingThe first HealthPathways UK site, South Tyneside, England.ParticipantsGeneral practitioners, nurses, practice managers, hospital consultants and system leaders (managers, commissioners) (n=76).ResultsUse of the pathways significantly increased over time. Themes were developed showing how online care pathways were used—leadership, pre-existing networks and relationships; development of systems and processes for care pathways, the use of online care pathways to support decision-making and referral, and perceived availability of resources. Inter-related themes were arranged into configurations consisting of contextual influences, mechanisms and outcomes. Recommendations were made for future implementations, such as improved data collection processes to understand how and why there was variance in the use of pathways.ConclusionsThis study was early in the implementation process; however, emerging themes will facilitate the future implementation and use of online care pathways. Recommendations are made for further research to include other health and social care users and patients to inform future developments.

PurposeThe aim of this action research was to explore, from a workforce and a patient/carer perspective, the skills and the capacity required to deliver integrated care and to inform future workforce development and planning in a new integrated care system in England.Design/methodology/approachSemi-structured interviews and focus groups with primary, community, acute care, social care and voluntary care, frontline and managerial staff and with patients and carers receiving these services were undertaken. Data were explored using framework analysis.FindingsAnalysis revealed three overarching themes: achieving teamwork and integration, managing demands on capacity and capability and delivering holistic and user-centred care. An organisational development (OD) process was developed as part of the action research process to facilitate the large-scale workforce changes taking place.Research limitations/implicationsThis study did not consider workforce development and planning challenges for nursing and care staff in residential, nursing care homes or domiciliary services. This part of the workforce is integral to the care pathways for many patients, and in line with the current emerging national focus on this sector, these groups require further examination. Further, data explore service users' and carers' perspectives on workforce skills. It proved challenging to recruit patient and carer respondents for the research due to the nature of their illnesses.Practical implicationsMany of the required skills already existed within the workforce. The OD process facilitated collaborative learning to enhance skills; however, workforce planning across a whole system has challenges in relation to data gathering and management. Ensuring a focus on workforce development and planning is an important part of integrated care development.Social implicationsThis study has implications for social and voluntary sector organisations in respect of inter-agency working practices, as well as the identification of workforce development needs and potential for informing subsequent cross-sector workforce planning arrangements and communication.Originality/valueThis paper helps to identify the issues and benefits of implementing person-centred, integrated teamworking and the implications for workforce planning and OD approaches.

The clinical experience of a student radiographer has traditionally been recorded in a paper log book. Accurate maintenance of the book relied upon the student's diligence. The electronic logbook is a method of accurately recording the clinical experience of the student radiographer by retrieval of information from the database of a hospital information or radiology management system. The system requires minimal software modification in order to incorporate fields defining the ability of the student in association with the degree of infirmity of the patient. Retrieved information is processed by a specially designed software package at the Academic Centre and reports issued to Clinical Tutors. Benefits of the system include easy monitoring of student workload, ensuring that the student receives a wide and varied experience during training; improvement in student motivation; and use of a final report form in the student's portfolio.

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