Challenges in turning a great idea into great health policy: the case of integrated care

Raus, Kasper; Mortier, Éric; Eeckloo, Kristof

doi:10.1186/s12913-020-4950-z

Cited by 50 publications

(42 citation statements)

References 60 publications

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“…There are some descriptions of 'integration' as a coordination of structure and processes, while 'integrated care' describes the experiences of the patient and their outcomes and highlights the confusion around terminology in the literature [10,12]. Integration, both nationally and internationally, has to consider how integration is set up and this can range from organisations remaining separate but working in a co-ordinated way, to having a formal collaboration with the same governance or full integration where there is one single organisation [13]. Integration can involve different combinations of services [14] depending on whether it is focussing on specific conditions or wider general populations [15].…”

Section: Introductionmentioning

confidence: 99%

More that unites us than divides us? A qualitative study of integration of community health and social care services

et al. 2020

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Background: The integration of community health and social care services has been widely promoted nationally as a vital step to improve patient centred care, reduce costs, reduce admissions to hospital and facilitate timely and effective discharge from hospital. The complexities of integration raise questions about the practical challenges of integrating health and care given embedded professional and organisational boundaries in both sectors. We describe how an English city created a single, integrated care partnership, to integrate community health and social care services. This led to the development of 12 integrated neighbourhood teams, combining and co-locating professionals across three separate localities. The aim of this research is to identify the context and the factors enabling and hindering integration from a qualitative process evaluation. Methods: Twenty-four semi-structured interviews were conducted with equal numbers of health and social care staff at strategic and operational level. The data was subjected to thematic analysis. Results: We describe three key themes: 1) shared vision and leadership; 2) organisational factors; 3) professional workforce factors. We found a clarity of vision and purpose of integration throughout the partnership, but there were challenges related to the introduction of devolved leadership. There were widespread concerns that the specified outcome measures did not capture the complexities of integration. Organisational challenges included a lack of detail around clinical and service delivery planning, tensions around variable human resource practices and barriers to data sharing. A lack of understanding and trust meant professional workforce integration remained a key challenge, although integration was also seen as a potential solution to engender relationship building. Conclusions: Given the long-term national policy focus on integration this ambitious approach to integrate community health and social care has highlighted implications for leadership, organisational design and interprofessional working. Given the ethos of valuing the local assets of individuals and networks within the new partnership we found the integrated neighbourhood teams could all learn from each other. Many of the challenges of integration could benefit from embracing the inherent capabilities across the integrated neighbourhood teams and localities of this city.

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Section: Introductionmentioning

confidence: 99%

More that unites us than divides us? A qualitative study of integration of community health and social care services

et al. 2020

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“…Lack of resources is a major challenge to policy and service transformation targeting the integration of delivery of care and support across systems (Raus et al, 2020). In the current study, insufficient third sector resources were seen to constrain the use of signposting and timely discharge, the impact of which relied on adequate support in the community to promote accessibility.…”

Section: Discussionmentioning

confidence: 99%

The impact of a needs‐based model of care on accessibility and quality of care within children's mental health services: A qualitative investigation of the UK i‐THRIVE Programme

Farr

Moore

Bruffell

et al. 2021

Child

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Background The i‐THRIVE Programme is a needs‐based model of care, based on the THRIVE Framework, that is being implemented across the United Kingdom with the aim of improving outcomes for children and young people's mental health and wellbeing. This study aimed to investigate the impact that this programme has on accessibility and quality of care, as viewed by key stakeholders. Methods Interviews with professionals and service users were conducted during the implementation of the THRIVE Framework in four sites of one mental health and community service provider. Results Three themes are identified: ‘impact of needs‐based groupings on referral’, ‘impact of collaborative and interagency approach’ and ‘impact of i‐THRIVE on clinical practice’. Findings suggest that accessibility was seen to be promoted through the integration of a needs‐based approach, flexible re‐referral, signposting and information sharing, the use of goal‐orientated interventions and collaboration over risk and treatment endings. Shared decision making was perceived to improve the experience of care for young people, as was interagency working. Goal‐focused interventions and upfront discussion of treatment endings were seen to help clinicians manage expectations and discharge but could also compromise effectiveness and engagement. Obstacles to impact were resistance to interagency working and a shortage of resources across the system. Conclusions i‐THRIVE is a promising approach with the potential to facilitate the accessibility and quality of mental health care. However, a tension exists between enhancing accessibility and quality of care, which points towards the importance of outcome and satisfaction monitoring. Obstacles to impact point to the importance of a whole‐system approach supported by sufficient resources across the locality.

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Section: Introductionmentioning

confidence: 99%

More that unites us than divides us? A qualitative study of integration of community health and social care services

Mitchell¹,

orcid²,

Tazzyman³

et al. 2020

Preprint

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Background: The integration of community health and social care services has been widely promoted nationally as a vital step to improve patient centred care, reduce costs, reduce admissions to hospital and facilitate timely and effective discharge from hospital. The complexities of integration raise questions about the practical challenges of integrating health and care given embedded professional and organisational boundaries in both sectors. We describe how an English city created a single, integrated care partnership, to integrate community health and social care services. This led to the development of twelve integrated neighbourhood teams, combining and co-locating professionals across three separate localities. The aim of this research is to identify the context and the factors enabling and hindering integration from a qualitative process evaluation.Methods: Twenty-four semi-structured interviews were conducted with equal numbers of health and social care staff at strategic and operational level. The data was subjected to thematic analysis. Results: We describe three key themes: 1) shared vision and leadership; 2) organisational factors; 3) professional workforce factors. We found a clarity of vision and purpose of integration throughout the partnership, but there were challenges related to the introduction of devolved leadership. There were widespread concerns that the specified outcome measures did not capture the complexities of integration. Organisational challenges included a lack of detail around clinical and service delivery planning, tensions around variable human resource practices and barriers to data sharing. A lack of understanding and trust meant professional workforce integration remained a key challenge, although integration was also seen as a potential solution to engender relationship building. Conclusions: Given the long-term national policy focus on integration this ambitious approach to integrate community health and social care has highlighted implications for leadership, organisational design and inter-professional working. Given the ethos of valuing the local assets of individuals and networks within the new partnership we found the integrated neighbourhood teams could all learn from each other. Many of the challenges of integration could benefit from embracing the inherent capabilities across the integrated neighbourhood teams and localities of this city.

show abstract

Challenges in turning a great idea into great health policy: the case of integrated care

Cited by 50 publications

References 60 publications

More that unites us than divides us? A qualitative study of integration of community health and social care services

More that unites us than divides us? A qualitative study of integration of community health and social care services

The impact of a needs‐based model of care on accessibility and quality of care within children's mental health services: A qualitative investigation of the UK i‐THRIVE Programme

More that unites us than divides us? A qualitative study of integration of community health and social care services

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