Factors that promote and hinder joint and integrated working between health and social care services: a review of research literature

Cameron, Ailsa M; Lart, Rachel A; Bostock, Lisa; Coomber, Caroline

doi:10.1111/hsc.12057

Cited by 198 publications

(310 citation statements)

References 38 publications

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“…Several factors were identified that could help integration, many of which have also been reported elsewhere, 69,92 for example co-location of services and or/practitioners, 1,92,93 aligned administrative systems and financial arrangements; 41,[94][95][96] shared IT systems 97,98 and shared outcome indicators.…”

Section: Chapter 7 Discussionmentioning

confidence: 70%

Outcomes assessment for people with long-term neurological conditions: a qualitative approach to developing and testing a checklist in integrated care

Aspinal

Bernard

Spiers

et al. 2014

Health Services and Delivery Research

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BackgroundFailure to demonstrate the effect of integration on service users using conventional outcome measures suggests that research to date has failed to measure the outcomes that actually matter to people with complex long-term conditions and that might result from integrated health and social care. Developing outcome measures that capture the important issues for service users may also help to better reflect the particular ways integrated teams work and what such teams strive to achieve in addressing service user outcomes.ObjectivesThe objectives of this research were to (1) identify factors that affect integration between health and social care; (2) identify outcomes important to people with long-term neurological conditions (LTNCs) who are clients of an ‘integrated’ service; (3) develop these outcomes into a checklist and explore whether or not these outcomes can be assessed in practice; and (4) understand how different models of integration affect outcomes.Design, methods and participantsA case study approach, using in-depth, semistructured interviews, was adopted. The cases were four English primary care trusts (PCTs) and their associated local authorities. Case sites had a neurological-rehabilitation team (NRT), each with a different approach to health and social care integration. The research took place in three stages. In stage 1, interviews with 43 commissioners, managers, NRT staff and social care practitioners, and documentary analysis, helped to understand service contexts and approaches to assessment. Interviews, guided by earlier outcomes work, were held with 35 people with LTNCs to identify important outcomes. Interviews with 13 carers illustrated relationships between NRTs and carers. In stage 2, these outcomes were developed into a checklist in partnership with NRTs. NRTs used the outcomes checklist (OC) as part of their routine assessment, and we monitored its use. In stage 3, we conducted interviews and focus groups with 21 NRT staff and 12 clients to evaluate the use of the OC in practice.AnalysisQualitative data were managed and analysed thematically using the framework approach.ResultsPerson, service and structural-level factors influenced integration between health and social care. Relationships between practitioners and services often drove integration in practice. However, wider structural arrangements were important and could facilitate these relationships. We identified 20 outcomes important to people with LTNCs. These were grouped into three outcome domains: personal comfort, economic and social participation, and autonomy. Use of the OC in practice was viewed differently by the NRTs. One NRT felt that it duplicated existing assessments, one felt that it covered issues outside their remit and two felt that the OC worked for them. Some of the outcomes could be difficult for staff and clients to raise but clients felt that they should all be included in assessments. Use of the OC was sometimes challenging due to staffing and caseload pressures, changes to service structures and remit, and competing demands of other compulsory paperwork. All NRTs thought that the OC had potential value as a benchmarking or training tool. Larger, more interdisciplinary models of integrated NRTs appeared to give more scope for interpreting, assessing and potentially achieving outcomes.ConclusionsMany of the outcomes that are important to service users with LTNCs are not addressed in validated ‘outcome measures’. This has implications for commissioners and practitioners to ensure that service users’ needs are met in practice. Turning the OC into a measurement tool could go some way to addressing this. Many of the outcomes are interdependent; an impact on one particular outcome will have a ‘knock-on’ effect on other outcomes. These inter-relationships demonstrate the complexity of what is important in the lives of people with LTNCs. Service changes can affect integrated arrangements negatively. More research is needed to explore the longer-term effects of organisational change on integrated service provision.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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Section: Chapter 7 Discussionmentioning

confidence: 70%

Outcomes assessment for people with long-term neurological conditions: a qualitative approach to developing and testing a checklist in integrated care

Aspinal

Bernard

Spiers

et al. 2014

Health Services and Delivery Research

View full text Add to dashboard Cite

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“…It is acknowledged in the literature that there are various approaches to integration and that no-one model is universally applicable (Curry and Ham, 2010) but that multiple factors contribute to its success.…”

Section: Literature Reviewmentioning

confidence: 99%

“…The facilitators and barriers to integrated care and integrated team working being well documented (Hudson, 2006a; Hudson, 2006b; Morrow et al, 2005; Syson and Bond, 2010; Tucker, 2010Cameron and Lart, 2003;Cameron et al, 2012) with many of these appearing to reflect different dimensions of culture. Kodner (2002) described integration as a culture rather than structure:…”

Section: Literature Reviewmentioning

confidence: 99%

Implementing Care Aims in an integrated team

Waterworth

Willcocks²,

Selfe

et al. 2015

British Journal of Healthcare Management

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This article reports the findings of a pilot study exploring the impact of implementing Care Aims in an integrated community health team. It describes the main findings and discusses the factors which appeared to impact on the implementation and use of the Care Aims approach in these teams.Care Aims is increasingly being used as a model of care within NHS services, particularly by Allied Health Professionals. The model has been traditionally used in uni-professional teams rather than integrated teams.This case study suggests Care Aims has potential to support integrated team working. In this study clinicians perceived Care Aims was a model that could improve care for patients, support professionals working together and support self-management. However it is unclear whether it was Care Aims itself or the training and discussion that took place that enabled this team to develop and agree more consistent working practices.Similar to previous studies, this study has shown how team and professional culture can influence how team members work together and provide care in an integrated way. Team and professional cultures Page 2 of 23 are also shown to influence how team members approach and embrace that change. As such Care Aims may be more challenging to some staff groups to implement. IntroductionIntegrated care continues to be a priority particularly for older people with multiple morbidities. Key messages in a recent report by Goodwin et al (2014) included that the starting point should be a clinical/service model designed to improve care for people; professionals needing to work together in multidisciplinary teams (with clearly defined roles) and that success is more likely if there is a specific focus on working with individuals and informal carers to support self-management.Care Aims is increasingly being used as a model of care within NHS services, particularly by Allied Health Professionals. Care Aims is a model of practice developed by Kate Malcomess (Malcomess, 2005a) which is designed to support clinicians demonstrate evidence-based practice through systematic reflection. Care Aims focuses on the impact and outcomes of care and requires clinicians to identify their main reason for intervening.This study offers a new approach to studying Care Aims in the context of integrated care as opposed to previous work which has been undertaken in uni-professional services such as Speech and Language Therapy and Learning Disabilities.The authors wanted to understand the impact of Care Aims on integrated team working and explore whether Care Aims had the potential to facilitate integrated team working as there appeared to be Page 3 of 23 parallels between Care Aims and some of the key messages supporting integrated team working and care.This paper reports the results of a pilot case study that is part of a wider research project exploring the effect of culture and context on integrated team working for allied health professionals working in primary care settings.There are many definitions of integrated team work...

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“…IRISS suggest that the 'emphasis should be on service integration rather than on organisational integration' (p. 10). Again, much of the research has focused on processes not outcomes and Cameron et al (2012) conclude:…”

Section: The Multi-disciplinary Environmentmentioning

confidence: 99%

Social work: a profession in flux

Daniel

2013

Journal of Workplace Learning

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PurposeThe purpose of this paper is to describe the current context of social work as a profession and some of the major transition factors that are affecting social workers and social work organisations.Design/methodology/approachThe paper first explores what social work is, and how it has developed as a profession. It reflects on social work academia and the place of social work educators and researchers. It then goes on to consider three factors that are having a major influence on social work as a profession: concepts of risk; personalisation; and the multi‐disciplinary environment.FindingsThe implications of these factors and the kind of transitions they are driving are discussed in the context of some of the potential implications for professional learning.Research limitations/implicationsThe paper does not aim to provide a comprehensive overview of all the factors that are affecting contemporary social work – the aim is to offer contextual information to help the reader consider some of the forces at play in social work. The paper does not introduce new empirical evidence, rather it identifies gaps in the existing evidence about these key influential factors.Social implicationsThe implications of social work in transition for society are that efficacy may be impeded if the profession is too inward looking.Originality/valueThis paper draws from the empirical and conceptual work of others – here the aim is to provide a broad overall context within which to consider the more detailed implications set out in further papers in the present issue.

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Factors that promote and hinder joint and integrated working between health and social care services: a review of research literature

Cited by 198 publications

References 38 publications

Outcomes assessment for people with long-term neurological conditions: a qualitative approach to developing and testing a checklist in integrated care

Outcomes assessment for people with long-term neurological conditions: a qualitative approach to developing and testing a checklist in integrated care

Implementing Care Aims in an integrated team

Social work: a profession in flux

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