1
|
Obi C, Ojiakor I, Etiaba E, Onwujekwe O. Collaborations and Networks Within Communities for Improved Utilization of Primary Healthcare Centers: On the Road to Universal Health Coverage. Int J Public Health 2024; 69:1606810. [PMID: 38887723 PMCID: PMC11180759 DOI: 10.3389/ijph.2024.1606810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 05/20/2024] [Indexed: 06/20/2024] Open
Abstract
Objectives Community involvement depends on the level of linked and targeted activities for health by community members. This study examines the collaborations employed within communities to ensure sustainable access and improved use of healthcare in the community. Methods This study was conducted in rural and urban local government areas in Anambra, Kano, and Akwa-Ibom, Nigeria. About 90 in-depth interviews and 12 focus group discussions were conducted with community stakeholders and service users. The findings were transcribed and coded via thematic analysis, guided by the Expanded Health Systems framework. Results Various horizontal collaborations in communities foster increased use of PHC services; promoting community health. Major horizontal collaborations in these communities were community-led, primary health facility-led, and Individual-led collaborations. Their actions revolved around advocacy, building and renovating PHC centers, equipping facilities, and sensitization to educate community members on the need to utilize services at PHC centers. Conclusion Strategic involvements and collaborations of local actors within communities give rise to improvements in the utilization of primary healthcare centres, reportedly resulting in improved access to PHC healthcare services for community members.
Collapse
Affiliation(s)
- Chinelo Obi
- Health Policy Research Group, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria
| | - Iheomimichineke Ojiakor
- Health Policy Research Group, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria
| | - Enyi Etiaba
- Health Policy Research Group, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria
- Department of Health Administration and Management, Faculty of Health Science and Technology, University of Nigeria, Enugu, Nigeria
| | - Obinna Onwujekwe
- Health Policy Research Group, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria
- Department of Health Administration and Management, Faculty of Health Science and Technology, University of Nigeria, Enugu, Nigeria
| |
Collapse
|
2
|
Sormunen E, Pesonen S, Toivio P, Nissinen S. Characteristics of Multiprofessional and Client-Oriented Approach in Occupational Health Services: A Cross-Sectional Survey Among Occupational Health Professionals. J Multidiscip Healthc 2024; 17:2121-2132. [PMID: 38736538 PMCID: PMC11082555 DOI: 10.2147/jmdh.s454138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 04/08/2024] [Indexed: 05/14/2024] Open
Abstract
Background Multiprofessional and client-oriented approaches are considered key factors for successful occupational health services, and for impressive occupational health cooperation between a client organisation and occupational health service provider. The purpose of this study was to find out the views of occupational health physicians, occupational health nurses, occupational physiotherapists, and occupational health psychologists about multiprofessional and client-oriented working methods. These working methods describe the guidelines for good occupational health practice in Finland, also serving the framework of the present study. Material and Methods The survey was conducted in May and June 2022. The data consisted of answers to open-ended questions of a larger questionnaire. The data was analysed with the method of theory-related thematic analysis. Seven occupational health service providers committed to the study. Altogether 121 professionals responded to the question surveying the multiprofessional approach, and 119 professionals responded to the question of client-oriented approach. Results The results showed that both the multiprofessional and client-oriented approaches are closely related to each other, and the views of these approaches are in line with the good occupational health practice. Multiprofessional approach was most commonly described with the theme of sharing expertise. Respectively, the theme of smooth cooperation most commonly described the client-oriented approach. At its best, the answers showed that a multiprofessional working strategy takes into account the expertise of different professionals so that the client can be offered high-quality, accurate content and timely occupational health services. Conclusion The results provide up-to-date information on working strategies of occupational health services in Finland. The results can be used in further development of multiprofessional and client-oriented work in occupational health services.
Collapse
Affiliation(s)
- Erja Sormunen
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - Sanna Pesonen
- Finnish Institute of Occupational Health, Helsinki, Finland
| | | | - Sari Nissinen
- Finnish Institute of Occupational Health, Helsinki, Finland
| |
Collapse
|
3
|
Vijayasingham L, Ansbro É, Zmeter C, Abbas LA, Schmid B, Sanga L, Larsen LB, Perone SA, Perel P. Implementing and evaluating integrated care models for non-communicable diseases in fragile and humanitarian settings. J Migr Health 2024; 9:100228. [PMID: 38577626 PMCID: PMC10992697 DOI: 10.1016/j.jmh.2024.100228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 03/08/2024] [Accepted: 03/26/2024] [Indexed: 04/06/2024] Open
Abstract
In this commentary, we advocate for the wider implementation of integrated care models for NCDs within humanitarian preparedness, response, and resilience efforts. Since experience and evidence on integrated NCD care in humanitarian settings is limited, we discuss potential benefits, key lessons learned from other settings, and lessons from the integration of other conditions that may be useful for stakeholders considering an integrated model of NCD care. We also introduce our ongoing project in North Lebanon as a case example currently undergoing parallel tracks of program implementation and process evaluation that aims to strengthen the evidence base on implementing an integrated NCD care model in a crisis setting.
Collapse
Affiliation(s)
- Lavanya Vijayasingham
- NCD in Humanitarian Settings Group, Department of Epidemiology and Population Health & Centre for Global Chronic Conditions, London School of Hygiene & Tropical Medicine, United Kingdom
| | - Éimhín Ansbro
- NCD in Humanitarian Settings Group, Department of Epidemiology and Population Health & Centre for Global Chronic Conditions, London School of Hygiene & Tropical Medicine, United Kingdom
| | - Carla Zmeter
- Beirut Delegation, International Committee for the Red Cross (ICRC) Beirut, Lebanon
| | - Linda Abou Abbas
- Beirut Delegation, International Committee for the Red Cross (ICRC) Beirut, Lebanon
| | - Benjamin Schmid
- NCD in Humanitarian Settings Group, Department of Epidemiology and Population Health & Centre for Global Chronic Conditions, London School of Hygiene & Tropical Medicine, United Kingdom
| | - Leah Sanga
- NCD in Humanitarian Settings Group, Department of Epidemiology and Population Health & Centre for Global Chronic Conditions, London School of Hygiene & Tropical Medicine, United Kingdom
| | | | - Sigiriya Aebischer Perone
- International Committee for the Red Cross (ICRC), Geneva, Switzerland
- Geneva University Hospitals, Geneva, Switzerland
| | - Pablo Perel
- NCD in Humanitarian Settings Group, Department of Epidemiology and Population Health & Centre for Global Chronic Conditions, London School of Hygiene & Tropical Medicine, United Kingdom
| |
Collapse
|
4
|
Gidlow CJ, Sams L, Buckless K, Ellis NJ, Duffy HC, Lambley-Burke R, Campbell P, Cooke A, Dziedzic K, Brookes M, Chockalingam N, Devall P, Mallen C. "We have to change our mindsets": a qualitative study of barriers and facilitators in research collaboration across integrated care system organisations. BMC Health Serv Res 2024; 24:264. [PMID: 38429760 PMCID: PMC10908113 DOI: 10.1186/s12913-024-10760-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 02/20/2024] [Indexed: 03/03/2024] Open
Abstract
The introduction of Integrated Care Systems (ICS) in England aimed to increase joint planning and delivery of health and social care, and other services, to better meet the needs of local communities. There is an associated duty to undertake collaborative research across ICS partners to inform this new integrated approach, which might be challenging given that organisations span health, local authority, voluntary and community sector, and research. This study aimed to explore the appetite for collaborative Research and Innovation (R&I) across ICSs, potential barriers and solutions. This qualitative study involved semi-structured interviews with 24 stakeholders who held senior positions within organisations across two ICS areas (Staffordshire and Stoke-on-Trent; Shropshire, Telford and Wrekin). Interview transcripts were analysed using inductive and deductive analysis, first mapping to the Theoretical Domains Framework (TDF), then considering key influences on organisational behaviour in terms of Capability, Opportunity and Motivation from the COM-B Behaviour Change Wheel. There were fundamental limitations on organisational opportunities for collaborative R&I: a historical culture of competition (rather than collaboration), a lack of research culture and prioritisation, compounded by a challenging adverse economic environment. However, organisations were motivated to undertake collaborative R&I. They recognised the potential benefits (e.g., skill-sharing, staff development, attracting large studies and funding), the need for collaborative research that mirrors integrated care, and subsequent benefits for care recipients. Related barriers included negative experiences of collaboration, fear of failing and low confidence. Capability varied across organisations in terms of research skills and confidence, which reflected the range of partners (from local authorities to NHS Trusts, primary care, and academic institutions). These findings indicate a need to shift from a culture of competition to collaboration, and to help organisations across ICS to prioritise research, and share resources and skills to mitigate the limiting effects of a constrained economic environment. This could be further explored using a systems change approach, to develop the collaborative research efforts alongside the overarching move towards integrated care.
Collapse
Affiliation(s)
- Christopher J Gidlow
- Centre for Health and Development (CHAD), Staffordshire University, Ashley Building, Leek Road, ST4 2DF, Stoke-on-Trent, UK.
| | - Lorna Sams
- Centre for Health and Development (CHAD), Staffordshire University, Ashley Building, Leek Road, ST4 2DF, Stoke-on-Trent, UK
| | - Kim Buckless
- Centre for Health and Development (CHAD), Staffordshire University, Ashley Building, Leek Road, ST4 2DF, Stoke-on-Trent, UK
| | - Naomi J Ellis
- Centre for Health and Development (CHAD), Staffordshire University, Ashley Building, Leek Road, ST4 2DF, Stoke-on-Trent, UK
| | - Helen C Duffy
- Midlands Partnership University NHS Foundation Trust, St George's Hospital, Corporation Street, ST16 3AG, Stafford, UK
| | - Ruth Lambley-Burke
- Midlands Partnership University NHS Foundation Trust, St George's Hospital, Corporation Street, ST16 3AG, Stafford, UK
| | - Paul Campbell
- Midlands Partnership University NHS Foundation Trust, St George's Hospital, Corporation Street, ST16 3AG, Stafford, UK
- Keele University, ST5 5BG, Keele, Staffordshire, UK
| | - Alison Cooke
- Keele University, ST5 5BG, Keele, Staffordshire, UK
- University Hospitals of North Midlands NHS Trust, Newcastle Road, ST4 6QG, Stoke-on-Trent, UK
| | | | - Matthew Brookes
- University of Wolverhampton, Wolverhampton, UK
- Department of Gastroenterology, New Cross Hospital, Wolverhampton, UK
| | - Nachiappan Chockalingam
- Centre for Health and Development (CHAD), Staffordshire University, Ashley Building, Leek Road, ST4 2DF, Stoke-on-Trent, UK
| | - Pam Devall
- NIHR Clinical Research Network West Midlands, New Cross Hospital, WV10 0QP, Wolverhampton, UK
| | | |
Collapse
|
5
|
Chong F, Jianping Z, Zhenjie L, Wenxing L, Li Y. Does competition support integrated care to improve quality? Heliyon 2024; 10:e24836. [PMID: 38333801 PMCID: PMC10850910 DOI: 10.1016/j.heliyon.2024.e24836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 01/01/2024] [Accepted: 01/15/2024] [Indexed: 02/10/2024] Open
Abstract
Introduction This work investigates the compatibility of integrated care and competition in China and analyses the impact of integrated care on regional care quality (DeptQ) within a competitive framework. Method The study was built on multivariate correspondence analysis and a two-way fixed-effects model. The data were collected from Xiamen's Big Data Application Open Platform and represent nine specialised departments that regularly performed inter-institutional referrals between 2016 and 2019. Results First, care quality for referred patients (ReferQ) and the relative scale of referred patients (ReferScale) and competition have an antagonistic but not completely mutually exclusive relationship. Second, ReferQ and competition both have a significant effect on DeptQ, but only when competition is weak can ReferQ and competition act synergistically on DeptQ. When competition is fierce, competition will weaken the impact of ReferQ on DeptQ. Conclusion Changes in the intensity of integrated care and competition ultimately affect care quality.
Collapse
Affiliation(s)
- Feng Chong
- School of Mathematics and Statistics, Xiamen University of Technology, Fujian, Xiamen, China
- Data Mining Research Center, Xiamen University, Fujian, Xiamen, China
| | - Zhu Jianping
- School of Management, Xiamen University, Fujian, Xiamen, China
- Data Mining Research Center, Xiamen University, Fujian, Xiamen, China
- National Institute for Data Science in Health and Medicine, Xiamen University, Fujian, Xiamen, China
| | - Liang Zhenjie
- Data Mining Research Center, Xiamen University, Fujian, Xiamen, China
- College of Economics and Management, Minjiang University, Fujian, Fuzhou, China
| | - Lin Wenxing
- Xiamen Health and Medical Big Data Center, Fujian, Xiamen, China
| | - Yumin Li
- School of Economics and Management, Nanjing University of Science and Technology, Jiangsu, Nanjing, China
| |
Collapse
|
6
|
Bosdijk A, Nieboer AP, Cramm JM. The development of an integrated neighborhood approach for health promotion and prevention: a qualitative exploration of stakeholders' views. Health Res Policy Syst 2023; 21:125. [PMID: 38017576 PMCID: PMC10683097 DOI: 10.1186/s12961-023-01077-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 11/20/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND Although the promise of integrated neighborhood approaches, including the essential roles of communities and collaboration between the medical and social domains, has been widely acknowledged, the realization of such approaches in practice often remains difficult. To gain insight into the development of integrated neighborhood approaches, this case study describes the experiences of stakeholders involved in such an approach for health promotion and prevention in Rotterdam. METHODS Interviews with 18 stakeholders (including health and social care professionals, health insurance employees, and policymakers) were conducted, and stakeholders' statements were analyzed thematically. RESULTS The results reveal a lack of alignment among the professional, organizational, and system levels. Elements needed for collaboration between health and social care professionals are not supported at the organizational and system levels. The lack of integration at the policy and organizational levels encourages competition and self-interest instead of stimulating collaboration. CONCLUSIONS Intersectoral collaboration and coordination must take place not only between professionals, but also at the organizational and policy levels. As long as integration at the organizational and system levels is lacking, professionals' ability to collaborate and provide coordinated support to neighborhood residents will be compromised.
Collapse
Affiliation(s)
- Anniek Bosdijk
- Department of Socio-Medical Sciences, Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands.
| | - Anna Petra Nieboer
- Department of Socio-Medical Sciences, Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands
| | - Jane Murray Cramm
- Department of Socio-Medical Sciences, Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands
| |
Collapse
|
7
|
Kelleher E, Martin AM, Caples M, Wills T. Acute service and disability service providers experiences of joint working to improve health care experiences of people with an intellectual disability compared to non-joint working: A mixed-method systematic review. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2023:17446295231209345. [PMID: 37864518 DOI: 10.1177/17446295231209345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2023]
Abstract
Persons with intellectual disabilities require frequent access to acute services. Many also access disability services within the community. Reports and enquiries have highlighted the sub-optimal healthcare provided to this group when accessing healthcare in acute services. Joint working between acute and disability services has been identified as a measure to improve healthcare for this group. A mixed method systematic review was undertaken to explore current evidence of joint working between both service providers. Twelve publications were included, and the data were analysed using thematic analysis. Confusion around responsibility and limited training in acute services prevented joint working from occurring. Information-sharing is pivotal in promoting joint-working, but measures which facilitated it were not always used. Albeit acute services demonstrated a strong commitment to deliver quality care to those with intellectual disabilities. Much of the available research captures the experiences of staff in acute services. There is a paucity of research available exploring experiences of disability service providers.
Collapse
|
8
|
Millar R, Aunger JA, Rafferty AM, Greenhalgh J, Mannion R, McLeod H, Faulks D. Towards achieving interorganisational collaboration between health-care providers: a realist evidence synthesis. HEALTH AND SOCIAL CARE DELIVERY RESEARCH 2023; 11:1-130. [PMID: 37469292 DOI: 10.3310/kplt1423] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
Background Interorganisational collaboration is currently being promoted to improve the performance of NHS providers. However, up to now, there has, to the best of our knowledge, been no systematic attempt to assess the effect of different approaches to collaboration or to understand the mechanisms through which interorganisational collaborations can work in particular contexts. Objectives Our objectives were to (1) explore the main strands of the literature about interorganisational collaboration and to identify the main theoretical and conceptual frameworks, (2) assess the empirical evidence with regard to how different interorganisational collaborations may (or may not) lead to improved performance and outcomes, (3) understand and learn from NHS evidence users and other stakeholders about how and where interorganisational collaborations can best be used to support turnaround processes, (4) develop a typology of interorganisational collaboration that considers different types and scales of collaboration appropriate to NHS provider contexts and (5) generate evidence-informed practical guidance for NHS providers, policy-makers and others with responsibility for implementing and assessing interorganisational collaboration arrangements. Design A realist synthesis was carried out to develop, test and refine theories about how interorganisational collaborations work, for whom and in what circumstances. Data sources Data sources were gathered from peer-reviewed and grey literature, realist interviews with 34 stakeholders and a focus group with patient and public representatives. Review methods Initial theories and ideas were gathered from scoping reviews that were gleaned and refined through a realist review of the literature. A range of stakeholder interviews and a focus group sought to further refine understandings of what works, for whom and in what circumstances with regard to high-performing interorganisational collaborations. Results A realist review and synthesis identified key mechanisms, such as trust, faith, confidence and risk tolerance, within the functioning of effective interorganisational collaborations. A stakeholder analysis refined this understanding and, in addition, developed a new programme theory of collaborative performance, with mechanisms related to cultural efficacy, organisational efficiency and technological effectiveness. A series of translatable tools, including a diagnostic survey and a collaboration maturity index, were also developed. Limitations The breadth of interorganisational collaboration arrangements included made it difficult to make specific recommendations for individual interorganisational collaboration types. The stakeholder analysis focused exclusively on England, UK, where the COVID-19 pandemic posed challenges for fieldwork. Conclusions Implementing successful interorganisational collaborations is a difficult, complex task that requires significant time, resource and energy to achieve the collaborative functioning that generates performance improvements. A delicate balance of building trust, instilling faith and maintaining confidence is required for high-performing interorganisational collaborations to flourish. Future work Future research should further refine our theory by incorporating other workforce and user perspectives. Research into digital platforms for interorganisational collaborations and outcome measurement are advocated, along with place-based and cross-sectoral partnerships, as well as regulatory models for overseeing interorganisational collaborations. Study registration The study is registered as PROSPERO CRD42019149009. Funding This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme and will be published in full in Health and Social Care Delivery Research; Vol. 11, No. 6. See the NIHR Journals Library website for further project information.
Collapse
Affiliation(s)
- Ross Millar
- Health Services Management Centre, School of Social Policy, University of Birmingham, Birmingham, UK
| | - Justin Avery Aunger
- Health Services Management Centre, School of Social Policy, University of Birmingham, Birmingham, UK
| | - Anne Marie Rafferty
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Joanne Greenhalgh
- School of Sociology and Social Policy, University of Leeds, Leeds, UK
| | - Russell Mannion
- Health Services Management Centre, School of Social Policy, University of Birmingham, Birmingham, UK
| | - Hugh McLeod
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | |
Collapse
|
9
|
van Scherpenseel MC, te Velde SJ, Veenhof C, Emmelot-Vonk MH, Barten JA. Contextual determinants influencing the implementation of fall prevention in the community: a scoping review. FRONTIERS IN HEALTH SERVICES 2023; 3:1138517. [PMID: 37249947 PMCID: PMC10210634 DOI: 10.3389/frhs.2023.1138517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 04/07/2023] [Indexed: 05/31/2023]
Abstract
Background Successful implementation of multifactorial fall prevention interventions (FPIs) is essential to reduce increasing fall rates in community-dwelling older adults. However, implementation often fails due to the complex context of the community involving multiple stakeholders within and across settings, sectors, and organizations. As there is a need for a better understanding of the occurring context-related challenges, the current scoping review purposes to identify what contextual determinants (i.e., barriers and facilitators) influence the implementation of FPIs in the community. Methods A scoping review was performed using the Arksey and O'Malley framework. First, electronic databases (Pubmed, CINAHL, SPORTDiscus, PsycINFO) were searched. Studies that identified contextual determinants that influence the implementation of FPIs in the community were included. Second, to both validate the findings from the literature and identify complementary determinants, health and social care professionals were consulted during consensus meetings (CMs) in four districts in the region of Utrecht, the Netherlands. Data were analyzed following a directed qualitative content analysis approach, according to the 39 constructs of the Consolidated Framework for Implementation Research. Results Fourteen relevant studies were included and 35 health and social care professionals (such as general practitioners, practice nurses, and physical therapists) were consulted during four CMs. Directed qualitative content analysis of the included studies yielded determinants within 35 unique constructs operating as barriers and/or facilitators. The majority of the constructs (n = 21) were identified in both the studies and CMs, such as "networks and communications", "formally appointed internal implementation leaders", "available resources" and "patient needs and resources". The other constructs (n = 14) were identified only in the . Discussion Findings in this review show that a wide array of contextual determinants are essential in achieving successful implementation of FPIs in the community. However, some determinants are considered important to address, regardless of the context where the implementation occurs. Such as accounting for time constraints and financial limitations, and considering the needs of older adults. Also, broad cross-sector collaboration and coordination are required in multifactorial FPIs. Additional context analysis is always an essential part of implementation efforts, as contexts may differ greatly, requiring a locally tailored approach.
Collapse
Affiliation(s)
- M. C. van Scherpenseel
- Research Group Innovation of Human Movement Care, Research Center for Healthy and Sustainable Living, HU University of Applied Sciences Utrecht, Utrecht, Netherlands
| | - S. J. te Velde
- Research Group Innovation of Human Movement Care, Research Center for Healthy and Sustainable Living, HU University of Applied Sciences Utrecht, Utrecht, Netherlands
| | - C. Veenhof
- Research Group Innovation of Human Movement Care, Research Center for Healthy and Sustainable Living, HU University of Applied Sciences Utrecht, Utrecht, Netherlands
- Department of Rehabilitation, Physiotherapy Science and Sport, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - M. H. Emmelot-Vonk
- Department of Geriatrics, University Medical Center Utrecht, Utrecht, Netherlands
| | - J. A. Barten
- Research Group Innovation of Human Movement Care, Research Center for Healthy and Sustainable Living, HU University of Applied Sciences Utrecht, Utrecht, Netherlands
- Department of Rehabilitation, Physiotherapy Science and Sport, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| |
Collapse
|
10
|
Quiroz-Saavedra R, Alfaro J, Rodríguez-Rivas ME. Perceptions of professionals about factors affecting the implementation of early childhood support systems: A case study evaluation from an ecological perspective. EVALUATION AND PROGRAM PLANNING 2023; 97:102210. [PMID: 36571969 DOI: 10.1016/j.evalprogplan.2022.102210] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 04/30/2022] [Accepted: 12/18/2022] [Indexed: 06/17/2023]
Abstract
This evaluation research looked at factors affecting collaboration across the various levels of implementation of early childhood support systems. An ecological conceptual framework was used to examine barriers and facilitators to implementing social and health care services from the perspective of the professionals involved at the national, state, and local level of government. A single case study following a qualitative research strategy was conducted with a total of 29 professionals from social development and health ministries, one municipality and a family health center responsible for implementing the Chile Grows with You system. The results show that at the national level, the main factors include socio-political aspects, funding, and the empathy that professional employees hold for peers who are at lower rungs in the hierarchy. At the state level workplace conditions play a key role. For the local level those factors include information system management and the political support of the local government. The discussion section emphasizes the relevance of considering the interdependence of such factors that influence implementation outcomes and the need to move away from a single program evaluation to a multilevel implementation analysis of public policy.
Collapse
Affiliation(s)
- Rodrigo Quiroz-Saavedra
- Universidad del Desarrollo, Faculty of Psychology, Av. Plaza 680, San Carlos de Apoquindo, Las Condes, Santiago 7610658, Chile.
| | - Jaime Alfaro
- Universidad del Desarrollo, Faculty of Psychology, Av. Plaza 680, San Carlos de Apoquindo, Las Condes, Santiago 7610658, Chile
| | - Matías E Rodríguez-Rivas
- Universidad del Desarrollo, Faculty of Psychology, Av. Plaza 680, San Carlos de Apoquindo, Las Condes, Santiago 7610658, Chile
| |
Collapse
|
11
|
Riordan F, O'Mahony L, Sheehan C, Murphy K, O'Donnell M, Hurley L, Dinneen S, McHugh SM. Implementing a community specialist team to support the delivery of integrated diabetes care: experiences in Ireland during the COVID-19 pandemic. HRB Open Res 2023. [DOI: 10.12688/hrbopenres.13635.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Background: While models of integrated care for people with chronic conditions have demonstrated promising results, there are still knowledge gaps about how these models are implemented in different contexts and which strategies may best support implementation. We aimed to evaluate the implementation of a multidisciplinary diabetes Community Specialist Team (CST) to support delivery of integrated type 2 diabetes care during COVID-19 in two health networks. Methods: A mixed methods approach was used. Quantitative data included administrative data on CST activity and caseload, and questionnaires with GPs, practice nurses (PN) and people with type 2 diabetes. Qualitative data were collected using semi-structured interviews and focus groups about the service from CST members, GPs, PNs and people with type 2 diabetes. We used the Consolidated Framework for Implementation Research framework to explain what influences implementation and to integrate different stakeholder perspectives. Results: Over a 6-month period (Dec 2020-May 2021), 516 patients were seen by podiatrists, 435 by dieticians, and 545 by CNS. Of patients who had their first CST appointment within the previous 6 months (n=29), 69% (n=20) waited less than 4 weeks to see the HCP. During initial implementation, CST members used virtual meetings to build ‘rapport’ with general practice staff, supporting ‘upskilling’ and referrals to the CST. Leadership from the local project team and change manager provided guidance on how to work as a team and ‘iron out’ issues. Where available, shared space enhanced networking between CST members and facilitated joint appointments. Lack of administrative support for the CST impacted on clinical time. Conclusions: This study illustrates how the CST benefited from shared space, enhanced networking, and leadership. When developing strategies to support implementation of integrated care, the need for administrative support, the practicalities of co-location to facilitate joint appointments, and relative advantages of different delivery models should be considered.
Collapse
|
12
|
Nursing Care Coordination in Primary Healthcare for Patients with Complex Needs: A Comparative Case Study. Int J Integr Care 2023; 23:5. [PMID: 36819614 PMCID: PMC9912854 DOI: 10.5334/ijic.6729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 01/24/2023] [Indexed: 02/05/2023] Open
Abstract
Introduction Despite nurses' substantial role in care coordination, few education programs exist to better support them in this role. Identification of a set of core care coordination activities across heterogeneous care coordination programs would facilitate the development of a standard of practice. We sought to examine care coordination activities across two care coordination programs in Family Medicine Groups in Quebec, and their relationship to the program design. Methods We performed a comparative case study of two care coordination programs in primary care targeting frequent users of healthcare services and people with Alzheimer's disease and related disorders. Data collection included documents and semi-structured interviews with key informants. Results Several activities were common to both programs, such as patient identification; assessment, development of an individualized service plan; and linking patients and caregivers with professionals and services. However, their components were different due to the impact of the integrated care program design, policy environment, and the target patient populations' complex needs. Discussion The homogeneity or heterogeneity of patients' complex needs shapes their care trajectory and the intensity of their care coordination needs. As the complexity of these needs grows, so does the necessity to build the care coordinators' capacity for integrated care.
Collapse
|
13
|
Hegedüs A, Schürch A, Bischofberger I. Implementing Buurtzorg-derived models in the home care setting: a Scoping Review. INTERNATIONAL JOURNAL OF NURSING STUDIES ADVANCES 2022; 4:100061. [PMID: 38745628 PMCID: PMC11080323 DOI: 10.1016/j.ijnsa.2022.100061] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 12/16/2021] [Accepted: 01/11/2022] [Indexed: 11/20/2022] Open
Abstract
Background Buurtzorg is a pioneering healthcare organization founded in the Netherlands. Buurtzorg has established independent, self-managing teams of nurses and promises high-quality home care at a lower cost through person-centered care, continuity of care, building trusting relationships, and networks in the neighborhood. Traditional home care services are increasingly reorganized according to the Buurtzorg-principles. Objectives This review aims to describe the experiences gathered during the implementation of the Buurtzorg-derived model outside the Netherlands. It further outlines their potential effects. Design Scoping Review. Methods Several electronic databases were searched for relevant articles, supplemented by hand-searching and internet searches for gray literature. Various publication types that described the implementation of the Buurtzorg model or its outcomes in countries other than the Netherlands were included. The data were analyzed using qualitative content analysis. Two authors coded the data in several cycles and created categories and subcategories. Results The review identified 25 publications reporting the experiences or outcomes of Buurtzorg-derived models outside the Netherlands. Upon implementing elements of Buurtzorg, the home care organizations adopted a person-centered care approach, with improved communication with patients and family caregivers, and could establish new networks with other services. The main challenges were related to the self-managed working culture, the organizational framework, or national healthcare policies, which hindered the implementation process. Conclusions The implementation of Buurtzorg-derived models is complex, challenging, and requires adaptations on several levels: upskilling of networking and staffing competencies in teams, leadership and IT requirements in the organization, and policy changes in the healthcare system. Individualized approaches and solid conceptual preparation are required for implementation. Tweetable abstract Experiences with the implementation of Buurtzorg in home care services outside the Netherlands. A scoping review @HegeduesAnna.
Collapse
Affiliation(s)
- Anna Hegedüs
- Research Institute, Careum School of Health, part of Kalaidos University of Applied Sciences, Zurich, Switzerland
- Bern University of Applied Sciences, Departement of Health Professions, Applied Research & Development in Nursing, Bern, Switzerland
| | - Anita Schürch
- Research Institute, Careum School of Health, part of Kalaidos University of Applied Sciences, Zurich, Switzerland
- Bern University of Applied Sciences, Departement of Health Professions, Competence Centre Participatory Health Care, Bern, Switzerland
| | - Iren Bischofberger
- Research Institute, Careum School of Health, part of Kalaidos University of Applied Sciences, Zurich, Switzerland
| |
Collapse
|
14
|
Aspinwall‐Roberts E, Fleming V, Khatri R, Jones P. 'They don't want them to have capacity': Multi-agency operationalisation of the Mental Capacity Act 2005 in England with adults who self-neglect. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e4395-e4404. [PMID: 35607758 PMCID: PMC10083994 DOI: 10.1111/hsc.13839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 03/21/2022] [Accepted: 04/22/2022] [Indexed: 06/15/2023]
Abstract
The number of adults who self-neglect and thus fall under the aegis of local authority adult safeguarding procedures in England has increased substantially since the introduction of the Care Act 2014. The requirement for collaborative working between agencies dealing with these adults in a safeguarding context is explicit in government policy and legislation. Decisions made by the multiplicity of agencies that may work with people who self-neglect are largely guided by the Mental Capacity Act 2005 (MCA). The overall objective of this research was to develop a clearer understanding of how the range of agencies that might typically be involved in the life of a self-neglecting person work together. This article examines how agencies put the MCA into practice in their work with people who self-neglect, and how they understand their own and others' roles and responsibilities in so doing. This qualitative study took place in two local authorities in England from 2016 to 2017 and informed a wider action research study which was completed in 2019. Non-probability purposive sampling was used to recruit participants from the professional groups who might typically be involved with self-neglect cases. À total of 245 participants from across 17 different professional groups took part in semi-structured interviews, in a group, paired or individual format, decided by their customary working configuration. Data from the interview transcripts was analysed using thematic analysis. Three key themes in relation to how participants understood the MCA and multi-agency working emerged from the analysis of this data set. These were; a lack of understanding of the MCA by participants and other agencies; a reluctance to engage with MCA assessments; and a perception of manipulation of the MCA by other professionals. This study underlines the importance of the informed application of the MCA in working with people who self-neglect, and an urgent need to consider how this could be enhanced if the service user is not to experience intrusive interventions resulting from professional misinterpretation.
Collapse
Affiliation(s)
- Elaine Aspinwall‐Roberts
- Faculty of Health, School of Nursing and Allied HealthLiverpool John Moores UniversityLiverpoolUK
| | - Valerie Fleming
- Faculty of Health, School of Nursing and Allied HealthLiverpool John Moores UniversityLiverpoolUK
| | - Rose Khatri
- Faculty of Health, School of Nursing and Allied HealthLiverpool John Moores UniversityLiverpoolUK
| | - Paul A. Jones
- Faculty of Health, School of Nursing and Allied HealthLiverpool John Moores UniversityLiverpoolUK
| |
Collapse
|
15
|
O'Donnell D, O'Donoghue G, Ní Shé É, O'Shea M, Donnelly S. Developing competence in interprofessional collaboration within integrated care teams for older people in the Republic of Ireland: A starter kit. J Interprof Care 2022; 37:480-490. [PMID: 35880753 DOI: 10.1080/13561820.2022.2075332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Current evidence offers little guidance as to how interprofessional collaboration can be fostered within the context of integrated care and older people. This research describes the co-design of core competencies for interprofessional collaboration within integrated care teams for older people and the development of practical guidance to support teams in building proficiency. Using a co-design approach, we conducted three studies (co-design workshops, qualitative interviews, and an online validation forum), the combined output of which is a Core Competency Framework, that includes three domains describing six competencies for proficiency in interprofessional collaboration within integrated care of older people. Domain one, Knowledge of the Team, includes the competencies; understanding roles, and making referrals. Domain two, Communication, includes the competencies; sharing information and communicating effectively and Domain three, Shared Decision-making, includes the final two competencies; supporting decision making with older people and collective clinical decision-making. In presenting a formal understanding of the competencies for interprofessional collaboration in the integrated care of older people and practical guidance for developing proficiency, this framework provides direction for future health service workforce development.
Collapse
Affiliation(s)
- Deirdre O'Donnell
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland.,UCD Centre for Interdisciplinary Research, Education and Innovation in Health Systems (UCD IRIS), Dublin, Ireland
| | - Grainne O'Donoghue
- School of Public Health, Physiotherapy & Sports Science, University College Dublin, Dublin, Ireland
| | - Éidín Ní Shé
- Graduate School of Healthcare Management, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Maire O'Shea
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland.,UCD Centre for Interdisciplinary Research, Education and Innovation in Health Systems (UCD IRIS), Dublin, Ireland
| | - Sarah Donnelly
- UCD Centre for Interdisciplinary Research, Education and Innovation in Health Systems (UCD IRIS), Dublin, Ireland.,School of Social Policy, Social Work and Social Justice, University College Dublin, Dublin, Ireland
| |
Collapse
|
16
|
Sun Y, Zhang X, Han Y, Yu B, Liu H. Evolutionary game model of health care and social care collaborative services for the elderly population in China. BMC Geriatr 2022; 22:616. [PMID: 35879656 PMCID: PMC9317207 DOI: 10.1186/s12877-022-03300-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 07/14/2022] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION The synergy of health care and elderly social care organizations has become the focus of the research on integrated health care and social care. This study aims to propose a collaborative strategy among health care and elderly social care service providers. METHODS An evolutionary game model is applied for performance analysis and optimization of the cooperation between health care and elderly social care organizations. The behavioural strategies and the impact of key parameters on promoting the cooperation of the players are presented in detail. RESULTS Simulation experiments and sensitivity analysis results indicate that (1) the behavioural evolution of health care organizations and elderly social care organizations forms three types of integrated health care and social care services, namely, the bilateral cooperation type, health care organization-led type and elderly social care organization-led type. (2) Increasing the additional benefits for cooperation and reducing the additional costs for cooperation can promote the willingness to synergize to provide integrated health care and elderly social care services. At the early stage of evolution, increasing the costs that elderly social care organizations pay to purchase health care services or pay for negotiation in the bilateral cooperation type can provide incentives for health care organizations to cooperate while reducing the cooperation preferences of elderly social care organizations. However, the long-term impact of the costs on the behavioural strategies for cooperation of the two players cannot be determined. CONCLUSION The behavioural decisions on cooperation between health care and elderly social care organizations influence each other; commitment to integration and effective collaboration can be achieved by increasing the additional benefits and reducing the marginal costs. The findings suggest that the political-economic context and government policies have a greater influence on promoting cooperation, thus yielding positive or negative results for integrated care practice.
Collapse
Affiliation(s)
- Yin Sun
- Faculty of Management and Economics, Kunming University of Science and Technology, Kunming, Yunnan Province, China
| | - Xudong Zhang
- Faculty of Management and Economics, Kunming University of Science and Technology, Kunming, Yunnan Province, China.
| | - Yuehong Han
- School of Marxism, Kunming University of Science and Technology, Kunming, Yunnan Province, China
| | - Bo Yu
- Faculty of Management and Economics, Kunming University of Science and Technology, Kunming, Yunnan Province, China.,School of Humanities and Management, Yunnan University of Chinese Medicine, Kunming, Yunnan Province, China
| | - Haidan Liu
- Faculty of Management and Economics, Kunming University of Science and Technology, Kunming, Yunnan Province, China
| |
Collapse
|
17
|
Values Underpinning Integrated, People-Centred Health Services: Similarities and Differences among Actor Groups Across Europe. Int J Integr Care 2022; 22:6. [PMID: 36043027 PMCID: PMC9374025 DOI: 10.5334/ijic.6015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 07/27/2022] [Indexed: 11/20/2022] Open
Abstract
Introduction: In addition to the functional aspects of healthcare integration, an understanding of its normative aspects is needed. This study explores the importance of values underpinning integrated, people-centred health services, and examines similarities and differences among the values prioritised by actors across Europe. Methods: Explorative cross-sectional design with quantitative analysis. A questionnaire of 18 values was conducted across Europe. A total of 1,013 respondents indicated the importance of each of the values on a nine-point scale and selected three most important values. Respondents were clustered in four actor groups, and countries in four European sub-regions. Results: The importance scores of values ranged from 7.62 to 8.55 on a nine-point scale. Statistically significant differences among actor groups were found for ten values. Statistically significant differences across European sub-regions were found for six values. Our analysis revealed two clusters of values: ‘people related’ and ‘governance and organisation’. Discussion and conclusion: The study found that all 18 values in the set are considered important by the respondents. Additionally, it revealed distinctions in emphasis among the values prioritised by actor groups and across sub-regions. The study uncovered two clusters of values that contribute to a conceptually based definition of integrated, people-centred health services.
Collapse
|
18
|
Tebaldi D, Stokes J. Defining Pooled' Place-Based' Budgets for Health and Social Care: A Scoping Review. Int J Integr Care 2022; 22:16. [PMID: 36186513 PMCID: PMC9479665 DOI: 10.5334/ijic.6507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 08/23/2022] [Indexed: 01/26/2023] Open
Abstract
Introduction Current descriptions of pooled budgets in the literature pose challenges to good quality evaluation of their contribution to integrated care. Addressing this gap is increasingly important given the shift from early models of integrated care targeting segments of the population, to more recent approaches that aim to target 'places', broader geographically defined populations. This review draws on the current international evidence to describe practical examples of pooled health and social care budgets, highlighting specific place-based approaches. Methods We initially conducted a scoping review, a systematic database search ('Medline', 'Embase', 'Econ Lit' and 'Google Scholar') complemented by further snowballing for academic and 'grey literature' publications (1995 - 2020). Results were analysed thematically according to budget characteristics and macro-environment, with additional specific case studies. Results Thirty-six primary studies were included, describing ten broad models of pooled budgets across seven countries. Most budgets targeted specific sub-populations rather than an entire geographically defined population. Specific budget structures varied and were generally under-described. The closest place-based models were for small populations and implemented in a national health system, or insurance-based with natural geographical boundaries. Conclusion Despite their increasing relevance in the current political debate, pooled place-based budgets are still at an early stage of implementation and research. Adequate description is required for future meta-analysis of effectiveness on outcomes.
Collapse
Affiliation(s)
- Davide Tebaldi
- Health Organisation, Policy & Economics (HOPE), Centre for Primary Care and Health Services Research, University of Manchester, Oxford Road, Manchester M13 9PL, England
| | - Jonathan Stokes
- Health Organisation, Policy & Economics (HOPE), Centre for Primary Care and Health Services Research, University of Manchester, Oxford Road, Manchester M13 9PL, England
| |
Collapse
|
19
|
Alonso JM, Andrews R. Does vertical integration of health and social care organizations work? Evidence from Scotland. Soc Sci Med 2022; 307:115188. [DOI: 10.1016/j.socscimed.2022.115188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 06/23/2022] [Accepted: 06/28/2022] [Indexed: 11/29/2022]
|
20
|
Lo K, Lockwood C. Improving cross-sector collaborations in place-based population health projects. PUBLIC HEALTH IN PRACTICE 2022; 4:100285. [PMID: 36570389 PMCID: PMC9773052 DOI: 10.1016/j.puhip.2022.100285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 06/20/2022] [Indexed: 12/27/2022] Open
Abstract
Objectives The objective of this study is to develop a practice-orientated partnership framework that can enable effective population health collaborations in rural areas, and to gain ground insights on the role and policies of the Department of Families, Fairness and Housing (DFFH) in administering population health projects. Study design Rapid evidence review and case study interviews with stakeholders. Methods The framework development started with a rapid review to identify evidence-based practices on collaboration for population health stakeholders. Best-practices from DFFH's policy document for place-based projects were also incorporated into the framework. After a preliminary draft of the framework was ready, semi-structured interviews were conducted with stakeholders to seek practitioner insights to validate the framework and contextualise it to local needs. Results Inputs from the stakeholder interviews were organised into two categories: "Inputs for framework" which contained responses that improved the framework, and "inputs for DFFH" which contained insights on the role and policies of DFFH in administering population health projects. Conclusions With its list of actionable activities and enablers organised into logical project phases, the framework provides a practical and intuitive guide that can help stakeholders navigate through complex place-based population health projects. The inputs for DFFH provided the department with valuable ground insights into the dynamics of cross-sector collaborations for further reflection about their roles and policies. Through the consultative interview process which meaningfully engaged key stakeholders, a level of understanding and support for the framework was gained, which would encourage future implementations of place-based population health projects.
Collapse
Affiliation(s)
- Kenneth Lo
- Faculty of Health and Medical Sciences, The University of Adelaide, SA, 5005, Australia,College of Medicine and Public Health, Flinders University, SA, 5042, Australia,Corresponding author. Faculty of Health and Medical Sciences, The University of Adelaide, SA, 5005, Australia.
| | - Craig Lockwood
- JBI, Faculty of Health and Medical Sciences, The University of Adelaide, Australia
| |
Collapse
|
21
|
Melin Emilsson U, Strid AL, Söderberg M. Lack of Coordination between Health Care and Social Care in Multi-Professional Teamwork - the Obstacle for Coherent Care of Older People Suffering from Multi-Morbidity. JOURNAL OF POPULATION AGEING 2022. [DOI: 10.1007/s12062-020-09300-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AbstractThe lack of a cohesive health and social care is a well-known problem of significance for ageing people in general and frail older people in particular. Responsibility for organising and conducting social care and healthcare for the elderly rests on different principals in different countries but difficulties with organisational coordination and collaboration between professions and authorities in social care and healthcare is an extensive concern worldwide. Regardless of the distribution of responsibilities, collaboration and coordination structures are complex and often lead to problems. However, the gap in the coordination between different organisations and the collaboration between professions, implying that frail older people with major care needs still living in their own homes are pinched, has received hardly any recognition. By closely following an implementation project focused on teamwork in order to improve collaboration and coordination between social care and healthcare, the purpose of this article is to fill this gap with the help of an example from Sweden. Data consisted of event diaries, observations, focus groups, structured questionnaires and interviews. Findings showed that multi-professional teams certainly were established, but did not work or last. Among the obstacles found the most prominent features were the various professions’ own organisations, territorial thinking and rivalries. The whole idea of the initiative to achieve a cohesive healthcare and social care for ageing frail older people fell through. By letting this happen, not only did the project hinder the development of better practice in serving older adults, but also cemented the problematic structures it was intended to dissolve.
Collapse
|
22
|
Discourses of middle managers' cross-boundary collaboration in health and social care. JOURNAL OF INTEGRATED CARE 2022. [DOI: 10.1108/jica-10-2021-0054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeIn the implementation of integrated care, the role of managers is important and their mutual collaboration should be addressed more visibly. The purpose of this study was to investigate how cross-boundary collaboration is constructed in the discourse of middle-level managers in health and social care.Design/methodology/approachThe study was based on a discursive approach. Group discussions with three groups of Finnish middle managers (n = 39) were analyzed using discourse analysis.FindingsFive ways of talking about cross-boundary collaboration were identified, labeled “ideal”, “structure”, “defence”, “money” and “support” discourses. In the ideal discourse, cross-boundary collaboration appeared as a “good thing” and is self-evident. Structural discourse defined managers as passive actors in self-sustaining entities. Defensive discourse highlighted the problems of cross-boundary collaboration and the hierarchy within the health and social sectors. Financial discourse constituted the ultimate obstacle to successful cross-boundary collaboration, and both strengthened and explained defensive discourse. Supportive discourse portrayed other managers as partners and as an important resource.Research limitations/implicationsCross-boundary collaboration can be experienced as a resource, helping managers cope with their workload. However, identification of and continuous attention to challenges at macro, meso and micro levels of integrated care is crucial for successful collaboration. Thus, critical discussion of collaboration needs to be given space.Originality/valueThe study design and discursive approach highlights the power of language and give voice to middle managers who are key actors when implementing integrated care.
Collapse
|
23
|
Skyberg HL. Diversity, friction, and harmonisation: an ethnographic study of interprofessional teamwork dynamics. BMC Health Serv Res 2022; 22:227. [PMID: 35183177 PMCID: PMC8857853 DOI: 10.1186/s12913-022-07596-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 02/02/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Although diversity, friction, and harmonisation in interprofessional teamwork are aspects frequently conceptualised, no empirical study discusses them in combination. Focusing on risk and function with respect to each aspect, this article empirically examines how dynamics between these aspects during interprofessional teamwork interactions fosters conditions for effective teamwork.
Methods
An ethnographic study of three interprofessional teams, in the context of mental health and substance use, was conducted in Norway. Data were collected through observations of 14 team meetings and 18 in-depth interviews with health and social work professionals. Thematic analysis was applied to code the data.
Results
A conceptual ideal-type model, which includes all three aspects was developed to represent the emergent findings. The results suggest that the diversity of professional perspectives inherent in interprofessional teams is the foundation of interprofessional teamwork. However, friction is needed to promote innovation, encourage new insights, and intensify discussions. In addition, harmonisation balances professional distinctions, fosters trust, and ties professionals together.
Conclusion
This article presents a comprehensive model of how professionals work together in interprofessional teams. The model makes visible the functions and risks of each aspect and the dynamics between them. Furthermore, the article argues for mobilisation and balance of all three aspects in combination to maximise the capacity of interprofessional teamwork. Such insight can be used to support the development and successful implementation of interprofessional teamwork in health care.
Collapse
|
24
|
I R Jenkinson J, Strike C, Hwang SW, Di Ruggiero E. Legal, geographic and organizational contexts that shape knowledge sharing in the hospital discharge process for people experiencing homelessness in Toronto, Canada. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e377-e387. [PMID: 33105525 DOI: 10.1111/hsc.13206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 09/28/2020] [Accepted: 10/01/2020] [Indexed: 06/11/2023]
Abstract
People experiencing homelessness use acute healthcare at higher rates than the general population, yet hospitals frequently discharge them to the streets or emergency shelters. Available literature on the hospital discharge process for people experiencing homelessness identifies knowledge sharing as an important and challenging part of the discharge process; however, it does little to explain what generates these challenges or what might support knowledge sharing. In this study, we explain under which contexts certain mechanisms are triggered to facilitate knowledge sharing between hospitals and shelters during the discharge process. Between September 2018 and April 2019, we interviewed 33 participants: hospital workers on general medicine wards across three hospitals; shelter workers; researchers, policy advisors or advocates working at the intersection of homelessness and healthcare in Toronto. We find that within the legal context of health information protection, the concept of "circle of care" has created barriers to knowledge sharing between hospitals and shelters by excluding shelter workers from discharge planning. We note, however, that the degree to which hospital workers have navigated these barriers and brought shelter workers into the discharge process varies across hospitals. We explore this variation and find that certain geographic and organisational contexts have activated the development of institutional- and individual-level relationships between hospitals and shelters or their workers, respectively. We suggest that these relationships generate increased trust and communication and have led to knowledge sharing between hospitals and shelters. These findings are applicable in most urban centres with hospitals and where people experiencing homelessness live. Understanding the role of context is imperative for developing appropriate and effective interventions to improve hospital discharge processes. The development and implementation of more effective discharge processes can contribute to improved post-discharge care and recovery for this patient population and contribute to addressing health equity.
Collapse
Affiliation(s)
| | - Carol Strike
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Stephen W Hwang
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Canada
- Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, Canada
| | - Erica Di Ruggiero
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| |
Collapse
|
25
|
Poškutė V, Kazlauskaitė R, Matonytė I. Stakeholder collaboration in long-term care of older people in Lithuania. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:193-202. [PMID: 33852735 DOI: 10.1111/hsc.13389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 02/08/2021] [Accepted: 03/03/2021] [Indexed: 06/12/2023]
Abstract
Demographic situation, changes in the role of women in society and growing demand for long-term care (LTC) of older people have challenged the ability to meet the growing LTC needs in most developed countries. In countries where responsibility for LTC is still largely laid on families, it is, however, even more critical and calls for improvements in formal LTC systems. More intensive stakeholder collaboration in LTC policy development, organising and delivery are of primary importance in improving LTC systems. Such collaboration, however, is not always successful; thus, it is critical to understand what makes it effective and efficient. In this paper, we specifically look into multistakeholder collaboration in LTC in Lithuania, one of the fastest ageing countries in the EU, with the demand for LTC services growing fast and exceeding the supply despite rising business and NGO engagement. To determine facilitators of such collaboration, we build on the data obtained through eight focus group discussions with all key stakeholder representatives (LTC policymakers, organisers and service providers [public, private and NGOs], 54 participants in total). Our findings indicate that in addition to national and organisational level facilitators studied in prior research, there are important individual level factors, such as meaningfulness at work, concern and care for others, possibility for personal growth and development, satisfaction with supervision, a sense of belonging and role clarity. On the other hand, our results show that collaboration is constrained by a shortage of human resources, increased workload caused by growing LTC demand, bureaucratic requirements, legal restrictions, lack of awareness of LTC service availability among elder persons, and prevailing social norms and attitudes to institutionalised care. Interestingly, a lack of financial resources is not perceived as a major constraint.
Collapse
Affiliation(s)
| | | | - Irmina Matonytė
- ISM University of Management and Economics, Vilnius, Lithuania
- General Jonas Žemaitis Military Academy of Lithuania, Vilnius, Lithuania
| |
Collapse
|
26
|
Challenges and chances for local health and social care integration – Lessons from Greater Manchester, England. JOURNAL OF INTEGRATED CARE 2021. [DOI: 10.1108/jica-07-2021-0040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
Sustainability and transformation partnerships (STPs) were introduced to England, asking 44 local areas to submit their health and social care plans for the period from October 2016 to March 2021. This study aims to offer a deeper understanding of the complex structure in the local practice, and to discuss the associated challenges and chances.
Design/methodology/approach
Documentary analysis, qualitative interviews and questionnaire survey are used for this study. Findings have been compared and analysed thematically.
Findings
The study participants reported that apart from pooled budgets, past collaborative experience and local leadership are crucial elements for transforming health and social care integration in Greater Manchester (GM). Also, this study provides policy recommendations to promote effective collaborative partnerships in local practices and mitigate local inequity of funding progress.
Research limitations/implications
The findings of this paper cannot be extrapolated to all stakeholders due to the limited samples. Meanwhile, some of the discussions about the case of GM may not be transferrable to other STPs.
Originality/value
This study argues that the success of pooled budgets is the result, rather than the cause, of effective negotiations between various stakeholders; and therefore, there is no evidence suggesting that pooled budgets can resolve the discoordination of health and social care. Moreover, due to the bottom-up approach adopted by STPs, more effective boroughs tend to receive additional funding, resulting in an increasing gap of development between effective and ineffective boroughs.
Collapse
|
27
|
Beech BM, Dobbins J, Woodard L, Liaw W, Bruce MA. Multisector Partnerships and Service Colocation to Increase Adoption of Influenza Vaccines and Address Food Insecurity. Popul Health Manag 2021; 25:430-432. [PMID: 34882018 DOI: 10.1089/pop.2021.0295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Bettina M Beech
- Department of Health Systems and Population Health Science, University of Houston, Houston, Texas, USA
| | | | - LeChauncy Woodard
- Department of Health Systems and Population Health Science, University of Houston, Houston, Texas, USA.,Humana Integrated Health System Sciences Institute, University of Houston, Houston, Texas, USA
| | - Winston Liaw
- Department of Health Systems and Population Health Science, University of Houston, Houston, Texas, USA
| | - Marino A Bruce
- Department of Health Systems and Population Health Science, University of Houston, Houston, Texas, USA.,Program for Research on Faith, Justice, and Health, Department of Behavioral and Social Sciences, University of Houston, Houston, Texas, USA
| |
Collapse
|
28
|
Turner S, Segura C, Niño N. Implementing COVID-19 Surveillance Through Inter-Organizational Coordination: A Qualitative Study of Three Cities in Colombia. Health Policy Plan 2021; 37:232-242. [PMID: 34875065 PMCID: PMC8689710 DOI: 10.1093/heapol/czab145] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 10/15/2021] [Accepted: 12/06/2021] [Indexed: 11/16/2022] Open
Abstract
Introducing comprehensive surveillance is recommended as an urgent public health measure to control and mitigate the spread of coronavirus disease 2019 (COVID-19) worldwide. However, its implementation has proven challenging as it requires inter-organizational coordination among multiple healthcare stakeholders. The purpose of this study was to examine the role of soft and hard mechanisms in the implementation of inter-organizational coordination strategies for COVID-19 surveillance within Colombia, drawing on evidence from the cities of Bogotá, Cali and Cartagena. The study used a case study approach to understand the perspectives of local and national authorities, insurance companies and health providers in the implementation of inter-organizational coordination strategies for COVID-19 surveillance. Eighty-one semi-structured interviews were conducted between June and November 2020. The data were analysed by codes and categorized using New NVivo software. The study identified inter-organizational coordination strategies that were implemented to provide COVID-19 surveillance in the three cities. Both soft (e.g. trust and shared purpose) and hard mechanisms (e.g. formal agreements and regulations) acted as mediators for collaboration and helped to address existing structural barriers in the provision of health services. The findings suggest that soft and hard mechanisms contributed to promoting change among healthcare system stakeholders and improved inter-organizational coordination for disease surveillance. The findings contribute to evidence regarding practices to improve coordinated surveillance of disease, including the roles of new forms of financing and contracting between insurers and public and private health service providers, logistics regarding early diagnosis in infectious disease and the provision of health services at the community level regardless of insurance affiliation. Our research provides evidence to improve disease surveillance frameworks in fragmented health systems contributing to public health planning and health system improvement.
Collapse
Affiliation(s)
- Simon Turner
- School of Management, University of los Andes, Bogotá, Colombia
| | - Carolina Segura
- School of Management, University of los Andes, Bogotá, Colombia
| | - Natalia Niño
- School of Medicine, University of los Andes, Bogotá, Colombia
| |
Collapse
|
29
|
Skempes D, Kiekens C, Malmivaara A, Michail X, Bickenbach J, Stucki G. Supporting government policies to embed and expand rehabilitation in health systems in Europe: A framework for action. Health Policy 2021; 126:158-172. [PMID: 34281701 DOI: 10.1016/j.healthpol.2021.06.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 05/25/2021] [Accepted: 06/28/2021] [Indexed: 11/28/2022]
Abstract
Investment in action is vital to confront the challenges associated with chronic diseases and disability facing European health systems. Although relevant policy responses are being increasingly developed, most of them fail to recognize the role of rehabilitation services in achieving public health and social goals. Comprehensive guidance is thus urgently needed to support rehabilitation policy development and expand access to rehabilitation care to meet population needs effectively. This paper describes a framework to guide policy action for rehabilitation in Europe. The framework was developed in collaboration with the European Academy of Rehabilitation Medicine based on a focused literature review and expert consultations. A review in PubMed and grey literature sources identified 458 references and resulted in 135 relevant documents published between 2006 and 2019. Thematic analysis of extracted information helped summarize the findings and develop the draft policy action framework. This was circulated to a wider group of experts and discussed in three workshops in 2018-2019. The framework was revised according to their feedback. The proposed framework contains 48 options for policy action organized in six domains and twelve subdomains that address several areas of health programming. The proposed framework provides a structure to understand the policy terrain related to rehabilitation in Europe and the measures required for translating aspirational political pronouncements into targeted programmatic action and tangible health and social outcomes.
Collapse
Affiliation(s)
- Dimitrios Skempes
- Swiss Paraplegic Research, Nottwil, Switzerland; Center for Rehabilitation in Global Health Systems, Department of Health Sciences and Medicine, University of Lucerne, Switzerland
| | - Carlotte Kiekens
- Spinal Unit, Montecatone Rehabilitation Institute, Imola (Bologna), Italy; Physical and Rehabilitation Medicine, University Hospitals Leuven - Department of Development and Regeneration, KU Leuven - University of Leuven, Leuven, Belgium
| | - Anti Malmivaara
- Centre for Health and Social Economics, National Institute for Health and Welfare and Orton Orthopedic Hospital and Orton Research Institute, Orton Foundation, Helsinki, Finland
| | - Xanthi Michail
- Department of Physiotherapy, University of West Attica, Athens, Greece
| | - Jerome Bickenbach
- Swiss Paraplegic Research, Nottwil, Switzerland; Center for Rehabilitation in Global Health Systems, Department of Health Sciences and Medicine, University of Lucerne, Switzerland
| | - Gerold Stucki
- Swiss Paraplegic Research, Nottwil, Switzerland; Center for Rehabilitation in Global Health Systems, Department of Health Sciences and Medicine, University of Lucerne, Switzerland.
| |
Collapse
|
30
|
Henderson L, Bain H, Allan E, Kennedy C. Integrated health and social care in the community: A critical integrative review of the experiences and well-being needs of service users and their families. HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:1145-1168. [PMID: 33058359 DOI: 10.1111/hsc.13179] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 08/13/2020] [Accepted: 09/02/2020] [Indexed: 06/11/2023]
Abstract
A need for people-centred health and social support systems is acknowledged as a global priority. Most nations face challenges in providing safe, effective, timely, affordable, coordinated care around the needs and preferences of people who access integrated health and social care (IHSC) services. Much of the current research in the field focuses on describing and evaluating specific models for delivering IHSC. Fewer studies focus on person-centred experiences, needs and preferences of people who use these services. However, current international guidance for integrated care sets a precedence of person-centred integrated care that meets the health and well-being needs of people who access IHSC services. This integrative literature review synthesises empirical literature from six databases (CINAHL; MEDLINE; AMED; TRIP; Web of Science and Science Direct; 2007-2019). This review aims to better understand the experiences and health and well-being needs of people who use IHSC services in a community setting. Twenty studies met the inclusion criteria and results were thematically analysed. Three overarching themes were identified, including relationships, promoting health and well-being and difficulty understanding systems. Findings of this review indicate that relationships hold significance in IHSC. People who access IHSC services felt that they were not always involved in planning their care and that there was a lack of clarity in navigating integrated systems; subsequently, this impacted upon their experiences of those services. However, service user and informal carer voices appear to be underrepresented in current literature and studies that included their views were found to be of low quality overall. Collectively, these findings support the need for further research that explores the person-centred experiences and needs of people who access IHSC.
Collapse
Affiliation(s)
- Louise Henderson
- School of Nursing, Midwifery & Paramedic Practice, Robert Gordon University, Aberdeen, UK
| | - Heather Bain
- School of Nursing, Midwifery & Paramedic Practice, Robert Gordon University, Aberdeen, UK
| | - Elaine Allan
- School Nursing AHSCP & NHSG Strategic Lead CEL 13 School Nursing, NHS Grampian, Aberdeen, UK
- School Nursing, School of Nursing, Midwifery & Paramedic Practice, Robert Gordon University, Aberdeen, UK
| | - Catriona Kennedy
- School of Nursing, Midwifery & Paramedic Practice, Robert Gordon University, Aberdeen, UK
- The University of Limerick, Limerick, Ireland
| |
Collapse
|
31
|
Alderwick H, Hutchings A, Briggs A, Mays N. The impacts of collaboration between local health care and non-health care organizations and factors shaping how they work: a systematic review of reviews. BMC Public Health 2021; 21:753. [PMID: 33874927 PMCID: PMC8054696 DOI: 10.1186/s12889-021-10630-1] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 03/11/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Policymakers in many countries promote collaboration between health care organizations and other sectors as a route to improving population health. Local collaborations have been developed for decades. Yet little is known about the impact of cross-sector collaboration on health and health equity. METHODS We carried out a systematic review of reviews to synthesize evidence on the health impacts of collaboration between local health care and non-health care organizations, and to understand the factors affecting how these partnerships functioned. We searched four databases and included 36 studies (reviews) in our review. We extracted data from these studies and used Nvivo 12 to help categorize the data. We assessed risk of bias in the studies using standardized tools. We used a narrative approach to synthesizing and reporting the data. RESULTS The 36 studies we reviewed included evidence on varying forms of collaboration in diverse contexts. Some studies included data on collaborations with broad population health goals, such as preventing disease and reducing health inequalities. Others focused on collaborations with a narrower focus, such as better integration between health care and social services. Overall, there is little convincing evidence to suggest that collaboration between local health care and non-health care organizations improves health outcomes. Evidence of impact on health services is mixed. And evidence of impact on resource use and spending are limited and mixed. Despite this, many studies report on factors associated with better or worse collaboration. We grouped these into five domains: motivation and purpose, relationships and cultures, resources and capabilities, governance and leadership, and external factors. But data linking factors in these domains to collaboration outcomes is sparse. CONCLUSIONS In theory, collaboration between local health care and non-health care organizations might contribute to better population health. But we know little about which kinds of collaborations work, for whom, and in what contexts. The benefits of collaboration may be hard to deliver, hard to measure, and overestimated by policymakers. Ultimately, local collaborations should be understood within their macro-level political and economic context, and as one component within a wider system of factors and interventions interacting to shape population health.
Collapse
Affiliation(s)
- Hugh Alderwick
- Health Foundation, 8 Salisbury Square, London, EC4Y 8AP UK
- London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH UK
| | - Andrew Hutchings
- London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH UK
| | - Adam Briggs
- Health Foundation, 8 Salisbury Square, London, EC4Y 8AP UK
- University of Warwick, Coventry, CV4 7AL UK
| | - Nicholas Mays
- London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH UK
| |
Collapse
|
32
|
Aunger JA, Millar R, Greenhalgh J, Mannion R, Rafferty AM, McLeod H. Why do some inter-organisational collaborations in healthcare work when others do not? A realist review. Syst Rev 2021; 10:82. [PMID: 33752755 PMCID: PMC7984506 DOI: 10.1186/s13643-021-01630-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 03/10/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Inter-organisational collaboration is increasingly prominent within contemporary healthcare systems. A range of collaboration types such as alliances, networks, and mergers have been proposed as a means to turnaround organisations, by reducing duplication of effort, enabling resource sharing, and promoting innovations. However, in practice, due to the complexity of the process, such efforts are often rife with difficulty. Notable contributions have sought to make sense of this area; however, further understanding is needed in order to gain a better understanding of why some inter-organisational collaborations work when others do not, to be able to more effectively implement collaborations in the future. METHODS Realist review methodology was used with the intention of formulating context-mechanism-outcome configurations (CMOCs) to explain how inter-organisational collaborations work and why, combining systematic and purposive literature search techniques. The systematic review encompassed searches for reviews, commentaries, opinion pieces, and case studies on HMIC, MEDLINE, PsycINFO, and Social Policy and Practice databases, and further searches were conducted using Google Scholar. Data were extracted from included studies according to relevance to the realist review. RESULTS Fifty-three papers were included, informing the development of programme theories of how, why, and when inter-organisational collaborations in healthcare work. Formulation of our programme theories incorporated the concepts of partnership synergy and collaborative inertia and found that it was essential to consider mechanisms underlying partnership functioning, such as building trust and faith in the collaboration to maximise synergy and thus collaborative performance. More integrative or mandated collaboration may lean more heavily on contract to drive collaborative behaviour. CONCLUSION As the first realist review of inter-organisational collaborations in healthcare as an intervention for improvement, this review provides actionable evidence for policymakers and implementers, enhancing understanding of mechanisms underlying the functioning and performing of inter-organisational collaborations, as well as how to configure the context to aid success. Next steps in this research will test the results against further case studies and primary data to produce a further refined theory. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42019149009.
Collapse
Affiliation(s)
- Justin Avery Aunger
- Health Services Management Centre, Park House, University of Birmingham, Birmingham, B15 2RT, UK.
| | - Ross Millar
- Health Services Management Centre, Park House, University of Birmingham, Birmingham, B15 2RT, UK
| | - Joanne Greenhalgh
- Sociology and Social Policy Department, University of Leeds, Leeds, LS2 9JT, UK
| | - Russell Mannion
- Health Services Management Centre, Park House, University of Birmingham, Birmingham, B15 2RT, UK
| | - Anne-Marie Rafferty
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, SE1 8WA, UK
| | - Hugh McLeod
- Population Health Sciences, University of Bristol & NIHR Applied Research Collaboration West, 9th Floor, Whitefriars, Lewins Mead, Bristol, BS1 2NT, UK
| |
Collapse
|
33
|
Wyatt S, Miller R, Spilsbury P, Mohammed MA. The impact of structural changes to community nursing services on the rate of emergency hospital use of older people: a longitudinal ecological study of based on 140 primary care trusts in England. JOURNAL OF INTEGRATED CARE 2021. [DOI: 10.1108/jica-09-2020-0056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
In 2011, community nursing services were reorganised in England in response to a national policy initiative, but little is known about the impact of these changes. A total of three dominant approaches emerged: (1) integration of community nursing services with an acute hospital provider, (2) integration with a mental health provider and (3) the establishment of a stand-alone organisation, i.e. without structural integration. The authors explored how these approaches influenced the trends in emergency hospital admissions and bed day use for older people.
Design/methodology/approach
The methodology was a longitudinal ecological study using panel data over a ten-year period from April 2006 to March 2016. This study’s outcome measures were (1) emergency hospital admissions and (2) emergency hospital bed use, for people aged 65+ years in 140 primary care trusts (PCTs) in England.
Findings
The authors found no statistically significant difference in the post-intervention trend in emergency hospital admissions between those PCTS that integrated community nursing services with an acute care provider and those integrated with a mental health provider (IRR 0.999, 95% CI 0.986–1.013) or those that did not structurally integrate services (IRR 0.996, 95% CI 0.982–1.010). The authors similarly found no difference in the trends for emergency hospital bed use.
Research limitations/implications
PCTs were abolished in 2011 and replaced by clinical commissioning groups in 2013, but the functions remain.
Practical implications
The authors found no evidence that any one structural approach to the integration of community nursing services was superior in terms of reducing emergency hospital use in older people.
Originality/value
As far as the authors are aware, previous studies have not examined the impact of alternative approaches to integrating community nursing services on healthcare use.
Collapse
|
34
|
Progovac AM, Tepper MC, Stephen Leff H, Cortés DE, (Cohen) Colts A, Ault-Brutus A, Hou SSY, Lu F, Banbury S, Sunder D, Cook BL. Patient and provider perception of appropriateness, acceptability, and feasibility of behavioral health home (BHH) core components based on program implementation in an urban, safety-net health system. IMPLEMENTATION RESEARCH AND PRACTICE 2021; 2:26334895211043791. [PMID: 37089996 PMCID: PMC9978621 DOI: 10.1177/26334895211043791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background This manuscript evaluates patient and provider perspectives on the core components of a Behavioral Health Home (BHH) implemented in an urban, safety-net health system. The BHH integrated primary care and wellness services (e.g., on-site Nurse Practitioner and Care Manager, wellness groups and tools, population health management) into an existing outpatient clinic for people with serious mental illness (SMI). Methods As the qualitative component of a Hybrid Type I effectiveness-implementation study, semi-structured interviews were conducted with providers and patients 6 months after program implementation, and responses were analyzed using thematic analysis. Valence coding (i.e., positive vs. negative acceptability) was also used to rate interviewees' transcriptions with respect to their feedback of the appropriateness, acceptability, and feasibility/sustainability of 9 well-described and desirable Integrated Behavioral Health Core components (seven from prior literature and two additional components developed for this intervention). Themes from the thematic analysis were then mapped and organized by each of the 9 components and the degree to which these themes explain valence ratings by component. Results Responses about the team-based approach and universal screening for health conditions had the most positive valence across appropriateness, acceptability, and feasibility/sustainability by both providers and patients. Areas of especially high mismatch between perceived provider appropriateness and measures of acceptability and feasibility/sustainability included population health management and use of evidence-based clinical models to improve physical wellness where patient engagement in specific activities and tools varied. Social and peer support was highly valued by patients while incorporating patient voice was also found to be challenging. Conclusions Findings reveal component-specific challenges regarding the acceptability, feasibility, and sustainability of specific components. These findings may partly explain mixed results from BHH models studied thus far in the peer-reviewed literature and may help provide concrete data for providers to improve BHH program implementation in clinical settings. Plain language abstract Many people with serious mental illness also have medical problems, which are made worse by lack of access to primary care. The Behavioral Health Home (BHH) model seeks to address this by adding primary care access into existing interdisciplinary mental health clinics. As these models are implemented with increasing frequency nationwide and a growing body of research continues to assess their health impacts, it is crucial to examine patient and provider experiences of BHH implementation to understand how implementation factors may contribute to clinical effectiveness. This study examines provider and patient perspectives of acceptability, appropriateness, and feasibility/sustainability of BHH model components at 6-7 months after program implementation at an urban, safety-net health system. The team-based approach of the BHH was perceived to be highly acceptable and appropriate. Although providers found certain BHH components to be highly appropriate in theory (e.g., population-level health management), their acceptability of these approaches as implemented in practice was not as high, and their feedback provides suggestions for model improvements at this and other health systems. Similarly, social and peer support was found to be highly appropriate by both providers and patients, but in practice, at months 6-7, the BHH studied had not yet developed a process of engaging patients in ongoing program operations that was highly acceptable by providers and patients alike. We provide these data on each specific BHH model component, which will be useful to improving implementation in clinical settings of BHH programs that share some or all of these program components.
Collapse
Affiliation(s)
- Ana M Progovac
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Cambridge Health Alliance, Cambridge, MA,
USA
| | - Miriam C Tepper
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Cambridge Health Alliance, Cambridge, MA,
USA
| | - H. Stephen Leff
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Dharma E Cortés
- Department of Psychiatry, Cambridge Health Alliance, Cambridge, MA,
USA
| | | | - Andrea Ault-Brutus
- Office of Health Equity, Nassau County Department of
Health, Mineola, NY, USA
| | - Sherry S-Y Hou
- Department of Epidemiology, McGill University, Montreal, Quebec, Canada
| | - Frederick Lu
- Boston University School of
Medicine, Boston, MA, USA
| | - Sara Banbury
- University of Pennsylvania Perelman
School of Medicine, Philadelphia, PA, USA
| | | | - Benjamin L Cook
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Cambridge Health Alliance, Cambridge, MA,
USA
| |
Collapse
|
35
|
Wain LM. Does integrated health and care in the community deliver its vision? A workforce perspective. JOURNAL OF INTEGRATED CARE 2020. [DOI: 10.1108/jica-10-2020-0061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeThe purpose of this paper is to explore and capture workforce perceptions, experiences and insights of the phenomena of integrated care (IC) in a community health and care NHS trust in England; including whether there are any associated factors that are enablers, barriers, benefits or challenges; and the level of workforce engagement in the process of integrated health and care.Design/methodology/approachA qualitative design based on an interpretivist research paradigm was used with a purposive sampling technique. Five in-depth semi-structured interviews were conducted with community nursing, social workers and allied health professionals. Colaizzi's (1978) descriptive phenomenological seven-step method was applied to analyse data, with the emergence of 170 significant statements, 170 formulated meanings and 8 thematic clustering of themes to reveal 4 emergent themes and 1 fundamental structure capturing the essential aspects of the structure of the phenomenon IC.FindingsThis study revealed four interdependent emergent themes: (1) Insight of IC and collaboration: affording the opportunity for collaboration, shared goals, vision, dovetailing knowledge, skills and expertise. Professional aspirations of person-centred and strength-based care to improve outcomes. (2) Awareness of culture and professionalism: embracing inter-professional working whilst appreciating the fear of losing professional identity and values. Working relationships based on trust, respect and understanding of professional roles to improve outcomes. (3) Impact of workforce engagement: participants felt strongly about their differing engagement experience in terms of restructuring and redesigning services. (4) Impact of organisational structure: information technology (IT) highlighted a barrier to IC as differing IT platforms prevent interoperability with one system to one patient. Shared positivity of IC, embracing new ways of working.Originality/valueThis study proposes considerations for future practice, policy and research from a local, national and global platform, highlighting the need for any IC strategy or policy to incorporate the uniqueness of the “voice of the workforce” as a key enabler to integration developments, only then can IC be a fully collaborative approach.
Collapse
|
36
|
Lalani M, Bussu S, Marshall M. Understanding integrated care at the frontline using organisational learning theory: A participatory evaluation of multi-professional teams in East London. Soc Sci Med 2020; 262:113254. [DOI: 10.1016/j.socscimed.2020.113254] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 04/29/2020] [Accepted: 07/22/2020] [Indexed: 10/23/2022]
|
37
|
Collaborative Experience Success Stories in Integrated Care of Older People: A Narrative Analysis. Int J Integr Care 2020; 20:9. [PMID: 32874168 PMCID: PMC7442177 DOI: 10.5334/ijic.5452] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Introduction: Inter-organisational collaboration is crucial in the care of older people, as is the development of integrated care. Storytelling in organisations is one way of understanding how to achieve successful collaboration. This article provides insights into the ways in which storytelling in collaborative experiences contributes to a collective identity instrumental in the successful collaborations involved in integrated care for older people. Theory: Managing cultural diversity is one specific theme in the theory of collaborative advantage; this is used in combination with theories of storytelling in organisations. Method: Interviews with staff from three different municipalities applying three various strategies for integrated care were carried out. Stories of the collaborative experiences were analysed using a narrative approach. Results: The most significant finding was that a similar type of success story was evident across all three municipalities. The story was identified as an epic-comedy story where success was accomplished through the heroic characterisations of the managers, in addition to their improvisation abilities and discretionary work towards common goals. Conclusion: It is suggested that storytelling in collaborative experiences is one way of overcoming cultural frictions between different collaborating actors and may contribute to a coherent sense of a collective identity, thus facilitating further collaboration.
Collapse
|
38
|
Cheng SM, Catallo C. Conceptual framework: factors enabling collaborative healthcare and social services integration. JOURNAL OF INTEGRATED CARE 2020. [DOI: 10.1108/jica-11-2019-0048] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeA conceptual framework for collaboratively based integrated health and social care (IHSC) integration is proposed to aid in understanding how to accomplish IHSC.Design/methodology/approachThis model is based on extant literature of successfully IHSC initiatives.FindingsThe model aims to identify enabling integration factors that support collaborative integration efforts between healthcare and social services organizations. These factors include shared goals and vision, culture, leadership, team-based care, information sharing and communications, performance measurement and accountability agreements, and dedicated resources and financing. It also identifies factors that act as external influencers that can support or hinder integration efforts among collaborating organizations. These factors are geographic setting, funding models, governance structures, and public policies. These factors are intended to ensure that a realist lens is applied when trying to understand and explain IHSC.Originality/valueThis model is intended to provide a framework to support research, policy and implementation efforts.
Collapse
|
39
|
Cho O. Impact of Physical Education on Changes in Students' Emotional Competence: A Meta-analysis. Int J Sports Med 2020; 41:985-993. [PMID: 32643773 DOI: 10.1055/a-1192-5812] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The theoretical background related to how physical activity positively influences children and adolescents' brain function for social and emotional competency has been stably structured. However, according to our review of the literature, no study has synthetically analyzed physical education interventions that produce positive outcomes related to learners' emotional status. Therefore, the aim of the study was to systematically analyze the effectiveness of physical education interventions designed to improve students' emotional ability. In October 2017, we searched electronic research databases for intervention studies that analyzed the impact of school physical education on students' emotional changes. We assessed the risk of bias, extracted data, and conducted meta-analysis to determine the effectiveness of physical education intervention. From an initial pool of 1200 non-duplicate records, 12 studies fulfilled the inclusion criteria. The effectiveness of school-based physical education was analyzed by calculating standard mean difference. Based on the results of the meta-analysis, students in intervention conditions changed their psychological conditions compared with students in usual practice conditions (standardized mean difference=0.30, 95% confidence interval=- 0.05-0.66). Physical and sport education for children and adolescents has positively influenced changes in their emotional conditions.
Collapse
Affiliation(s)
- Ooksang Cho
- Department of Physical Education, Korea National Sport University, Songpa-gu, Korea (the Republic of)
| |
Collapse
|
40
|
Doheny M, Agerholm J, Orsini N, Schön P, Burström B. Impact of integrated care on trends in the rate of emergency department visits among older persons in Stockholm County: an interrupted time series analysis. BMJ Open 2020; 10:e036182. [PMID: 32499268 PMCID: PMC7279653 DOI: 10.1136/bmjopen-2019-036182] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To investigate the association between the implementation of an integrated care (IC) system in Norrtälje municipality and changes in trends of the rate of emergency department (ED) visits. DESIGN Interrupted time series analysis from 2000 to 2015. SETTING Stockholm County. PARTICIPANTS All inhabitants 65+ years in Stockholm County on 31 December of each study year. INTERVENTION IC was established by combining the funding, administration and delivery of health and social care for older persons in Norrtälje municipality, within Stockholm County. OUTCOME Rates of hospital-based ED visits. RESULTS IC was associated with a decrease in the rate of ED visits (incidence rate ratio: 0.997, 95% CI 0.995 to 0.998) among inhabitants 65+ years in Norrtälje. However, the rate of ED visits remained higher in Norrtälje than the rest of Stockholm in the preintervention and postintervention periods. Stratified analyses showed that IC was associated with a decline in the trend of the rate of ED visits among those 65-79 years, the lowest income group and born outside of Sweden. However, there was no significant decrease in the trend among those 80+ years. CONCLUSION The implementation of IC was associated with a modest change in the trend of ED visits in Norrtälje, though the rate of ED visits remained higher than in the rest of Stockholm. Changes in the composition of the population and contextual changes may have impacted our findings. Further research, using other outcome measures is needed to assess the impact of IC on healthcare utilisation.
Collapse
Affiliation(s)
- Megan Doheny
- Global Public Health, Karolinska Institute, Stockholm, Sweden
| | | | - Nicola Orsini
- Global Public Health, Karolinska Institute, Stockholm, Sweden
| | - Pär Schön
- Aging Research Center, Karolinska, Stockholm, Sweden
| | - Bo Burström
- Global Public Health, Karolinska Institute, Stockholm, Sweden
| |
Collapse
|
41
|
Garrett S, Pullon S, Morgan S, McKinlay E. Collaborative care in 'Youth One Stop Shops' in New Zealand: Hidden, time-consuming, essential. J Child Health Care 2020; 24:180-194. [PMID: 31104474 DOI: 10.1177/1367493519847030] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Young people in New Zealand have high morbidity but low service utilization rates. Dedicated youth services 'Youth One Stop Shops' provide 'wraparound' health and social care. However, little is understood about how staff within these services interact with each other or with external agencies to provide this specialist care. This article reports on volume and type of internal and inter-agency health and social service staff-staff interactions, to better understand elements of potential collaboration in day-to-day practice. An observational, case-study approach was utilized. Four dedicated youth services recorded data over three-month periods about a selected number of high-use clients. Youth service staff recorded all interactions with colleagues within their organization and staff from external services. A large volume of non-patient contact work was revealed, with a high proportion of 'complex/involved' interactions recorded. The range and diversity of external agencies with which youth service staff interacted with to meet the needs of young people was extensive and complex. The focus on 'information sharing' and 'complex/involved' interactions demonstrates a well-coordinated, wraparound service delivery model. Current funding formulae take inadequate account of the volume of non-patient contact work that youth services provide for high-needs young people.
Collapse
Affiliation(s)
- Susan Garrett
- Department of Primary Health Care and General Practice, University of Otago, Wellington South, New Zealand
| | - Susan Pullon
- Department of Primary Health Care and General Practice, University of Otago, Wellington South, New Zealand
| | - Sonya Morgan
- Department of Primary Health Care and General Practice, University of Otago, Wellington South, New Zealand
| | - Eileen McKinlay
- Department of Primary Health Care and General Practice, University of Otago, Wellington South, New Zealand
| |
Collapse
|
42
|
Kelly L, Harlock J, Peters M, Fitzpatrick R, Crocker H. Measures for the integration of health and social care services for long-term health conditions: a systematic review of reviews. BMC Health Serv Res 2020; 20:358. [PMID: 32336288 PMCID: PMC7183623 DOI: 10.1186/s12913-020-05206-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 04/12/2020] [Indexed: 01/09/2023] Open
Abstract
Background As people are living longer with higher incidences of long-term health conditions, there is a move towards greater integration of care, including integration of health and social care services. Integrated care needs to be comprehensively and systematically evaluated if it is to be implemented widely. We performed a systematic review of reviews to identify measures which have been used to assess integrated care across health and social care services for people living with long-term health conditions. Methods Four electronic databases (PUBMED; MEDLINE; EMBASE; Cochrane library of systematic reviews) were searched in August 2018 for relevant reviews evaluating the integration of health and social care between 1998 and 2018. Articles were assessed according to apriori eligibility criteria. A data extraction form was utilised to collate the identified measures into five categories. Results Of the 18 articles included, system outcomes and process measures were most frequently identified (15 articles each). Patient or carer reported outcomes were identified in 13 articles while health outcomes were reported in 12 articles. Structural measures were reported in nine articles. Challenges to measuring integration included the identification of a wide range of potential impacts of integration, difficulties in comparing findings due to differences in study design and heterogeneity of types of outcomes, and a need for appropriate, robust measurement tools. Conclusions Our review revealed no shortage of measures for assessing the structures, processes and outcomes of integrated care. The very large number of available measures and infrequent use of any common set make comparisons between schemes more difficult. The promotion of core measurement sets and stakeholder consultation would advance measurement in this area.
Collapse
Affiliation(s)
- Laura Kelly
- Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Headington, Oxford, OX3 7LF, UK.,Harris Manchester College, Oxford, OX1 3TD, UK
| | - Jenny Harlock
- Health Sciences, University of Warwick, Coventry, CV4 7AL, UK
| | - Michele Peters
- Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Headington, Oxford, OX3 7LF, UK
| | - Ray Fitzpatrick
- Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Headington, Oxford, OX3 7LF, UK
| | - Helen Crocker
- Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Headington, Oxford, OX3 7LF, UK.
| |
Collapse
|
43
|
Kjellberg I, Szücs S. Pursuing collaborative advantage in Swedish care for older people: stakeholders' views on trust. JOURNAL OF INTEGRATED CARE 2020. [DOI: 10.1108/jica-01-2020-0001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeThe purpose of this paper is to explore stakeholder views on the policy of integrated health and social care for older people with complex needs in Sweden and the issue of trust in implementing the policy.Design/methodology/approachThe study used a qualitative interview design and interviews with nine strategically selected stakeholders. A thematic analysis focused on trust, as defined in the theory of collaborative advantage, was used.FindingsThis study of health and social care exposed a lack of trust on political, strategic and inter-professional levels. Two opposing lines of argument were identified in the interviews. One advocated a single government authority for health and social care. The other was in accordance with recently implemented national policies, which entailed more collaboration between local government authorities, obliging them to make joint local agreements. The Swedish experience is discussed in an international context, examining the need for collaboration in integrated care services for older people.Research limitations/implicationsAlthough the findings are important for the current adjustment in health and social care for older people, the number of interviewees are limited. Future studies will include more regions and longitudinal studies.Originality/valueSweden is currently undergoing an extensive adjustment in line with recent national government policy which involves more primary health care and a corresponding reduction in the number of hospital beds. The restructuring of the care system for older people with complex needs is a paradox, as it simultaneously increases the need for centralisation while also increasing coordination and collaboration on a local basis.
Collapse
|
44
|
Communication and Coordination Processes Supporting Integrated Transitional Care: Australian Healthcare Practitioners' Perspectives. Int J Integr Care 2020; 20:1. [PMID: 32322183 PMCID: PMC7164380 DOI: 10.5334/ijic.4685] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Introduction: Although a large body of research has identified effective models of transitional care, questions remain about the optimal translation of this knowledge into practice. In Australia, the introduction of a model of consumer-directed care uniquely challenges the practice of integrated care transitions for older adults. This study aimed to identify strengths and weaknesses in transitional care for older adults in an Australian setting by describing healthcare practitioners’ experiences of care provision. Methods: The study used a qualitative design in two phases: 1) semi-structured interviews, 2) one focus group. The setting comprised one public health network and five community services in urban Australia. In Phase 1, health practitioners across settings were interviewed about their experience of transitional care. Phase 2 sought feedback about the Phase 1 findings from different practitioners. All data were thematically analysed. Findings: In Phase 1), 48 healthcare practitioners were interviewed across multiple settings. Few participants were aware of the introduction of consumer-directed care in community aged care. Four main themes were identified: ‘Rapid and safe care transition’, ‘Discussing as a team’, ‘Questioning the discharge’, and ‘Engaging patients and carers’. In Phase 2), seven participants from different settings reviewed and endorsed the findings from Phase 1. Discussion and conclusions: Findings indicate that healthcare practitioners use a range of communication and coordination processes in optimising integrated transitional care. Although participants involved their patients in transitional care planning, most participants were unaware of the recent implementation of consumer-directed care. In contexts of community-based care shaped by multidisciplinary, sub-acute and CDC models, care integration must focus on improved communication with patients and carers to ascertain their needs and to support their increased responsibility in their care transitions.
Collapse
|
45
|
Abstract
PurposeThe purpose of this paper is to present a case study of an intersectoral partnership that has taken place in Scotland (United Kingdom) entitled Gamechanger. The main idea of Gamechanger was for statutory, commercial and voluntary organisations to work in partnership to harness the power of football (soccer), to tackle health inequalities and social exclusion. The paper will detail how Gamechanger has been developed, with reference to the newly developed “Incite” model for effective intersectoral partnership working.Design/methodology/approachThis paper draws on the authors’ experiences of leading and evaluating intersectoral partnerships from 2015 to 2019. The report draws on the work which took place during that period, and the achievements in relation to Gamechanger.FindingsGamechanger has led to significant innovations. It has encouraged sectors to work together, and develop new ways of responding to difficult societal problems.Originality/valueGamechanger is believed to be the first initiative of its kind developed with a football club in Scotland.ConclusionsThis work has been developed through robust community-informed efforts. The scope and scale of the projects to deliver community benefits is significant. Gamechanger has provided a means for football to take a different approach to how it works to benefit communities.
Collapse
|
46
|
Kumpunen S, Edwards N, Georghiou T, Hughes G. Why do evaluations of integrated care not produce the results we expect? INTERNATIONAL JOURNAL OF CARE COORDINATION 2020. [DOI: 10.1177/2053434520909089] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A number of evaluations of models of integrated care have not produced the expected result of reduced hospital admissions, and in some cases have even found people receiving integrated care services using hospitals more than matched controls. We tested three hypotheses for these surprising results with a group of 50 integrated care experts in a seminar: (1) problems with the model; (2) problems of implementation; and (3) problems of evaluation. Our group of experts did not rule out any of these hypotheses and came up with some advice as to manage these issues. For example, model designers should rigorously test the underlying logic; commissioners should seek out advice from experts and patients/professionals; and evaluators should choose outcomes wisely, use mixed methods approaches, and provide regular feedback loops to implementation sites. Evaluating integrated care is a skilled task that requires multiple approaches in terms of the design and implementation of the models. National research funders or other appropriate bodies might consider developing an advisory service to provide support to local systems planning evaluations.
Collapse
|
47
|
Anjara SG, Ní Shé É, O'Shea M, O'Donoghue G, Donnelly S, Brennan J, Whitty H, Maloney P, Claffey A, Quinn S, McMahon N, Bourke N, Lang D, Reilly P, McGuigan C, Cosgrave S, Lawlor L, O'Shea D, McAuliffe E, O'Donnell D. Embedding collective leadership to foster collaborative inter-professional working in the care of older people (ECLECTIC): Study protocol. HRB Open Res 2020; 3:8. [PMID: 32789287 PMCID: PMC7359747 DOI: 10.12688/hrbopenres.13004.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2020] [Indexed: 11/20/2022] Open
Abstract
Background: The National Integrated Care Programme for Older People (NICPOP), formerly NCPOP aims to support older people to live well in their homes by developing primary and secondary care services for older people, especially those with complex needs. The programme develops integrated intermediate care which traverses both hospital and community settings through multidisciplinary and interagency teams. This team-based approach to the integration of health services is a novel innovation in Irish health service delivery and will require, over time, a shift in cultures of care to allow for the development of competencies for inter-professional collaboration across the care continuum. The ECLECTIC project will develop an implementation framework for achieving, maintaining and monitoring competencies for interprofessional collaboration among multi-disciplinary teams charged with delivering care for older people across the continuum from acute to community settings. Design: The ECLECTIC research design has been developed in collaboration with the NICPOP. In phase one of the project, a co-design team will collaborate to define and shape competencies for interprofessional collaboration. Phase two will involve the delivery of a collective leadership intervention over a 10-month period with multidisciplinary professionals working with older people across two geographical regions (Mullingar/Midlands and Beaumont/Dublin North). Each group will comprise of members of two multidisciplinary teams charged with coordinating and delivering care to older people across the continuum of acute to community care. Observations of collaborative inter-professional working will take place before, during, and after intervention. In phase three of the study, analysis of the interview and observation data will be presented to the co-design team in order to develop an implementation framework for future teams. Discussion: The co-design process will develop core competencies and performance indicators for collaborative interprofessional working. The resulting implementation framework will be implemented nationally as part of the NICPOP.
Collapse
Affiliation(s)
- Sabrina G Anjara
- School of Nursing, Midwifery and Health Systems, University College Dublin, Belfield, Dublin, 4, Ireland
| | - Éidín Ní Shé
- School of Nursing, Midwifery and Health Systems, University College Dublin, Belfield, Dublin, 4, Ireland
| | - Marie O'Shea
- School of Nursing, Midwifery and Health Systems, University College Dublin, Belfield, Dublin, 4, Ireland
| | - Gráinne O'Donoghue
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Belfield, Dublin, 4, Ireland
| | - Sarah Donnelly
- School of Social Policy, Social Work and Social Justice, University College Dublin, Belfield, Dublin, 4, Ireland
| | - John Brennan
- National Clinical Programme for Older People, Royal College of Physicians of Ireland, Dublin, 2, Ireland
| | - Hellen Whitty
- National Clinical Programme for Older People, Royal College of Physicians of Ireland, Dublin, 2, Ireland
| | | | - Anne Claffey
- Regional Hospital Mullingar, Mullingar, N91 NA43, Ireland
| | | | - Niamh McMahon
- St. James's University Hospital, Dublin, 8, Ireland.,School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin, 2, Ireland
| | - Noeleen Bourke
- Regional Hospital Mullingar, Mullingar, N91 NA43, Ireland.,Health Service Executive CHO 8 (Longford and Westmeath), Mullingar, Ireland
| | | | - Patrice Reilly
- Health Service Executive CHO 9 (Dublin North City and County), Dublin, Ireland
| | | | | | | | | | - Eilish McAuliffe
- School of Nursing, Midwifery and Health Systems, University College Dublin, Belfield, Dublin, 4, Ireland
| | - Deirdre O'Donnell
- School of Nursing, Midwifery and Health Systems, University College Dublin, Belfield, Dublin, 4, Ireland
| |
Collapse
|
48
|
Lette M, Boorsma M, Lemmens L, Stoop A, Nijpels G, Baan C, de Bruin S. Unknown makes unloved-A case study on improving integrated health and social care in the Netherlands using a participatory approach. HEALTH & SOCIAL CARE IN THE COMMUNITY 2020; 28:670-680. [PMID: 31773803 PMCID: PMC7028071 DOI: 10.1111/hsc.12901] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 10/04/2019] [Accepted: 11/11/2019] [Indexed: 06/10/2023]
Abstract
Many initiatives integrating health and social care have been implemented in order to provide adequate care and support to older people living at home. Further development of existing initiatives requires iterative processes of developing, implementing and evaluating improvements to current practice. This case study provides insight into the process of improving an existing integrated care initiative in the Netherlands. Using a participatory approach, researchers and local stakeholders collaborated to develop and implement activities to further improve collaboration between health and social care professionals. Improvement activities included interprofessional meetings focussing on reflection and mutual learning and workplace visits. Researchers evaluated the improvement process, using data triangulation of multiple qualitative and quantitative data sources. According to participating professionals, the improvement activities improved their communication and collaboration by establishing mutual understanding and trust. Enabling factors included the safe and informal setting in which the meetings took place and the personal relationships they developed during the project. Different organisational cultures and interests and a lack of ownership and accountability among managers hindered the improvement process, whereas issues such as staff shortages, time constraints and privacy regulations made it difficult to implement improvements on a larger scale. Still, the participatory approach encouraged the development of partnerships and shared goals on the level of both managers and professionals. This case study highlights that improving communication between professionals is an important first step in improving integrated care. In addition, it shows that a participatory approach, in which improvements are co-created and tailored to local priorities and needs, can help in the development of shared goals and trust between stakeholders with different perspectives. However, stakeholders' willingness and ability to participate in such an improvement process is challenged by many factors.
Collapse
Affiliation(s)
- Manon Lette
- Department of General Practice and Elderly Care MedicineAmsterdam Public Health Research InstituteAmsterdam UMC – VU University AmsterdamAmsterdamThe Netherlands
- Centre for Nutrition, Prevention and Health Services ResearchNational Institute for Public Health and the EnvironmentBilthovenThe Netherlands
| | - Marijke Boorsma
- Department of General Practice and Elderly Care MedicineAmsterdam Public Health Research InstituteAmsterdam UMC – VU University AmsterdamAmsterdamThe Netherlands
| | - Lidwien Lemmens
- Centre for Nutrition, Prevention and Health Services ResearchNational Institute for Public Health and the EnvironmentBilthovenThe Netherlands
| | - Annerieke Stoop
- Department of General Practice and Elderly Care MedicineAmsterdam Public Health Research InstituteAmsterdam UMC – VU University AmsterdamAmsterdamThe Netherlands
- Centre for Nutrition, Prevention and Health Services ResearchNational Institute for Public Health and the EnvironmentBilthovenThe Netherlands
- Scientific Centre for Transformation in Care and Welfare (Tranzo)University of TilburgTilburgThe Netherlands
| | - Giel Nijpels
- Department of General Practice and Elderly Care MedicineAmsterdam Public Health Research InstituteAmsterdam UMC – VU University AmsterdamAmsterdamThe Netherlands
| | - Caroline Baan
- Centre for Nutrition, Prevention and Health Services ResearchNational Institute for Public Health and the EnvironmentBilthovenThe Netherlands
- Scientific Centre for Transformation in Care and Welfare (Tranzo)University of TilburgTilburgThe Netherlands
| | - Simone de Bruin
- Centre for Nutrition, Prevention and Health Services ResearchNational Institute for Public Health and the EnvironmentBilthovenThe Netherlands
| |
Collapse
|
49
|
Abstract
Introduction The importance of management to the implementation of integrated care is recognised in evidence and practice. Despite this recognition, there is a lack of clarity about what 'good' management of integrated care looks like, if the competences are different to management for 'traditional' care, and how such competences can be acquired. Theory and methods This exploratory study is based on qualitative interviews with participants with extensive experience of implementing integrated care in senior professional, research, administrative and/or policy roles. It conceptualises management as working at 'strategic' and 'operational' levels. Results Management of integrated care was seen to require an ability to create networks across professions and organisations, to be comfortable with distributing responsibilities, and to thoroughly understand the wider system. Competences to support these new ways of working included an understanding of how to implement people-centredness, to have courage to challenge the status quo, and to demonstrate humility to learn from others. Structured development opportunities for managers were lacking, but seen as vital for the sustainability of change. Discussion and conclusion Management for integrated care remains an underdeveloped concept and practice. A first formulation of the competences necessary was achieved, but more work is urgently required to understand how to better prepare and support managers to achieve necessary changes in practice and culture.
Collapse
|
50
|
Hynek KA, Malmberg-Heimonen I, Tøge AG. Improving interprofessional collaboration in Norwegian primary schools: A cluster-randomized study evaluating effects of the LOG model on teachers' perceptions of interprofessional collaboration. J Interprof Care 2020:1-10. [PMID: 31928248 DOI: 10.1080/13561820.2019.1708281] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 11/25/2019] [Accepted: 12/16/2019] [Indexed: 10/25/2022]
Abstract
Increased demand for interprofessional collaboration within the educational field also increases the need for the development and evaluation of interventions to improve collaboration. In Norway, the LOG model was developed and implemented in compulsory schools to facilitate interprofessional collaboration by increasing arenas for more efficient use of existing interprofessional resources. We evaluate the effects of the model on teachers' perceptions of interprofessional collaboration in a cluster-randomized trial, with 19 schools randomized to the experimental group and 16 schools to the control group. We use data from 5th-7th grade teachers in the 35 participating schools (N = 157) prior to randomization and one-year into the implementation. Response rates were 70% and 74%, respectively. The PINCOM-Q scale was used to analyze effects of the model on various dimensions of interprofessional collaboration. At the one-year follow-up, the LOG model demonstrates no significant effects on teachers' perceptions of interprofessional collaboration. However, there is an indication of effect on the organizational aim dimension (ES = -0.39, CI = -0.82-0.03), but the evidence is not conclusive.
Collapse
Affiliation(s)
- Kamila Angelika Hynek
- Department of Mental Health and Suicide, Norwegian Institute of Public Health, Oslo, Norway
| | - Ira Malmberg-Heimonen
- Department of Social Work, Child Welfare and Social Policy, Oslo Metropolitan University, Norway
| | - Anne Grete Tøge
- Department of Social Work, Child Welfare and Social Policy, Oslo Metropolitan University, Norway
| |
Collapse
|