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Article
Publication date: 12 March 2018

Madeline Naick

The provision of telecare for older adults in England is increasingly being facilitated by care navigators in the non-statutory sector. The purpose of this paper is to…

Abstract

Purpose

The provision of telecare for older adults in England is increasingly being facilitated by care navigators in the non-statutory sector. The purpose of this paper is to explore the experiences of care navigators when assessing older adults for telecare and to understand what contextual and organisational factors impact on their practice.

Design/methodology/approach

A purposeful sample of care navigators and telecare installers was selected. Care navigators were recruited from five non-statutory organisations. In order to provide an insight into telecare provision by this sector, telecare installers were also recruited. Semi-structured interviews were conducted with 11 participants covering: role, training, assessment, reviews, installation, suitability, impact, aims, outcomes, and organisational structure. Interview data were analysed using the framework approach.

Findings

Five main themes emerged from the analysis: responsiveness, autonomy, knowledge exchange, evolving practice, and sustaining performance.

Research limitations/implications

This study included a small sample, and was only based in one local authority, focusing on the experience of care navigators in only one sector.

Practical implications

The findings suggest that strategic placement of care navigators could support the demand for telecare assessment to facilitate discharges from hospital. This study highlights the perception of home assessment as a gold standard of practice for care navigators. In order to develop a more sustainable model for care navigators’ capacity to work within hospital teams and provide home assessments needs further consideration.

Originality/value

This study is one of the first to explore the role of the care navigator and their involvement in the provision of telecare for older adults.

Details

Quality in Ageing and Older Adults, vol. 19 no. 1
Type: Research Article
ISSN: 1471-7794

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Article
Publication date: 1 November 2018

Laura Funk and Wanda Hounslow

The purpose of this paper is to examine how formal navigators interpret their roles supporting families of older adults.

Abstract

Purpose

The purpose of this paper is to examine how formal navigators interpret their roles supporting families of older adults.

Design/methodology/approach

This study was an interpretive inquiry informed by critical gerontology and discourse analytic methods. Interview data were collected and analyzed from 22 formal service providers who helped older adults and their families navigate health and social care resources in one Western Canadian city.

Findings

Although acknowledging structural barriers to service access, participants emphasized individual empowerment as their dominant strategy, interpreting their roles as providing information and education about services. In part, these interpretations may reflect the limited nature of their ability to help broker access or advocate; in part, they may also reflect the broader political and economic discourses surrounding care in Canada.

Research limitations/implications

When providers position navigation and access to care as individual problems, this can obscure structural burden as well as potential inequities among older adults. Future research should examine whether navigational role interpretations are similar or different to those of navigators in other regions. Navigators in other health and social care contexts may enact differing meanings in their work.

Practical implications

Although formal public navigators can play an important role, approaches that go beyond providing information may better meet families’ needs for support.

Originality/value

This is one of the first studies focused specifically on providers’ interpretations of the meaning of navigational work in health and social care for older adults, and to extend a critical gerontological gaze toward the issue of system navigation.

Details

Quality in Ageing and Older Adults, vol. 20 no. 1
Type: Research Article
ISSN: 1471-7794

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Article
Publication date: 1 April 2008

Gerald Wistow and Gill Callaghan

This article is the second which the Journal of Integrated Care has published about the Hartlepool connected care pilot. It takes up the narrative from the launch of the…

Abstract

This article is the second which the Journal of Integrated Care has published about the Hartlepool connected care pilot. It takes up the narrative from the launch of the community audit report in February 2006 to the project's successful bid to become one of the 26 DoH social enterprise pilots some 12 months later. It seeks to understand the barriers encountered as the pilot sought to implement a service model based on an audit of local needs and ambitions. It identifies the need for support outside the local policy systems if holistic, community‐based initiatives are to be initiated and implemented. In addition, it considers some of the implementation dilemmas that the pilot posed for local agencies and that it had itself to face and resolve during this second phase in its development.

Details

Journal of Integrated Care, vol. 16 no. 2
Type: Research Article
ISSN: 1476-9018

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Article
Publication date: 6 February 2020

Agnieszka Sobolewska, Amy-Louise Byrne, Clare Lynette Harvey, Eileen Willis, Adele Baldwin, Sandy McLellan and David Heard

The purpose of the paper is to explore how the national, state and organisational health policies in Australia support the implementation of person-centred care in…

Abstract

Purpose

The purpose of the paper is to explore how the national, state and organisational health policies in Australia support the implementation of person-centred care in managing chronic care conditions.

Design/methodology/approach

A qualitative content analysis was performed regarding the national, state and organisational Queensland Health policies using Elo and Kyngas' (2008) framework.

Findings

Although the person-centred care as an approach is well articulated in health policies, there is still no definitive measure or approach to embedding it into operational services. Complex funding structures and competing priorities of the governments and the health organisations carry the risk that person-centred care as an approach gets lost in translation. Three themes emerged: the patient versus the government; health care delivery versus the political agenda; and health care organisational processes versus the patient.

Research limitations/implications

Given that person-centred care is the recommended approach for responding to chronic health conditions, further empirical research is required to evaluate how programs designed to deliver person-centred care achieve that objective in practice.

Practical implications

This research highlights the complex environment in which the person-centred approach is implemented. Short-term programmes created specifically to focus on person-centred care require the right organisational infrastructure, support and direction. This review demonstrates the need for alignment of policies related to chronic disease management at the broader organisational level.

Originality/value

Given the introduction of the nurse navigator program to take up a person-centred care approach, the review of the recent policies was undertaken to understand how they support this initiative.

Details

Journal of Health Organization and Management, vol. 34 no. 2
Type: Research Article
ISSN: 1477-7266

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Article
Publication date: 16 February 2015

Bob Hudson

As the notion of “integrated care” has received ever greater policy traction, so the idea that a named individual should take responsibility for coordinating the various…

Abstract

Purpose

As the notion of “integrated care” has received ever greater policy traction, so the idea that a named individual should take responsibility for coordinating the various elements of care for service users has also gained ground. The purpose of this paper is to look at the proposal to hand this role to GPs, examine the policy expectations and explore some of the implementation dilemmas.

Design/methodology/approach

Review of policy documents and relevant literature.

Findings

That the role of “care coordinator” has rarely succeeded in the past and that there are specific difficulties in expecting GPs to take on the task.

Research limitations/implications

Review of existing literature linked to emergent policy – no original research.

Originality/value

This is a new application of an enduring policy concept. Currently the literature is thin.

Details

Journal of Integrated Care, vol. 23 no. 1
Type: Research Article
ISSN: 1476-9018

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Article
Publication date: 7 December 2018

David Robertshaw and Ainslea Cross

Effective integrated healthcare systems require capable, trained workforces with leadership, shared governance and co-ordination. The purpose of this paper is to…

Abstract

Purpose

Effective integrated healthcare systems require capable, trained workforces with leadership, shared governance and co-ordination. The purpose of this paper is to characterise roles and responsibilities in relation to integrated care from the perspective of massive open online course (MOOC) participants.

Design/methodology/approach

MOOC discussion board posts were analysed using framework analysis consisting of transcription, familiarisation, coding, developing an analytical framework and application of the framework.

Findings

Boundaries and key issues surrounding roles and responsibilities were highlighted and participants suggested a number of enablers which could enhance integrated care in addition to barriers to consider and overcome.

Originality/value

Enablers included introduction of shared communication and IT systems to support continuity of care. Awareness and understanding of dementia was seen as crucial to promote person-centred care and care planning. The roles of education and experience were highlighted. Barriers preventing effective roles and suitable responsibility include funding, role conflicts, time constraints and time-consuming paperwork.

Details

Journal of Integrated Care, vol. 27 no. 2
Type: Research Article
ISSN: 1476-9018

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Article
Publication date: 12 January 2018

Serena Yu, Kees van Gool, Karen Edwards, Sue Kirby, Karen Gardner, Louise Robinson, Tricia Linehan, Mark Harris and Jane Hall

The Western New South Wales Integrated Care Strategy (ICS) was rolled out from November 2014 across three rural sites. The purpose of this paper is to assess its impact on…

Abstract

Purpose

The Western New South Wales Integrated Care Strategy (ICS) was rolled out from November 2014 across three rural sites. The purpose of this paper is to assess its impact on general practices, and examine the feasibility of implementing an ICS, within a predominantly fee-for-service delivery model.

Design/methodology/approach

Mixed methods were used to analyse the implementation of the ICS, including practice-level patient data on changes in service provision. This includes unit-record data on 130 enroled patients across three rural sites, as well as qualitative data collection from providers.

Findings

There were significant increases in both revenue-generating and non-revenue-generating activities (primarily care coordination activities) associated with implementing the ICS. Each occasion of service involved greater contact time with practice staff other than GPs, as well as greater administration time. There is evidence that ICS activities such as case conferencing and team care planning substitute for traditional GP consultations. Overall, the study found that a significant investment of resources – namely staff time devoted to a range of activities – was required to support the implementation of the ICS. Such an investment was supported both externally and through revenue-generating practice-level activities.

Research limitations/implications

The data collection and evaluation project is ongoing, with analysis based on the first wave of data from three sites.

Practical implications

At the practice level, a substantial commitment of resources is required to invest in, and sustain, a new model of integrated care (IC). This commitment can currently be supported both through higher revenue generation at the practice level, and externally by health system stakeholders, but changes in financial settings could impact on financial viability.

Originality/value

This paper provides evidence on the role of blended payment mechanisms in facilitating the implementation of IC in a rural setting where there are medical workforce constraints.

Details

Journal of Integrated Care, vol. 26 no. 1
Type: Research Article
ISSN: 1476-9018

Keywords

Content available
Article
Publication date: 25 October 2019

Bob Erens, Gerald Wistow, Nicholas Mays, Tommaso Manacorda, Nick Douglas, Sandra Mounier-Jack and Mary Alison Durand

All areas in England are expected by National Health Service (NHS) England to develop integrated care systems (ICSs) by April 2021. ICSs bring together primary, secondary…

Abstract

Purpose

All areas in England are expected by National Health Service (NHS) England to develop integrated care systems (ICSs) by April 2021. ICSs bring together primary, secondary and community health services, and involve local authorities and the voluntary sector. ICSs build on previous pilots, including the Integrated Care Pioneers in 25 areas from November 2013 to March 2018. This analysis tracks the Pioneers’ self-reported progress, and the facilitators and barriers to improve service coordination over three years, longer than previous evaluations in England. The paper aims to discuss these issues.

Design/methodology/approach

Annual online key informant (KI) surveys, 2016–2018, are used for this study.

Findings

By the fourth year of the programme (2017), KIs had shifted from reporting plans to implementation of a wide range of initiatives. In 2018, informants reported fewer “significant” barriers to change than previously. While some progress in achieving local integration objectives was evident, it was also clear that progress can take considerable time. In parallel, there appears to have been a move away from aspects of personalised care associated with user control, perhaps in part because the emphasis of national objectives has shifted towards establishing large-scale ICSs with a particular focus on organisational fragmentation within the NHS.

Research limitations/implications

Because these are self-reports of changes, they cannot be objectively verified. Later stages of the evaluation will look at changes in outcomes and user experiences.

Originality/value

The current study shows clearly that the benefits of integrating health and social care are unlikely to be apparent for several years, and expectations of policy makers to see rapid improvements in care and outcomes are likely to be unrealistic.

Details

Journal of Integrated Care, vol. 28 no. 1
Type: Research Article
ISSN: 1476-9018

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Article
Publication date: 1 August 2005

Bob Hudson

Public sector reform will be at the heart of Labour's third term of office. The changes under way or planned in children's services and adult social care services in…

Abstract

Public sector reform will be at the heart of Labour's third term of office. The changes under way or planned in children's services and adult social care services in England are prototypes of the pursuit of services that are person‐centred, seamless and proactive, with a focus on positive outcomes and well‐being. This article examines the similarities in approach between the two sets of changes, and warns that implementation will be a difficult task.

Details

Journal of Integrated Care, vol. 13 no. 4
Type: Research Article
ISSN: 1476-9018

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Book part
Publication date: 7 October 2011

Victoria A. Parker and Christy Harris Lemak

As health care delivery becomes increasingly focused on patient-centered models, interventions such as patient navigation that have the potential to improve care

Abstract

As health care delivery becomes increasingly focused on patient-centered models, interventions such as patient navigation that have the potential to improve care coordination garner interest from health care managers and clinicians. The ability to understand how and to what extent patient navigation is successful in addressing coordination issues, however, is hampered by multiple definitions, vague boundaries, and different contextual implementations of patient navigation. Using a systematic review strategy and classification method, we review both the conceptual and empirical literature regarding navigation in multiple clinical contexts. We then describe and conceptualize variation in how patient navigation has been defined, implemented, and theorized to affect outcomes. This review suggests that patient navigation varies along multiple dimensions and that the variation is related to differing resources, constraints, and goals. We propose a conceptual model to frame further research and suggest that research in this area must carefully account for this variation in order to accurately assess the benefits of patient navigation and provide actionable knowledge for managers.

Details

Biennial Review of Health Care Management
Type: Book
ISBN: 978-0-85724-714-8

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