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11 – 20 of over 34000With practice‐based commissioning becoming a requirement in the NHS, this article reviews its potential impact on the established practical arrangements for health and social care…
Abstract
With practice‐based commissioning becoming a requirement in the NHS, this article reviews its potential impact on the established practical arrangements for health and social care partnerships. It raises a number of serious questions about the future and, with the management of longterm conditions in mind, sets out challenges that lie ahead.
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Professional partnerships between housing and health are not impossible, but they take time, commitment and dedicated strategic leadership. The language and culture of the two…
Abstract
Purpose
Professional partnerships between housing and health are not impossible, but they take time, commitment and dedicated strategic leadership. The language and culture of the two sectors are sometimes complex and do not always match. There can be issues understanding each other’s motivation, ethics and terminology which can cause a barrier when working together. The purpose of this paper is to share the journey of how Wakefield District Housing (WDH) is working with the care and health sector to create sustainable partnerships that benefit both parties, getting to a stage where they could successfully integrate with healthcare providers in the Wakefield district.
Design/methodology/approach
The paper offers the reader an overview of how WDH’s membership of the Wakefield Health and Wellbeing Board enabled improved partnership working with NHS and other members, including the establishment of a Housing, Health and Social Care Partnership, the employment of dedicated senior staff, co-located multi-disciplinary teams and joint design of new services.
Findings
WDH has demonstrated that the organisation understands the challenges facing NHS colleagues, has acknowledged the complexities of the system that their partners work in and looked for solutions alongside them. The opportunities within partnership working are boundless and, if successful, the outcomes for tenants and the wider Wakefield population could be in excess of those envisaged in planning the project. Partnerships will almost inevitably encounter challenges along the way but if all partners keep their own and shared visions in mind, further success is within reach and all parties will get there faster by not going alone.
Practical implications
The paper offers useful guidance and ideas for other housing organisations aiming to improve their contribution to local integrated healthcare.
Originality/value
This paper provides an original perspective from inside the programme, offering practical, comprehensive and deliverable initiatives to improve health outcomes for local communities.
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Charlotte Goldman and Jane Carrier
This article follows an earlier article in this journal (Goldman, 2010), examines the emerging government policy on integration and considers some of the implications for joint…
Abstract
This article follows an earlier article in this journal (Goldman, 2010), examines the emerging government policy on integration and considers some of the implications for joint financing. Most primary care trusts (PCTs) and councils with adult social care responsibilities are engaged in joint financing and wider health and social care partnership arrangements. But, with the demise of PCTs and the growth in GP commissioning, there are issues and questions about the future of such arrangements. However, despite these organisational changes, partners must continue to be able to demonstrate the outcomes that integrated health and social care services are achieving.
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To meet the multidimensional needs of patients, health services are increasingly implementing complex programmes of care through partnerships between public, private and voluntary…
Abstract
Purpose
To meet the multidimensional needs of patients, health services are increasingly implementing complex programmes of care through partnerships between public, private and voluntary sector organisations. The purpose of this paper is to explore the implementation process of a complex, multi-innovative regional health and social care partnership to coordinate end-of-life care in the South East of England.
Design/methodology/approach
The study adopted a pragmatic, pluralist design using primarily qualitative methods including observations, interviews, focus group and document review. Implementation theory provided the research framework.
Findings
While progress was made towards greater collaboration in the provision of end-of-life care, regional coordination of care among the 13 partner organisations was not achieved as envisioned. Low engagement stemming from national health system changes delayed decision making and shifted partners’ priorities. Individual stakeholder interest and motivation carried the elements that were successful.
Practical implications
The external political and economic environment hindered the involvement of some of the partners and suggests that a concept of “project resiliency” is particularly important for complex, multi-organisational projects which are implemented over time and by multiple stakeholders from different sectors. Future research should look further at what contributes to project resiliency and whether it might be operationalized so that projects can develop resilient factors for success.
Originality/value
Project resiliency is a new concept that bridges a gap in understanding how time-limited multi-organisational projects function amid a changing environment.
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Within the space of three years, the Department of Health oscillated between a commitment to partnership working and the imposition of structural change in the pursuit of…
Abstract
Within the space of three years, the Department of Health oscillated between a commitment to partnership working and the imposition of structural change in the pursuit of integrated care. The idea of care trusts which integrate health and social care functions acquired political currency, despite the absence of any evidence base to inform the model. This article urges caution and suggests that the partnership model deserves a chance to deliver results.
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Elizabeth McCay, Kristin Cleverley, Audrey Danaher and Naomi Mudachi
The purpose of this paper is to describe a partnership, the Ryerson-Centre for Addiction and Mental Health Collaborative for Client-Centred and Family Sensitive Care…
Abstract
Purpose
The purpose of this paper is to describe a partnership, the Ryerson-Centre for Addiction and Mental Health Collaborative for Client-Centred and Family Sensitive Care Collaborative, between an urban university and tertiary care mental health facility to build capacity in using research evidence to support client-centred care. A cornerstone of the partnership was a study exploring the connection between effective interprofessional collaboration and the capacity to provide exemplary client-centred care in mental health.
Design/methodology/approach
The Collaborative brings together organizations with shared values and a commitment to client-centred interprofessional care. It is a strategic approach in amplifying opportunities for the uptake of research evidence and knowledge transfer. One of the principal deliverables for the Collaborative was a multi-phased study exploring the relationship between team collaboration and client-centred care.
Findings
Research findings identified a significant association between the level of team effectiveness and collaboration and the staffs’ perceived capacity to deliver client-centred care. Client and family member perspectives highlighted the importance of interprofessional team functioning and collaboration. The work of the Collaborative helped narrow the knowledge practice gap through: a research practicum to mentor graduate students; knowledge exchange and dissemination; and working with advanced practice staff to support change within the organization.
Originality/value
Inter-organizational relationships, such as the Collaborative, support initiatives that accelerate the use of clinically relevant research and bridge the knowledge practice gap. A university/tertiary care teaching facility partnership represents a promising model for advancing and disseminating evidenced-based knowledge.
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– The purpose of this paper is to explore the presence and nature of integrated care in community hospitals.
Abstract
Purpose
The purpose of this paper is to explore the presence and nature of integrated care in community hospitals.
Design/methodology/approach
Staff reported their views and experiences of integrated care in 48 questionnaires for a Community Hospitals Association programme. An analytical framework was developed based on eight types of integration, and the community hospital services concerned were grouped into nine service categories.
Findings
Staff reported multiple types of integration, averaging four types (median), with a range of two to eight (of the eight types studied). The types of integration most frequently reported were multidisciplinary care, and community hospital/secondary care and community hospital/primary care. Integration with communities, patients and the third sector featured in many of the services. Integration with social care and local authorities were least frequently reported. Services with the highest number of types of integration (5+) included palliative care, maternity services and health promotion. Staff reported that commitment was a positive factor whilst a lack of staff resources hindered partnership working.
Research limitations/implications
Staff volunteered to be part of the programme which promoted good practice, and although the findings from the study cannot be generalised, they do contribute knowledge on key partnerships in local hospitals. Further research on the types, levels and outcomes of integrated care in a larger sample of community hospitals would build on this study and enable further exploration of partnership working.
Practical implications
The analytical framework developed for the study is being applied by staff and community groups as a tool to help assess appropriate partnership working and help identify the scope for further developing integrated care. The evidence of integrated working is available to inform those commissioning and providing community health services.
Originality/value
This study has shown that integrated working is present in community hospitals. This research provides new knowledge on the types of integrated care present in a range of community hospital services. The study shows a tradition of joint working, the presence of multiple simultaneous types of integration and demonstrated that integrated care can be provided in a range of services to patients of all ages in local communities.
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Ailsa Stewart and Gillian MacIntyre
The purpose of this paper is to examine the persistent challenges in implementing care management within the context of integration. In addition the appropriateness of the care…
Abstract
Purpose
The purpose of this paper is to examine the persistent challenges in implementing care management within the context of integration. In addition the appropriateness of the care management model will be considered within the current, personalization focused, health and social care policy landscape. The paper draws upon a recent evaluation of a care management and assessment pilot project within a health and social care partnership in Scotland.
Design/methodology/approach
A multi‐method approach was adopted, including interviews, vignettes and focus groups, in order to capture data around expectations in relation to the pilot as well as exploring processes and outcomes for those involved.
Findings
This paper argues that whilst progress has been made with regard to care management, specific and persistent challenges remain. Professional and organizational boundaries, communication and information sharing remain key challenges. Policy imperatives have shifted the emphasis in community care services towards self‐care, co‐production and personalization contributing to a lack of clarity over the place of care management within the broader integration agenda.
Research limitations/implications
This research was undertaken in one partnership locality in Scotland and as such the findings are related to that particular area. However, the key messages arising from this paper resonate with the broader academic literature on care management and as such are likely to be of interest to a broader audience.
Originality/value
This paper brings together integrated working, care management and the developing policy framework of self‐care to consider the challenges for care management in this context.
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In this first of two articles, the authors assess the implications of policy developments in partnership and contestability, commissioning and procurement, and local jurisdiction…
Abstract
In this first of two articles, the authors assess the implications of policy developments in partnership and contestability, commissioning and procurement, and local jurisdiction for adult services joint ventures. They argue for creative responses to service delivery in which policy implementation is seen as an opportunity for local health and social care agencies to honour the history of, and future aspirations for, local partnerships. A second article will detail the very different responses to the policy agenda of four case study sites, exploring the local contours and aspirations underlying their decisions, with the intention of provoking discussion about the art of the possible in the broader community of interest.The papers draw on the authors' work funded by the Integrated Care Network (ICN) and Care Services Improvement (CSIP), which comprised a series of workshops to inform the further development of the plans of four local health and social care communities ‐ Portsmouth, Wolverhampton, Barnsley and Milton Keynes ‐ for commissioning and provision of adult care services, providing a community of interest in which aspirations, challenges and emerging solutions were exchanged and explored. Here we summarise transferable learning for the broader community of interest, drawn from the more detailed reports available from the ICN (Freeman & Peck, 2006, 2007).
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James A. Shaw, Pia Kontos, Wendy Martin and Christina Victor
The purpose of this paper is to use theories of institutional logics and institutional entrepreneurship to examine how and why macro-, meso-, and micro-level influences…
Abstract
Purpose
The purpose of this paper is to use theories of institutional logics and institutional entrepreneurship to examine how and why macro-, meso-, and micro-level influences inter-relate in the implementation of integrated transitional care out of hospital in the English National Health Service.
Design/methodology/approach
The authors conducted an ethnographic case study of a hospital and surrounding services within a large urban centre in England. Specific methods included qualitative interviews with patients/caregivers, health/social care providers, and organizational leaders; observations of hospital transition planning meetings, community “hub” meetings, and other instances of transition planning; reviews of patient records; and analysis of key policy documents. Analysis was iterative and informed by theory on institutional logics and institutional entrepreneurship.
Findings
Organizational leaders at the meso-level of health and social care promoted a partnership logic of integrated care in response to conflicting institutional ideas found within a key macro-level policy enacted in 2003 (The Community Care (Delayed Discharges) Act). Through institutional entrepreneurship at the micro-level, the partnership logic became manifest in the form of relationship work among health and social care providers; they sought to build strong interpersonal relationships to enact more integrated transitional care.
Originality/value
This study has three key implications. First, efforts to promote integrated care should strategically include institutional entrepreneurs at the organizational and clinical levels. Second, integrated care initiatives should emphasize relationship-building among health and social care providers. Finally, theoretical development on institutional logics should further examine the role of interpersonal relationships in facilitating the “spread” of logics between macro-, meso-, and micro-level influences on inter-organizational change.
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