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11 – 20 of over 60000Lonan A. Oldam, Giovanna I. Cruz, Sarah M. McGhee, Lottie Morris, Judi Watson and Anne Mills
Palliative care requires integration between services, organisations and the community. A series of community engagement programmes, named “Listening Events”, were conducted…
Abstract
Purpose
Palliative care requires integration between services, organisations and the community. A series of community engagement programmes, named “Listening Events”, were conducted across the Isle of Man. The aim was to involve the community in the development of Hospice strategy by sharing their views on the future of palliative and end of life care.
Design/methodology/approach
Three Listening Event programmes were conducted in community settings, secondary schools and the Isle of Man’s University College. The investigators facilitated discussions on current knowledge of Hospice services, what would matter to people should they need to use these, and how Hospice could best serve the community in the future. Participants and investigators noted thoughts and comments. Data were analysed using thematic analysis.
Findings
In total, 899 people participated from across the community. Main themes surrounded effective care, person-centred care and integrated care. Most themes agreed across the three programmes, despite some nuances.
Originality/value
The results were used as an evidence base from which Hospice Isle of Man’s new strategy was derived in order to ensure that it aligned with the community’s needs. By initiating conversations and discussions in the community, the Listening Events may have also increased understanding about hospice care.
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The purpose of this paper is to explore the evolving of integrated care, focussing on developments in why what matters to the patient matters and how to better understand the…
Abstract
Purpose
The purpose of this paper is to explore the evolving of integrated care, focussing on developments in why what matters to the patient matters and how to better understand the value the patient brings to and anticipates from integrated care.
Design/methodology/approach
A descriptive piece that draws on relevant research findings, literature, reports and health policy.
Findings
Although integrated care is a contemporary policy agenda, it is bringing back to the forefront the benefits of a population health planning approach. The shift in the health systems focus from inward looking to outward looking is promising, albeit has taken 25 years and is still evolving. Leadership is being demonstrated, however, a shared vision is elusive and not all voices are being heard. The development of a narrative that defines integrated care from the patient’s point of view is an important step. Next is better understanding the immediate and anticipatory public value integrated care offers.
Originality/value
This is a novel perspective of an enduring health reform policy concept. Currently the literature is thin.
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Integrated health care lacks a theoretical concept of the user figure that is appropriate to reflect users’ various claims and multi-dimensional interrelations in the care…
Abstract
Purpose
Integrated health care lacks a theoretical concept of the user figure that is appropriate to reflect users’ various claims and multi-dimensional interrelations in the care process. The paper aims to discuss this issue.
Design/methodology/approach
Key goals of integrated health care, such as a continuity of care, seamless services and better health outcomes depend strongly on users’ capabilities to engage themselves in the care process. These goals are hardly reachable if integrated health care schemes operate with a one-dimensional understanding of users’ identity.
Findings
The suggested concept of users’ identity facets suggests that users draw from different sources while receiving integrated health care. Thus, users are patients, co-producers, citizens, consumers and community members in one person and at the same time. Each facet of the user identity gains or loses relevance depending on health care contexts, health statuses, personal values and the design of service arrangements. As demonstrated by the example of disease management programmes (DMPs), care schemes for chronically ill persons, users have to apply different facets of their identities in order to benefit best from service provision. Moreover, addressing users’ identity may facilitate the extent of integration in DMPs.
Originality/value
Integrated health care schemes are challenged to invent strategies that facilitate and support coherence among users’ diverse identities in the process of service provision. Lessons could be learned from small-scale and localized integrated health care networks.
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This review aims to focus on the role of evidence in informing policy and practice in health and social care integration.
Abstract
Purpose
This review aims to focus on the role of evidence in informing policy and practice in health and social care integration.
Design/methodology/approach
Following discussion of the importance of defining the terms that are being used, the review addresses UK policy and practice developments in respect of integrated health and social care over the last two decades. It explores the extent to which these accord with the available evidence on effective strategies.
Findings
The review demonstrates that the focus in delivering integrated care should be on the local systems and cultures that can deliver positive outcomes for individuals. Structural change will not guarantee integrated care and diverts from the detail of local implementation that needs to be achieved. Current developments in both Scotland and England have some promise of delivering enduring progress.
Originality/value
The review provides a synthesis of key bodies of evidence and allows comparison between different polities within the UK.
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Brendan Clifford, Sandra Squires and Jenny Layton Wood
To share a case study of a service improvement review of practice and ambition for Health and Wellbeing Boards in the English West Midlands in the changing context of Integrated…
Abstract
Purpose
To share a case study of a service improvement review of practice and ambition for Health and Wellbeing Boards in the English West Midlands in the changing context of Integrated Care Systems.
Design/methodology/approach
Mixed qualitative methods: 33 semi-structured interviews with senior care and health leaders; a computer-based self-assessment tool for Health and Wellbeing Boards; and desktop analysis of Joint Health and Wellbeing Strategies.
Findings
“Place-based partnership” is a motivating concept, embracing the agency of leaders in pursuing local strategies and solutions. The need for strong leadership was recognised. The opportunity for Integrated Care Systems to contribute to narrowing health inequalities was welcomed by building on local place-based models, maximising council expertise in managing population health and wellbeing in their areas.
Research limitations/implications
The case study is a snapshot of a developing area at a time when further government guidance for Integrated Care Systems was pending. More specific analysis of place-based partnerships in the West Midlands in the context of Health and Wellbeing Boards and Integrated Care Systems would seem beneficial. In addition, further research of subsequent changes such as the Hewitt Review is also considered important.
Practical implications
The review shows the assertion of “place” as a unifying concept for Health and Wellbeing Boards and Integrated Care Systems. It suggests closer involvement of leaders in children's services with local Health and Wellbeing Boards is needed.
Social implications
Health and Wellbeing Boards and Integrated Care Partnerships share common aims of improving the health and wellbeing of local populations. Maximising integration especially on preventative approaches and fully engaging communities in health would have positive social impact.
Originality/value
The case study adds to the relatively less well-developed literature on Health and Wellbeing Boards and their link with Integrated Care Partnerships.
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Dag Olaf Torjesen, Gro Kvåle and Charlotte Kiland
Integration between primary and secondary healthcare services and institutions has been at the core of health policy in Scandinavian countries over the last decade. This paper is…
Abstract
Integration between primary and secondary healthcare services and institutions has been at the core of health policy in Scandinavian countries over the last decade. This paper is based on an explorative case study of recent reforms in the healthcare sector and their outcomes in Denmark, Norway and Sweden. We discuss the possibilities of and problems for integrating the healthcare sector through the coordination mechanisms of hierarchy, market and network. The paper also discusses whether the institutional logic of the healthcare field is moving from a dual logic of ‘cure’ and ‘care’ towards a unifying logic of ‘integrated care’. We find that although the organisational principles that regulate the relationship between actors in the healthcare field in the three countries have changed, the challenge of achieving a mix of coordinative mechanisms that promote, rather than weaken, integration remains. However, the new organisational and regulative arrangements are an arena for increased interaction and collaboration between the actors, and thus a foundation for change towards the institutional logic of integrated health care.
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Efthimia Pantzartzis, Andrew Price and Francis Edum Fotwe
Health and social care facilities are usually complex buildings that require continuous effort to provide resilient and sustainable responses to changes in demographics…
Abstract
Purpose
Health and social care facilities are usually complex buildings that require continuous effort to provide resilient and sustainable responses to changes in demographics, technologies, diseases and models of care. Despite resilience and sustainability concepts being frequently used by practitioners and researchers, ambiguities in their definitions often result in a lack of operational solutions to record, monitor and improve the resilience and sustainability of health and social care facilities. Although the importance and complexity of the issues are widely acknowledged, there is little strategic guidance as to how they should be achieved. The purpose of this paper is to assess the suitability of developing a roadmap for improving the resilience and sustainability of UK health and social care facilities, and to identify the layers and processes needed to construct such a roadmap.
Design/methodology/approach
A qualitative approach was adopted, starting with a literature review of different types of roadmaps and their suitability to support the desired improvement objectives. Layers and processes were thus developed using the key issues identified in three recent research streams, and the roadmap was structured.
Findings
The major findings have been captured within a three-layer, four-step process generic roadmap for improving the resilience and sustainability of health and social care facilities that can be used to monitor performance, plans future actions and implement response to change.
Practical implications
This paper targets decision makers, especially estate managers, but the proposed layers and processes can be modified for other stakeholders.
Originality/value
This paper suggests an original approach for the development of a roadmap for resilience and sustainability of health and social care facilities, and specifically of how to structure layers and processes, envisioning a more integrated development of service provision and infrastructure asset management.
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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 general…
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.
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Jeanette Prorok, Kelly Kay, Adam Morrison and Salinda Anne Horgan
Performance measures are an important mediating mechanism that influences the design and delivery of care. Unfortunately, it is still commonly the case that acute care indicators…
Abstract
Purpose
Performance measures are an important mediating mechanism that influences the design and delivery of care. Unfortunately, it is still commonly the case that acute care indicators are employed to assess the efficacy of integrated care. This hinders the ability to accurately assess and continuously improve integrated care efforts for priority populations, including older persons who live with complex health and social care requirements. A core set of indicators is needed from which to assess the quality and impact of integrated care on these older persons and care partners.
Design/methodology/approach
A modified Delphi process was employed that comprised of the following steps: (1) selection of an indicator inventory (2) defining criteria for ranking and achieving consensus, (3) recruiting participants, (4) iterative voting rounds and analysis and (5) selection of a core indicator set.
Findings
The study produced a core set of 16 indicators of integrated care that pertain to older persons who live with health and social care requirements. The set can be applied by health and social care organizations and systems to assess the quality and impact of integrated care for this population across the continuum of care.
Research limitations/implications
Although the gap in the availability of relevant indicators was the impetus for the study, this also meant there was a dearth of validated indicators to draw from. There are significant gaps in commonly used data sets with respect to indicators of integrated care as it relates to older persons and care partner.
Practical implications
The indicator set is intended to follow the older person and care partner throughout their health journey, enabling a whole systems view of their care. The set can be used in full or in part by health and social care systems and organizations across various primary, acute, rehabilitative and community settings for program development and evaluation purposes.
Social implications
The core set of indicators that emerged out of this study is a first step toward ensuring that older persons who live with complex health and social care requirements and their care partners receive quality integrated care across the continuum of care.
Originality/value
The findings are informed by the perspectives of older persons, care partners and healthcare professionals. Future research is needed to test, validate and potentially expand the indicator set.
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