scholarly journals Building healthy strong communities: Integrating health and social care through system transformation Introduction: We describe here the development of a person-centred integrated care policy framework for central and inner-west Sydney Australia.

2019 ◽  
Vol 19 (4) ◽  
pp. 82
Author(s):  
John Eastwood ◽  
Lisa Parsci ◽  
Lou-Anne Blunden
Keyword(s):  
Integrated Care ◽  
Social Care ◽  
Policy Framework ◽  
System Transformation ◽  
Care Policy ◽  
Health And Social Care ◽  
Sydney Australia

scholarly journals An integrated care programme in London: qualitative evaluation

2018 ◽  
Vol 26 (4) ◽  
pp. 296-308 ◽  
Author(s):  
Thomas Round ◽  
Mark Ashworth ◽  
Tessa Crilly ◽  
Ewan Ferlie ◽  
Charles Wolfe
Keyword(s):  
Nursing Home ◽  
Integrated Care ◽  
Hospital Admissions ◽  
Clinical Care ◽  
System Transformation ◽  
Care Programme ◽  
Content Type ◽  
Lessons Learnt ◽  
Health And Social Care ◽  
Shared Ownership

PurposeA well-funded, four-year integrated care programme was implemented in south London. The programme attempted to integrate care across primary, acute, community, mental health and social care. The purpose of this paper is to reduce hospital admissions and nursing home placements. Programme evaluation aimed to identify what worked well and what did not; lessons learnt; the value of integrated care investment.Design/methodology/approachQualitative data were obtained from documentary analysis, stakeholder interviews, focus groups and observational data from programme meetings. Framework analysis was applied to stakeholder interview and focus group data in order to generate themes.FindingsThe integrated care project had not delivered expected radical reductions in hospital or nursing home utilisation. In response, the scheme was reformulated to focus on feasible service integration. Other benefits emerged, particularly system transformation. Nine themes emerged: shared vision/case for change; interventions; leadership; relationships; organisational structures and governance; citizens and patients; evaluation and monitoring; macro level. Each theme was interpreted in terms of “successes”, “challenges” and “lessons learnt”.Research limitations/implicationsEvaluation was hampered by lack of a clear evaluation strategy from programme inception to conclusion, and of the evidence required to corroborate claims of benefit.Practical implicationsKey lessons learnt included: importance of strong clinical leadership, shared ownership and inbuilt evaluation.Originality/valuePrimary care was a key player in the integrated care programme. Initial resistance delayed implementation and related to concerns about vertical integration and scepticism about unrealistic goals. A focus on clinical care and shared ownership contributed to eventual system transformation.

The Sociotechnical Challenge of Integrating Telehealth and Telecare into Health and Social Care for the Elderly

2015 ◽  
pp. 1177-1189 ◽  
Author(s):  
Ken Eason ◽  
Patrick Waterson ◽  
Priya Davda
Keyword(s):  
Integrated Care ◽  
Social Care ◽  
The Elderly ◽  
Successful Implementation ◽  
Pilot Studies ◽  
Care For The Elderly ◽  
Sociotechnical Design ◽  
Frail Elderly People ◽  
Health And Social Care ◽  
Health Communities

Telehealth and telecare have been heralded as major mechanisms by which frail elderly people can continue to live at home but numerous pilot studies have not led to the adoption of these technologies as mainstream contributors to the health and social care of people in the community. This paper reviews why dissemination has proved difficult and concludes that one problem is that these technologies require considerable organisational changes if they are to be effective: successful implementation is not just a technical design issue but is a sociotechnical design challenge. The paper reviews the plans of 25 health communities in England to introduce integrated health and social care for the elderly. It concludes that these plans when implemented will produce organisational environments conducive to the mainstream deployment of telehealth and telecare. However, the plans focus on different kinds of integrated care and each makes different demands on telehealth and telecare. Progress on getting mainstream benefits from telehealth and telecare will therefore depend on building a number of different sociotechnical systems geared to different forms of integrated care and incorporating different forms of telehealth and telecare.

scholarly journals Sharing a vision. Do participants in integrated care programmes have the same goals and objectives?

2019 ◽  
Vol 33 (3) ◽  
pp. 122-129
Author(s):  
Axel Kaehne
Keyword(s):  
Integrated Care ◽  
Social Care ◽  
Care Delivery ◽  
Shared Vision ◽  
Window Of Opportunity ◽  
Care Providers ◽  
Care Services ◽  
The North ◽  
Health And Social Care ◽  
Goals And Objectives

Integrating health and social care services remains one of the most difficult undertakings in the field of care delivery. One of the key requirements for success in integration programmes is a shared vision amongst care providers. Shared visions may contain views as to what the new services should look like, how it should operate and what it should be able to achieve. The paper reports findings of an evaluation of a service integration programme in the North of England. It confirms that a programme consensus on issues such as aims and objectives and programme logics is seen by participants as a key to success. Yet, the study also found that there is a specific window of opportunity in integration programmes when participating organisations start on relatively high levels of commitment and enthusiasm which tend to tail off relatively quickly. The paper closes with a discussion about the implications of the findings for programme designers and service planners.

Partnership working across sectors: a multi-professional perspective

2019 ◽  
Vol 27 (4) ◽  
pp. 328-345 ◽  
Author(s):  
Nancy El-Farargy
Keyword(s):  
Integrated Care ◽  
Workforce Development ◽  
Social Care ◽  
Third Sector ◽  
Adult Health ◽  
Content Type ◽  
The Third ◽  
Health And Social Care ◽  
Professional Perspective ◽  
The Third Sector

Purpose The Public Bodies (Joint Working) (Scotland) Act 2014 set the framework for the integration of adult health and social care services. Teams, organisations and sectors are now required to work in partnership and interdependently to deliver shared outcomes for the people they serve. The purpose of this paper is to explore any features, practices and behaviours that could influence effective partnership working across sectors. Design/methodology/approach A questionnaire was designed and distributed to a range of stakeholders working in health, social care and the third sector. With reference to the changing health and social care reform agenda, the aims of the survey were to gather views, experiences and perceptions of working across sectors, and any workforce development needs. Findings The majority of respondents were from the NHS (80.3 per cent, 118/147), and experiences were largely drawn from those working with the third sector. The utility of working with the third sector was positively highlighted; however, there were limited opportunities to fully engage. Whilst formal education and training was welcomed, workforce development needs were mostly related to fostering relationships and building mutual trust. Originality/value This paper highlights views, perceptions, enablers and barriers to integrated care in Scotland. Whilst the Scottish integration landscape is currently not fully fledged, insights into prevailing attitudes towards integrated care, by a cohort of the Scottish health and care workforce, are offered. In particular, reflections by the NHS workforce to working with third sector services are discussed.

scholarly journals Implementing Mobile Health–Enabled Integrated Care for Complex Chronic Patients: Intervention Effectiveness and Cost-Effectiveness Study

10.2196/22135 ◽  
2021 ◽  
Vol 9 (1) ◽  
pp. e22135
Author(s):  
Jordi de Batlle ◽  
Mireia Massip ◽  
Eloisa Vargiu ◽  
Nuria Nadal ◽  
Araceli Fuentes ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Usual Care ◽  
Integrated Care ◽  
Mobile Health ◽  
Social Care ◽  
Short Form ◽  
Care Model ◽  
Chronic Patients ◽  
Patient Centered ◽  
Health And Social Care

Background Integrated care can generate health and social care efficiencies through the defragmentation of care and adoption of patient-centered preventive models. eHealth can be a key enabling technology for integrated care. Objective The aim of this study was to assess the effectiveness and cost-effectiveness of the implementation of a mobile health (mHealth)-enabled integrated care model for complex chronic patients. Methods As part of the CONNECARE Horizon 2020 project, a prospective, pragmatic, two-arm, parallel implementation trial was held in a rural region of Catalonia, Spain. During 3 months, elderly patients with chronic obstructive pulmonary disease or heart failure and their carers experienced the combined benefits of the CONNECARE organizational integrated care model and the eHealth platform supporting it, consisting of a patient self-management app, a set of integrated sensors, and a web-based platform connecting professionals from different settings, or usual care. We assessed changes in health status with the 12-Item Short-Form Survey (SF-12), unplanned visits and admissions during a 6-month follow up, and the incremental cost-effectiveness ratio (ICER). Results A total of 48 patients were included in the integrated care arm and 28 patients receiving usual care were included in the control arm (mean age 82 years, SD 7 years; mean Charlson index 7, SD 2). Integrated care patients showed a significant increase in the SF-12 physical domain with a mean change of +3.7 (SD 8.4) (P=.004) and total SF-12 score with a mean change of +5.8 (SD 12.8) (P=.003); however, the differences in differences between groups were not statistically significant. Integrated care patients had 57% less unplanned visits (P=.004) and 50% less hospital admissions related to their main chronic diseases (P=.32). The integrated care program generated savings in different cost scenarios and the ICER demonstrated the cost-effectiveness of the program. Conclusions The implementation of a patient-centered mHealth-enabled integrated care model empowering the patient, and connecting primary, hospital, and social care professionals reduced unplanned contacts with the health system and health costs, and was cost-effective. These findings support the notion of system-wide cross-organizational care pathways supported by mHealth as a successful way to implement integrated care.

scholarly journals Understanding service reorganisation in the Irish health & social care system from 1998 to 2020: lessons for reform and transformation

2021 ◽  
Vol 4 ◽  
pp. 106
Author(s):  
Sarah Barry ◽  
Malgorzata Stach ◽  
Steve Thomas ◽  
Sara Burke
Keyword(s):  
Integrated Care ◽  
Social Care ◽  
System Reform ◽  
Policy Document ◽  
Policy Makers ◽  
Reform Implementation ◽  
Services Delivery ◽  
Health And Social Care ◽  
Service Reorganisation ◽  
Care System

Background: Given policy drives for integrated care and other reforms requiring service reorganisation this study analyses service reorganisation in the Irish health and social care system from 1998 to 2020 with the aim of identifying lessons for reform implementation and system learning generally. Methods: A mixed-method, co-designed study of three distinct datasets through in a policy document analysis, a thematic analysis of interviews with elite respondents, and a formal review of the international literature, sets the Irish reorganisation story in the context of services and system reorganisation elsewhere. This approach is apt given the complexity involved. Results: We find repeated policy declarations for forms of integrated care from the early 1990s in Ireland. These have not resulted in effective change across the system due to political, organisational and implementation failures. We identify poor clarity and commitment to policy and process, weak change management and resourcing, and reluctance from within the system to change established ways of working, cultures and allegiances. Given its narrative approach and identification of key lessons, this study is of use to policy makers, researchers and practitioners, clinical and managerial. It forms part of a bigger project of evidence building for the implementation of Sláintecare, Ireland’s 10-year health system reform programme. Conclusions: The paper captures important lessons for regionalisation of services delivery and other reorganisations in service-based systems more generally. We find evidence of a negative policy/implementation/practice cycle repeatedly missing opportunities for reform. Learning to break this cycle is essential for implementing Sláintecare and other complex reorganisational health reforms generally.

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