Citation
Dickinson, H. and Glasby, R.M.a.J. (2014), "The challenges of delivering integration", Journal of Integrated Care, Vol. 22 No. 4. https://doi.org/10.1108/JICA-07-2014-0027
Publisher
:Emerald Group Publishing Limited
The challenges of delivering integration
Article Type: Editorial From: Journal of Integrated Care, Volume 22, Issue 4
Integration has remained an important theme within health and social care for at least a few decades now, but has received even more attention in recent months. With growing pressures on local authorities and NHS organisations, national governments have paid significant attention to the issue of how to encourage more effective working between health and social care organisations. Despite the fact that many attempts have been made to improve joint working across health and social care it appears that we have still not managed to achieve this beyond some pockets of best practice.
This is not necessarily indicative of failure of local organisations but more reflective of the difficulties of working collaboratively. The UK is not alone in this situation and many countries are struggling with the challenge of how to make integration a reality. What we do know to date is that there are no easy answers when it comes to this topic. Integration cannot be achieved by the introduction of a structure, an IT system, financial incentives or co-location alone. It is a far more complex and multi-faceted process that involves interventions at all levels of organisations. In this issue are a collection of papers that seek to add to the evidence base about what helps in making a reality of integration.
In our first paper Elizabeth Bradbury reflects on the experience of the Advancing Quality Alliance's regional integrated care discovery community which sought to translate integrated care theory into practice at scale and to test ways to address the system enablers of integrated care. This account clearly illustrates some of the challenges of delivering improvement in the context of complex systems and indicates some principles to help keep on going in difficult times. The paper provides a helpful lesson in how teams can be helped to become more confident in managing large-scale change initiatives and areas for future development of this agenda.
Although the literature on collaboration talks about the benefits that this way of working might deliver, it does not always practice this principle itself. Claire Kennedy and Simon Morioka report on a project which sought together sources of advice and evidence for those developing integrated care. This includes considerations of the narrative for integrated care, the business case, barriers and enablers and tools and support. The resulting toolkit was launched earlier this year and is free and easily accessible through the English Local Government Association and NHS websites. This is already proving to be a helpful tool to support the development of integration and we would be interested in receiving case studies from organisations that have drawn on these resources to inform their local practice.
Gill Walker and Laura Gillies focus on the issue of culture change through an innovative education resource. They report on the development and use of this tool in the Scottish context which has seen a considerable focus on the integration agenda for some time and has an ambitious policy agenda in this space. Of note in this education programme is the use of drama in encouraging professionals to think about interprofessional work. This has demonstrated an impressive impact on learners in this programme which should hopefully translate into better integrated working in practice.
Our final UK paper is from Yang Tain, James Thompson and David Buck focuses on the cost of falls within a rural community. This study was initiated as providing evidence to commissioners and providers about the whole system costs of falls which should help commissioners and providers better understand issues relating to falls treatment and develop better integrated responses to frail elderly patient needs. These costs will be used as a baseline and the impacts of different models of care will be assessed against this over time. We look forward to further updates about this project and evidence about the most effective ways to support those individuals who have suffered a fall.
The final paper in this issue is by Sharda Nandram and Nicole Koster and sets out lessons from Buurtzorg, a Dutch organisation which has had some success in organising services in a client focused way. The success factors in this case seem to relate to the creative use of IT, the delivery of care via self-managed teams and an emphasis on front-line works being empowered to work autonomously and exercise professional discretion in the provision of care. This is an important and powerful finding and illustrates that some of the best ways to deliver integration is to allow professionals on the front line to take a lead.
Helen Dickinson, Robin Miller and Jon Glasby