Alliance Manchester Business School, University of Manchester and NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Greater Manchester, Booth Street West, Manchester, M15 6PB, UK.
Salford Royal NHS Foundation Trust, University of Manchester and NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Greater Manchester, Salford, UK.
BMC Fam Pract. 2020 May 29;21(1):96. doi: 10.1186/s12875-020-01168-z.
The integration of community health and social care services has been widely promoted nationally as a vital step to improve patient centred care, reduce costs, reduce admissions to hospital and facilitate timely and effective discharge from hospital. The complexities of integration raise questions about the practical challenges of integrating health and care given embedded professional and organisational boundaries in both sectors. We describe how an English city created a single, integrated care partnership, to integrate community health and social care services. This led to the development of 12 integrated neighbourhood teams, combining and co-locating professionals across three separate localities. The aim of this research is to identify the context and the factors enabling and hindering integration from a qualitative process evaluation.
Twenty-four semi-structured interviews were conducted with equal numbers of health and social care staff at strategic and operational level. The data was subjected to thematic analysis.
We describe three key themes: 1) shared vision and leadership; 2) organisational factors; 3) professional workforce factors. We found a clarity of vision and purpose of integration throughout the partnership, but there were challenges related to the introduction of devolved leadership. There were widespread concerns that the specified outcome measures did not capture the complexities of integration. Organisational challenges included a lack of detail around clinical and service delivery planning, tensions around variable human resource practices and barriers to data sharing. A lack of understanding and trust meant professional workforce integration remained a key challenge, although integration was also seen as a potential solution to engender relationship building.
Given the long-term national policy focus on integration this ambitious approach to integrate community health and social care has highlighted implications for leadership, organisational design and inter-professional working. Given the ethos of valuing the local assets of individuals and networks within the new partnership we found the integrated neighbourhood teams could all learn from each other. Many of the challenges of integration could benefit from embracing the inherent capabilities across the integrated neighbourhood teams and localities of this city.
将社区卫生和社会保健服务整合已在全国范围内得到广泛推广，这是改善以患者为中心的护理、降低成本、减少住院人数以及促进及时有效出院的重要步骤。整合的复杂性引发了关于整合卫生和保健服务的实际挑战的问题，因为这两个部门都存在着根深蒂固的专业和组织界限。我们描述了一个英国城市如何创建一个单一的、综合的护理伙伴关系，以整合社区卫生和社会保健服务。这导致了 12 个综合邻里团队的发展，将三个不同地区的专业人员结合并集中在一起。这项研究的目的是从定性的过程评估中确定促进和阻碍整合的背景和因素。
对战略和运营层面的卫生和社会保健工作人员进行了 24 次半结构化访谈，受访者人数相等。对数据进行了主题分析。
我们描述了三个关键主题：1）共同的愿景和领导力；2）组织因素；3）专业劳动力因素。我们发现整个伙伴关系都对整合有明确的愿景和目标，但在引入分散的领导方面存在挑战。人们普遍担心指定的结果衡量标准没有捕捉到整合的复杂性。组织方面的挑战包括临床和服务交付规划缺乏细节、人力资源实践的差异以及数据共享的障碍。缺乏理解和信任意味着专业劳动力的整合仍然是一个主要挑战，尽管整合也被视为建立关系的潜在解决方案。
鉴于国家对整合的长期政策关注，这种雄心勃勃的社区卫生和社会保健整合方法对领导力、组织设计和跨专业工作提出了影响。鉴于新伙伴关系中重视个人和网络的本地资产的精神，我们发现综合邻里团队可以相互学习。整合的许多挑战都可以从利用这座城市的综合邻里团队和地区的内在能力中受益。
