Department of Health Policy and Management, Yale University School of Public Health, New Haven, Connecticut, USA
Department of Health Policy and Management, Yale University School of Public Health, New Haven, Connecticut, USA.
BMJ Open. 2022 May 13;12(5):e054847. doi: 10.1136/bmjopen-2021-054847.
To understand whether and how effective integration of health and social care might occur in the context of major system disruption (the COVID-19 pandemic), with a focus on how the initiative may overcome past barriers to integration.
Rapid, descriptive case study approach with deviant case sampling to gather and analyse key informant interviews and relevant archival documents.
The innovation ('COVID-19 Protect') took place in Norfolk and Waveney, UK, and aimed to foster integration across highly diverse organisations, capitalising on existing digital technology to proactively identify and support individuals most at risk of severe illness from COVID-19.
Twenty-six key informants directly involved with project conceptualisation and early implementation. Participants included clinicians, executives, digital/information technology leads, and others. Final sample size was determined by theoretical saturation.
Four primary recurrent themes characterised the experiences of diverse team members in the project: (1) ways of working that supported rapid collaboration, (2) leveraging diversity and clinician input for systems change, (3) allowing for both central control and local adaptation and (4) balancing risk taking and accountability.
This rapid case study underscores the role of leadership in large systems change efforts, particularly in times of major disruption. Project leadership overcame barriers to integration highlighted by prior studies, including engaging with aversion to clinical/safety risk, fostering distributed leadership and developing shared organisational practices for data sharing and service delivery. These insights offer considerations for future efforts to support strategic integration of health and social care.
了解在重大系统中断（COVID-19 大流行）背景下，健康和社会保健的有效整合是否以及如何发生，重点关注该倡议如何克服以往整合障碍。
采用快速、描述性的案例研究方法，并采用离群案例抽样，以收集和分析主要知情人访谈和相关档案文件。
该创新（“COVID-19 Protect”）发生在英国的诺福克和沃威尼地区，旨在促进高度多样化组织之间的整合，利用现有数字技术主动识别和支持最有可能因 COVID-19 而患上重病的个人。
26 名直接参与项目概念化和早期实施的主要知情人。参与者包括临床医生、管理人员、数字/信息技术负责人等。最终样本量由理论饱和度确定。
四个主要的反复出现的主题描述了项目中不同团队成员的经验：（1）支持快速协作的工作方式，（2）利用多样性和临床医生的投入进行系统变革，（3）允许中央控制和地方适应，（4）平衡风险承担和问责制。
这项快速案例研究强调了领导力在大型系统变革努力中的作用，尤其是在重大破坏时期。项目领导层克服了先前研究强调的整合障碍，包括应对对临床/安全风险的规避、培养分布式领导力以及为数据共享和服务提供开发共同的组织实践。这些见解为未来支持健康和社会保健的战略整合提供了考虑因素。
