Systems, not structures: Changing Health & Social Care

In his speech of 4 November 2015, the then Minister for Health, Simon Hamilton MLA, announced that in response to recommendation 1 of The Right Time, The Right Place report by Sir Liam Donaldson, he would appoint an expert, clinically led panel to consider and lead an informed debate on the best configuration of Health and Social Care services in NI.

The Panel was appointed in January 2016 and comprised local and international members.

PANEL MEMBERS

Professor Rafael Bengoa (Chair)
Dr Alan Stout
Bronagh Scott
Mairead McAlinden
Mr Mark A Taylor

EXPERT ADVICE ON SOCIAL CARE WAS PROVIDED BY:

Sean Holland
Fionnuala McAndrew

THE PANEL WAS SUPPORTED IN ITS WORK BY:

Alastair Campbell
Vikki Greenwood
Catherine Tumelty

The Development, Description and Appraisal of an Emergent Multimethod Research Design to Study Workforce Changes in Integrated Care Interventions

In this paper, they provide a detailed and explicit description of the processes and decisions underlying and shaping the emergent multimethod research design of their study on workforce changes in integrated chronic care. They argue that the terminology developed for the description of mixed methods designs should also be used for multimethod designs such as the one presented here. 

The SELFIE framework for integrated care for multi-morbidity: Development and description

The rise of multi-morbidity constitutes a serious challenge in health and social care organisation that requires a shift from disease-towards person-centred integrated care. The aim of the current study was to develop a conceptual framework that can aid the development, implementation, description, and evaluation of integrated care programmes for multi-morbidity. The framework structures relevant concepts in integrated care for multimorbidity and can be applied by different stakeholders to guide development, implementation, description, and evaluation. 

Professional groups driving change toward patient-centred care: interprofessional working in stroke rehabilitation in Denmark

Patient-centred care based on needs has been gaining momentum in health policy and the workforce. This creates new demand for interprofessional teams and redefining roles and tasks of professionals, yet little is known on how to improve new health policies more effectively. Their aim was to analyse the role and capacity of healht professions in driving organisational change in interprofessional working and patient-centred care.

Changes in Hospital–Physician Affiliations in U.S. Hospitals and Their Effect on Quality of Care

Many U.S. policymakers believe that increased integration between hospitals and physicians may foster better care and potentially decrease health care spendind. The logic behind this notion is straightforward: When physicians are employed or otherwise more substantially influenced by the hospitals in which the work, they are less likely to focus on generating revenue to maintain an independent practice and more likely to focus on patient care. The objetive of this article was to examine changes in United States acute care hospitals that reported employment relationships with their physicians and to determine whether quality of care improved after the hospitals switched to this integration model. 

Managing In- and Out-Migration of Health Workforce in Selected Countries in South East Asia Region

There is an increasing trend of international migration of health professionals from low -and middle- income countries to high-income countries as well as across middle- income countries. The WHO Global Code of Practice on the International Recruitment of Health Personnel was created better address health workforce development and the ethical coduct of international recruitment. This study assessed policies and practices in 4 countries in South East Asia on managing the in -and out- migration of doctors and nurses to see whether the managementet has been in line with the WHO Global Code and has fostered health workforce development in the region; and draws lessons from these countries. 

Reimagining community services: making the most of our assets

The purpose of this research was to understand the current state of community services and to explore how the health and care systems needs to change to enable these to meet the needs of the population now and in the future

Strengthening the public health workforce: An estimation of the long-term requirements for public health specialists in Serbia

At the beginning of the 21st century, planning the public health workforce requirements came into the focus of policy makers. The need for improved provision of essential public health services, driven by a challenging non-communicable disease and causes of death and disability within Serbia, calls for a much needed estimation of the requirements of the public health professionals. Mid and long-term public health specialists’ supply and demand estimations out to 2025were developed based on national staffing standards and regional distribution of the workforce in public health institutes of Serbia

Does the Patient-centered Medical Home Model Change Staffing and Utilization in the Community Health Centers?

 Few studies have looked under the hood of practice redesign to understand whether and, if so, how staffing changed with the adoption of patient-centered medical home (PCMH), and whether these staffing changes impacted utilization. So the objective of this article was to examine the workforce transformation occurring in community health centers that have achieved PCMH status, and to assess the relationship of those changes to utilization, as measured by the number of visits.

An evidence-based approach to understanding the competency development needs of the health service management workforce in Australia

Competent managers are essential to the productivity of organisations and the sustainability of health systems. Effective workforce development strategies sensitive to the current competency development needs of health service managers (HSMs) are required. The aim of this article was
to conduct a 360° assessment of the competence of Australian HSMs to identify managerial competence levels, and training and development needs.

Closing the gap: Key areas for action on the health and care workforce

Staffing is the make-or-break issue for the NHS in England. Workforce shortages are already having a direct impact on patient care and staff experience. Urgent action is now required to avoid a vicious cycle of growing shortages and declining quality. The workforce implementation plan to be published later this year presents a pivotal opportunity to do this. In this joint report with the Nuffield Trust and the Health Foundation, they set out a series of policy actions that, evidence suggests, should be at the heart of the workforce implementation plan. They focus on nursing and general practice, where the workforce problems are particularly severe.

ICIC20 – 20th International Conference on Integrated Care (Virtual Edition)

The 20th International Conference on Integrated Care (ICIC20) will take place virtually, the dates 9th, 16th, 23rd and 30th September 2020.

The conference will build on themes from previous years and in particular would like to include in this year's programme papers that are focusing on the following areas:

• Meeting the challenges of integrated care in early development, childhood and transitional care in adolescents
• Integrated community care approaches for better management of diseases with a stigmatizing effect, including for example mental health and addiction issues 
• Better managing the care of vulnerable populations including for example war veterans, and preventing isolation and loneliness 
• Integrating survivorship, caring for carers, palliative and end-of-life care 
• Use of Artificial Intelligence (AI) and digital tools in the people-centred integrated care

Integrated care workforce development: university-community collaboration

Behavioral health workforce shortages to provide quality care services for children, adolescents, and transitional age youth are well established. This paper highlights the workforce shortage and the need to infuse interprofessional education to engage in integrated care for children, adolescents and transitional age youth with behavioral health needs. 

Realising the True Value of Integrated Care: Beyond COVID-19

Stronger and more resilient care systems and communities are better able to cope, respond and adapt to new challenges and crises such as the current COVID-19 pandemic. They are able to quickly come together to ‘act as one’ and collaborate across disciplines and sectors towards a common goal. This is the essence of integrated care and this is what the International Foundation for Integrated Care (IFIC) stands for – creating a more connected health and care system.

ICIC20 – 20th International Conference on Integrated Care (Virtual Edition)

Collaboration for Impact: Co-creating a Workforce Development Toolkit Using an Arts-based Approach

The identification, communication and management of health risk is a core task of Community Health Workers who operate at the boundaries of community and primary care, often through not-for-profit community interest companies. However, there are few opportunities or resources for workforce development. Publicly funded researchers have an obligation to be useful to the public and furthermore, university funding is increasingly contingent on demonstrating the social impact of academic research. Collaborative work with participants and other stakeholders can have reciprocal benefits to all but may be daunting to some researchers, unused to such approaches.

Care during and beyond the COVID-19 Crisis: Workforce Capacity and Capability

Online Learning: Certificate in Integrated Care

The Certificate in Integrated Care has been designed using IFIC’s 9 Pillars of Integrated Care as a module based course of online learning. The accessible, high quality programme is offered through our digital, innovative and dynamic online learning platform. This comprehensive introductory level self-managed Certificate in Integrated Care accredited by CPD Standards UK delivered 100% online and in the comfort of your own home.

The course is based on The 9 Pillars of Integrated Care with the 5 modules as follows:

Framework for countries to achieve an integrated continuum of long-term care

The framework for countries to achieve an integrated continuum of long-term care identifies key aspects necessary to achieve an integrated continuum of long-term care service provision and to facilitate the integration of long-term services within existing health and social care systems.

The framework will guide countries in assessing system-level components to implement sustainable and equitable long-term care actions. By applying this framework, countries can begin to develop and shape their long-term care systems as part of their universal health coverage programmes and promote investment in long-term care and the health workforce, including carers.

Download framework

Designing and Governing Responsive Local Care Systems – Insights from a Scoping Review of Paramedics in Integrated Models of Care

Programs that fill gaps in fractured health and social services in response to local needs can provide insight on enacting integrated care. Grassroots programs and the changing roles of paramedics within them were analyzed to explore how the health workforce, organizations and governance could support integrated care. In this study, five concepts were identified for fostering integrated care in local systems: single point-of-entry care pathways; flexible and mobile workforce; geographically-based cross-cutting organizations; permissive regulation; and assessing system-level value.

How do three components of professional commitment influence nurse-reported patient-centred care and care quality?

Patient-centred care and care quality are the two critical care outcomes. However, no study has yet examined how the three components of professional commitment are related to nurse-reported patient-centred care and care quality, showing a research gap. This study shows that affective professional commitment is positively associated with nurse-reported patient-centred care, which is positively associated with nurse-reported care quality.

When the Note Doesn't Fit: Social Workers Documenting in the Electronic Health Record on Integrated Health Teams

A qualitative study was conducted to understand how social workers document their work in the electronic health record (EHR) in integrated primary care settings. Three themes emerged from the analysis of the focus groups: 1) considerable variability in where and how social workers document their practice within the EHR; 2) EHR functions are not designed for social work practice; and 3) EHR documentation practices as helpful for demonstrating social workers’ contributions to other integrated care team members. Education, training, and EHR adaptations are needed as social workers and other nontraditional healthcare providers continue to partake in team-based service delivery, especially in integrated primary care.

The Integrated Care Workforce: What does it Need? Who does it Take?

The health and care workforce was under pressure long before the pandemic due to the development of new technologies, recurring policy reforms and dwindling ressources. It has though taken the outcry in the aftermath of COVID-19 for researchers and policymakers to realise that something fundamental needs to change. In the integrated care literature and in this journal, the fact that integrated care implementation does not work without the involvement and support of the workforce has been a recurring theme, but also little heeded. Concepts like the Quadruple Aim or the WHO European Framework for Action for integrated health services delivery have helped to shift the focus on workforce planning, education and training or role definitions for integrated care.