Towards a theoretical framework for Integrated Team Leadership (IgTL)

This study presents a framework for the leadership of integrated, interprofessional health, and social-care teams (IgTs) based on a previous literature review and a qualitative study. The theoretical framework for Integrated Team Leadership (IgTL) is based on contributions from 15 professional and nonprofessional staff, in 8 community teams in the United Kingdom. Participants shared their perceptions of IgT’s good practice in relation to patient outcomes. There were two clear elements, Person-focused and Task-focused leadership behaviors with particular emphasis on the facilitation of shared professional practices. Person-focused leadership skills include: inspiring and motivating; walking the talk; change and innovation; consideration ...

Partnership and accountability in the era of integrated care: a tale from England

In England, the 2012 Health and Social Care Act was heralded to be among the most significant changes in policy for the National Health Service (NHS) since its inception in 1948. Yet a key theme of the policy, namely the intensification of competition in service provision, has not fully materialised.
The 2014 Five Year Forward View outlined visions for a more integrated health and care system in England. Subsequent guidance introduced new organisational forms, such as the so-called Sustainability and Transformation Plans and integrated care systems

Government leadership that supports community-lead integrated care: An analysis of advances and missteps

Integrated care that substantively impacts population health as well as provides quality care requires buy-in, engagement and commitment over time by a plethora of  government and community groups. There is considerable evidence of the complexity of care models that work such that long term commitment is required to truly impact health. These days, beyond work opportunities, most municipal government and community leaders realise that good quality health services are critical to retaining and recruiting residents, especially noteworthy as an issue in rural communities.  How do places manage bottom-up, top-down tensions as politics and control issues intervene across differrent levels of ...

The “Patient-centered coordination by a care team” questionnaire achieves satisfactory validity and reliability

Increasing prevalence of chronic conditions and multimorbidity challenges health care systems and calls for patient-centered coordination of care. Implementation and evaluation of health policies focusing on the development of patient-centered coordination of care needs valid instruments measuring this dimension of care. The aim of this validation study was to assess the psychometric properties of the French version of the 14-item Patient-Centered Coordination by a Care Team (PCCCT) questionnaire in a primary care setting. 

Care Redesign Survey: To Improve Chronic Disease Care, Change the Payment Model

Many health care organizations are reasonably effective in treating chronic diseases, but they are limited from doing better by fee-for-service payment, which remains the predominant payment model in the United States. The latest NEJM Catalyst Insights Council report serves as a snapshot in time, showing the intent of health care providers to be proactive in treating chronic disease, but limitations in their ability to address population health

Patient centred care for multimorbidity improves patient experience, but quality of life is unchanged

The UK has an ageing population. A 2018 study of multimorbidity in England found that 54% of people over 65 had multimorbidity in 2015. This is expected to rise to 68% by 2035, with 17% of people over 65 expected to have four or more conditions. National guidelines tend to focus on single conditions. People with multimorbidity may have their conditions managed individually without due consideration of the overall burden of their diseases and treatments. Recognition of this prompted the National Institute for Health and Care Excellence (NICE) and other international organisations to develop guidelines on managing multimorbidity. These focus ...

Continuity of care and referral rate: challenges for the future of health care

As health care costs rise, an increasingly greater proportion of the gross domestic product is spent on health care. In this context, Continuity of care could reduce health care consumption by patients and reduce the number of referrals to specialist care, but it is unknown if there is a difference in referral rates to specific medical specialties.

The aim of this study was to determine the relationship between continuity of care and both the referral rate (referrals per patient per year) and the medical specialties for which this relationship was strongest.

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 ...

New models of home care

Policy-makers have outlined their ambitions to provide joined-up care closer to home and enable people to remain independent and in their own homes. Home care will be a central component of realising these ambitions. However, there are serious concerns about the state of the home care market
and the quality of care service users receive.
In this case, the present report summarises the evidence on innovations and models of home care that demonstrate potential in the following key opportunity areas:
1. Technology and digital
2. Co-ordinated care planning
3. Recruitment and retention
4. Autonomous team working
5. Alternative approaches to ...

The multispecialty community provider (MCP) emerging care model and contract framework

Across the country, NHS leaders have been developing sustainability and transformation plans (STPs) to implement the NHS Five Year Forward View. Nearly all of the STPs involve creating new models of accountable care provision.  Some are planning MCPs, others the bigger primary and acute care systems (PACS) model, under which all hospital services are also included under a single  form of integrated provision. The underlying logic of an MCP is that by focusing on prevention and redesigning care, it is possible to improve health and wellbeing, achieve better quality, reduce  avoidable hospital admissions and elective activity, and unlock more efficient ...