See the published version of this preprint at BMC Family Practice.
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Research article
Claire Mitchell
University of Manchester
Corresponding Author
ORCiD: https://orcid.org/0000-0002-2445-8468
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background: 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 twelve 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.
Methods: 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.
Results: 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.
Conclusions: 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.
Keywords
integration, community services, health care, social care, qualitative research
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CURRENT STATUS: Published
View the published article at BMC Family Practice.
Version 3
Posted 20 May, 2020
No community comments so far
Editorial decision: Accept
On 16 May, 2020
Editor assigned
On 08 May, 2020
Editor invited
On 07 May, 2020
Submission checks complete
On 20 Sep, 2019
No comments provided
Editorial decision: Minor revision
On 23 Apr, 2020
Review #1 received
Received 21 Apr, 2020
Reviewers invited
Invitations sent on 30 Mar, 2020
Reviewer #1 agreed
On 30 Mar, 2020
Editor assigned
On 24 Mar, 2020
Submission checks complete
On 23 Mar, 2020
Editor invited
On 23 Mar, 2020
No comments provided
Editorial decision: Major revision
On 12 Feb, 2020
Review #2 received
Received 27 Jan, 2020
Reviewer #2 agreed
On 21 Jan, 2020
Review #1 received
Received 16 Dec, 2019
Reviewer #1 agreed
On 02 Dec, 2019
Reviewers invited
Invitations sent on 30 Oct, 2019
Submission checks complete
On 20 Sep, 2019
Editor assigned
On 19 Sep, 2019
Editor invited
On 18 Sep, 2019
First submitted
On 13 Sep, 2019
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
General Practice
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See the published version of this preprint at BMC Family Practice.
This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Claire Mitchell
University of Manchester
Corresponding Author
ORCiD: https://orcid.org/0000-0002-2445-8468
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
View the published article at BMC Family Practice.
Version 3
Posted 20 May, 2020
No community comments so far
Editorial decision: Accept
On 16 May, 2020
Editor assigned
On 08 May, 2020
Editor invited
On 07 May, 2020
Submission checks complete
On 20 Sep, 2019
No comments provided
Editorial decision: Minor revision
On 23 Apr, 2020
Review #1 received
Received 21 Apr, 2020
Reviewers invited
Invitations sent on 30 Mar, 2020
Reviewer #1 agreed
On 30 Mar, 2020
Editor assigned
On 24 Mar, 2020
Submission checks complete
On 23 Mar, 2020
Editor invited
On 23 Mar, 2020
No comments provided
Editorial decision: Major revision
On 12 Feb, 2020
Review #2 received
Received 27 Jan, 2020
Reviewer #2 agreed
On 21 Jan, 2020
Review #1 received
Received 16 Dec, 2019
Reviewer #1 agreed
On 02 Dec, 2019
Reviewers invited
Invitations sent on 30 Oct, 2019
Submission checks complete
On 20 Sep, 2019
Editor assigned
On 19 Sep, 2019
Editor invited
On 18 Sep, 2019
First submitted
On 13 Sep, 2019
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
General Practice
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at BMC Family Practice.
Background: 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 twelve 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.
Methods: 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.
Results: 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.
Conclusions: 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.
This is a list of supplementary files associated with this preprint. Click to download.
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