Author:

Abstract

Introduction:

Integrated care is delivered by frontline staff working in a coordinated manner holistically for the patient, but these staff require organisational structures and processes designed to enable this. Tools such as the Scirocco model (1) assess organisational readiness, but the experts in defining contextual needs and barriers are the field staff. To plan the organisational journey, the Health Service Executive in Ireland surveyed all its staff to obtain the view from their position.

Theory/Methods:

Assisted by scientific and advisory groups, the team revised the tool developed in the Integrate EU project (2) for the Irish context and to avoid technical language. The revised tool was applied as a web survey to all health service employees in Ireland, and those in contracted partner services (final n=1,701). Nine care group themed workshops (n=97 staff and patients) facilitated by an independent expert used the same questionnaire to triangulate the findings (3).

Results:

The modified tool (38 items) had seven dimensions, closely based on the Integrate tool but using more accessible terms. Responses from the survey and workshops compared well. For each topic, the highest and lowest scored items were (item wording shortened):

Dimension 1: Engaging Service Users:

High: Service users and care professionals work together to understand the service user

Low: Service users have access to their own health care records

Dimension 2 – Coordinating Care Services

High: Care professionals work together to undertake care assessments and planning

Low: Volunteers and the community are actively

Dimension 3 – Partnerships Between Professionals

High: Multi- and inter-professional training and education are continuously supported Professionals recognise and enact shared accountability

Low: Formal agreements exist that support collaborative working

Dimension 4 – Communication and Information

High: Users care professionals work together to obtain agreed reliable information sources

Low: There is a uniform patient/ service user identifier

Dimension 5 – Delivering Care Services

High: No item scored highly

Low: Care providers share a common record or care plan specifying who is responsible

Dimension 6 – Enabling Platform for Integrated Care

High: No item scored highly

Low: All stakeholders are actively involved in the design of integrated care programmes

Dimension 7 – Common Reference Frame

High: No item scored highly

Low: There is a process for building awareness and trust in integrated care services

Discussion:

The rich data showed a staff professionally committed to integrated care, but with a lack of organisational facilitation. Narrative comments showed that some structural changes to strengthen management accountability had deepened silos and barriers.

Conclusions:

Field staff gave a clear and challenging view.

Lessons learned:

Listening to staff is feasible and valuable.

Limitations:

This is a one country study.

Suggestions for future research:

Replication in another health system.

1. https://www.scirocco-project.eu/scirocco-tool/

2. Calciolari S et al.. The Project Integrate Framework; http://www.projectintegrate.eu.com/wp-content/uploads/2017/04/The-Project-Integrate-Framework-TOP.pdf

3. Keeling D et al. Assessing the State of Preparedness to Deliver Integrated Care in a National Health System by Developing and Applying the Project Integrate Conceptual Framework as a Tool; submission to ICIC 2020.