Elizabeth Mansfield, Jane Sandercock, Penny Dowedoff, Sara Martel, Michelle Marcinow, Richard Shulman, Sheryl Parks, Mary-Lynn Peters, Judith Versloot, Jason Kerr and Ian Zenlea
In Canada, integrated care pilot projects are often implemented as a local reform strategy to improve the quality of patient care and system efficiencies. In the qualitative study…
Abstract
Purpose
In Canada, integrated care pilot projects are often implemented as a local reform strategy to improve the quality of patient care and system efficiencies. In the qualitative study reported here, the authors explored the experiences of healthcare professionals when first implementing integrated care pilot projects, bringing together physical and mental health services, in a community hospital setting.
Design/methodology/approach
Engaging a qualitative descriptive study design, semi-structured interviews were conducted with 24 healthcare professionals who discussed their experiences with implementing three integrated care pilot projects one year following project launch. The thematic analysis captured early implementation issues and was informed by an institutional logics framework.
Findings
Three themes highlight disruptions to established logics reported by healthcare professionals during the early implementation phase: (1) integrated care practices increased workload and impacted clinical workflows; (2) integrating mental and physical health services altered patient and healthcare provider relationships; and (3) the introduction of integrated care practices disrupted healthcare team relations.
Originality/value
Study findings highlight the importance of considering existing logics in healthcare settings when planning integrated care initiatives. While integrated care pilot projects can contribute to organizational, team and individual practice changes, the priorities of healthcare stakeholders, relational work required and limited project resources can create significant implementation barriers.
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Elizabeth Mansfield, Onil Bhattacharyya, Jennifer Christian, Gary Naglie, Vicky Steriopoulos and Fiona Webster
Canada’s primary care system has been described as “a culture of pilot projects” with little evidence of converting successful initiatives into funded, permanent programs or…
Abstract
Purpose
Canada’s primary care system has been described as “a culture of pilot projects” with little evidence of converting successful initiatives into funded, permanent programs or sharing project outcomes and insights across jurisdictions. Health services pilot projects are advocated as an effective strategy for identifying promising models of care and building integrated care partnerships in local settings. In the qualitative study reported here, the purpose of this paper is to investigate the strengths and challenges of this approach.
Design/methodology/approach
Semi-structured interviews were conducted with 34 primary care physicians who discussed their experiences as pilot project leads. Following thematic analysis methods, broad system issues were captured as well as individual project information.
Findings
While participants often portrayed themselves as advocates for vulnerable patients, mobilizing healthcare organizations and providers to support new models of care was discussed as challenging. Competition between local healthcare providers and initiatives could impact pilot project success. Participants also reported tensions between their clinical, project management and research roles with additional time demands and skill requirements interfering with the work of implementing and evaluating service innovations.
Originality/value
Study findings highlight the complexity of pilot project implementation, which encompasses physician commitment to addressing care for vulnerable populations through to the need for additional skill set requirements and the impact of local project environments. The current pilot project approach could be strengthened by including more multidisciplinary collaboration and providing infrastructure supports to enhance the design, implementation and evaluation of health services improvement initiatives.
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Elizabeth Barkham, Santhana Gunasekaran and Caroline Lovelock
The purpose of this paper is to offer a general review of care for individuals on the autism spectrum, including Asperger's syndrome within a medium secure setting.
Abstract
Purpose
The purpose of this paper is to offer a general review of care for individuals on the autism spectrum, including Asperger's syndrome within a medium secure setting.
Design/methodology/approach
The authors undertook a review of the current literature relating to pathways to care, offending characteristics and treatment interventions. They examined the available evidence and current practice.
Findings
Available evidence suggests offending characteristics of individuals with autism are different to those of mental disorders such as schizophrenia. Limited evidence in treatment interventions and in risk management for those with autism presents a challenge to clinicians. The heterogeneity makes a strong case for an individualised case formulation approach to treatment and risk management.
Originality/value
This paper offers an overview of the current evidence base relating to the treatment of individuals with autism spectrum disorders within medium secure settings.