Jenny Billings, Rasa Mikelyte, Anna Coleman, Julie MacInnes, Pauline Allen, Sarah Croke and Kath Checkland
The purpose of this paper is to investigate the perceptions of key informants on a national support programme for the development of new care models (NCM) in England…
Abstract
Purpose
The purpose of this paper is to investigate the perceptions of key informants on a national support programme for the development of new care models (NCM) in England (2015/2016–2017/2018). It focuses on the perceived facilitators and barriers affecting the development and implementation of the NCM programme and offers some insight into the role of national level support in enabling local integration initiatives.
Design/methodology/approach
A set of 29 interviews were carried out with a variety of respondents at the national level (including current and past programme leads, strategic account managers, advisors to the programme and external regulators) between October 2017 and March 2018, and analysed thematically.
Findings
A set of facilitative elements of the programme were identified: the development of relationships and alliances, strong local and national leadership, the availability of expert knowledge and skills, and additional funding. Challenges to success included perceived expectations from the national Vanguard programme, oversight and performance monitoring, engagement with regulators, data availability and quality, as well as timetables and timescales. Crucially, the facilitators and challenges were found to interact in dynamic and complex ways, which resulted in significant tensions and ambiguities within the support programme.
Research limitations/implications
While the sample was drawn from a range of different senior players and the authors ensured a diverse sample associated with the NCM support programme, it inevitably cannot be complete and there may have been valuable perspectives absent.
Originality/value
The paper demonstrates that the analysis of facilitators and challenges with respect to the national support of implementation of integrated care initiatives should move beyond the focus on separate influencing factors and address the tensions that the complex interplay among these factors create.
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Julie MacInnes, Sabrena Jaswal, Rasa Mikelyte and Jenny Billings
The purpose of this study is to examine the implementation, care processes and sustainability of an integrated, intermediate Acute Response Team (ART) service. The primary aims of…
Abstract
Purpose
The purpose of this study is to examine the implementation, care processes and sustainability of an integrated, intermediate Acute Response Team (ART) service. The primary aims of the service are to enhance the level of health and social care integration across a range of organisations, to ensure a timelier and appropriate service for people in the community at risk of admission to hospital.
Design/methodology/approach
A qualitative methodology was employed in order to gain a deep understanding of the experiences of staff members within the ART service and external stakeholders. Twenty-one professionals took part in a focus group or one-to-one interviews. Data were analysed thematically.
Findings
The key to successful implementation was that the service was co-created from the “ground-up” with support from local provider organisations. The inclusion of general practitioners (GPs) as part of the team was instrumental in setting up and maintaining the service and seems to be unique in intermediate care settings. Referrals into the ART service were dependent on awareness of the service at the interface with mainstream services. Transitions out were sometimes delayed due lack of availability of social care packages. To ensure sustainability of the ART and other integrated intermediate care services, continued resources, especially skilled staff members, are necessary.
Originality/value
This study adds to the intermediate care and acute response service literature by offering insights into “what works” from a professional perspective in terms of service implementation, care processes and sustainability, in an integrated care system.
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Anna Coleman, Julie D. MacInnes, Rasa Mikelyte, Sarah Croke, Pauline W. Allen and Kath Checkland
The article aims to argue that the concept of “distributed leadership” lacks the specificity required to allow a full understanding of how change happens. The authors therefore…
Abstract
Purpose
The article aims to argue that the concept of “distributed leadership” lacks the specificity required to allow a full understanding of how change happens. The authors therefore utilise the “Strategic Action Field Framework” (SAF) (Moulton and Sandfort, 2017) as a more sensitive framework for understanding leadership in complex systems. The authors use the New Care Models (Vanguard) Programme as an exemplar.
Design/methodology/approach
Using the SAF framework, the authors explored factors affecting whether and how local Vanguard initiatives were implemented in response to national policy, using a qualitative case study approach. The authors apply this to data from the focus groups and interviews with a variety of respondents in six case study sites, covering different Vanguard types between October 2018 and July 2019.
Findings
While literature already acknowledges that leadership is not simply about individual leaders, but about leading together, this paper emphasises that a further interdependence exists between leaders and their organisational/system context. This requires actors to use their skills and knowledge within the fixed and changing attributes of their local context, to perform the roles (boundary spanning, interpretation and mobilisation) necessary to allow the practical implementation of complex change across a healthcare setting.
Originality/value
The SAF framework was a useful framework within which to interrogate the data, but the authors found that the category of “social skills” required further elucidation. By recognising the importance of an intersection between position, personal characteristics/behaviours, fixed personal attributes and local context, the work is novel.
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Rasa Mikelyte and Alisoun Milne
The purpose of this paper is to explore evidence about the role played by micro-cultures in long-term care (LTC) settings in shaping residents’ mental health and wellbeing.
Abstract
Purpose
The purpose of this paper is to explore evidence about the role played by micro-cultures in long-term care (LTC) settings in shaping residents’ mental health and wellbeing.
Design/methodology/approach
A scoping review on micro-cultures in LTC, including database search of academic and grey literature using pre-determined combinations of key terms and specific inclusion/exclusion criteria. The review followed the methodological framework of Arksey and O’Malley (2005).
Findings
Micro-cultures (localised, distinctive cultures of a small group of people) in LTC are complex, multi-faceted and multi-directional; they include social dynamics as well as structural and environmental factors. Although much work has been done on the nature of micro-cultures, limited work has focused on LTC for older people. Initiatives to promote the mental health and wellbeing of residents rarely consider micro-cultures in any holistic way; they tend to be taken into account either as part of a contextual backdrop, or as a uni-directional process often equated with the concept of “care culture” or “organisational culture”.
Originality/value
The role played by micro-cultures in influencing the mental health and wellbeing of older people living in LTC settings is significantly under researched. The findings of this review suggest that their complexity and multidimensionality challenges researchers. However if the authors are to develop interventions that promote the mental health and wellbeing of residents it is important to invest in work to explore their nature and systemic influence.