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Cheng, Siu Mee; Catallo, Cristina
2023 Journal of Integrated Care
doi: 10.1108/jica-11-2022-0055
Canada's population is aging and there are concerns that the welfare system may not support the increased demands on it. Integrated health and social care (IHSC) produces positive health and system outcomes but it needs to be better understood within a Canadian context. The purpose of this collective case study of three IHSC initiatives in Alberta, Ontario and Nova Scotia was to determine the factors that support successful services integration among different healthcare and social services organizations serving older adults within a Canadian context.Design/methodology/approachThis study used the Cheng and Catallo (2020) IHSC conceptual framework (CF) to guide the research. Primary data were based on key informant interviews of representatives from organizations that comprised each case and focus groups. A cross-case analysis was undertaken to determine common themes.FindingsThe cross-case analysis revealed that the three cases shared common integration and external influence factors based on the Cheng and Catallo (2020) CF. Some new factors were identified.Originality/valueThe study revealed that the Canadian context was important in influencing integration in the three cases and that there is a unique Canadian aspect to IHSC. The study offers up practical insights for government leaders and service administrators to improve IHSC for older adults. The study also identifies how the Cheng and Catallo (2020) IHSC CF can be enhanced and points to research opportunities to test the framework.
Khan, Zana; Park, Sophie; Black, Georgia
2023 Journal of Integrated Care
doi: 10.1108/jica-02-2023-0010
This article aims to present a systematic review and synthesis of evidence on the experiences, role and use of IPE in IH fields by using a meta-ethnographic approach including key concepts, reciprocal and refutational translation and lines of argument. Inclusion health (IH) practice suggests that the needs of excluded groups are more effectively addressed through collaborative working. Interprofessional education (IPE) occurs when two or more professions engage in shared practice and learning, resulting in improved collaboration and quality of care. Studies on IPE to train staff in fields relating to IH exist, but without a settled consensus on the best approaches/activities to foster inclusive practice.Design/methodology/approachThis synthesis is underpinned by a meta-ethnographic approach. It provides explicit stages of data collection and interpretation, while providing space to engage with emerging themes and concepts iteratively (reflecting on author experiences) and inductively (reasoning and interpretation). This study made use of electronic databases and journals for English language peer reviewed articles between 2000 and 2020. Of the 2217 articles, 19 papers were included. The lead author and reviewer completed the review process and a second reviewer reviewed 10% at each stage. The quality was assessed using a modified CASP checklist. Iterative analysis involved PPI and staff stakeholders.FindingsA total of 16 concepts embedded in 19 papers provide insight into the nature of IPE in IH (IH) for staff. It was found that IPE in IH covers a broad group of practitioners and is a complex activity involving individual and organisation readiness, practical and pedagogical factors, influenced by setting, method, curriculum, lived experience, reflection and a learner-driven approach. Barriers to design, implementation and translation into practice were also found to exist.Practical implicationsMost studies used a combination of core learning and group work. Educational modes include mentoring or coaching, reflective practice, immersive learning and people lived experience of exclusion involved in or facilitation thematically centred in trauma-informed informed care, cultural competence, communities of practice and service learning. The aim of these methods was to promote collaboration through identifying shared experiences, problems and tensions and critical reflection of services and organisations. Such transformative learning is reported to challenge stigma, discrimination and misinformation and promote collective empowerment to address social injustice through human connection. Effective models of IPE re-instated the therapeutic relationship and alliances between patients and staff.Social implicationsThis review also calls for the development of health and care workers’ professionalism in relation to their own reflexivity, establishing anti-racist curricula, challenge stigma and ensuring clinicians are aware of and able to negotiate tension and difference identified within the consultation and between themselves. Apart from developing generalist skills, this analysis suggests that IPE in IH may be able to challenge stigma and discrimination towards IH groups by destabilising existing norms and siloed working with the aim of achieving robust interprofessional practice.Originality/valueIPE in IH is a complex activity affected by individual and organisation readiness, setting, experiential, practical and pedagogical factors. Models of teaching are focused on re-instating the therapeutic relationship. There are no systematic reviews in this field and previously there was no settled consensus on the best approaches and learning activities to foster inclusive and collaborative practice.
Clifford, Brendan; Squires, Sandra; Wood, Jenny Layton
2023 Journal of Integrated Care
doi: 10.1108/jica-11-2022-0053
To share a case study of a service improvement review of practice and ambition for Health and Wellbeing Boards in the English West Midlands in the changing context of Integrated Care Systems.Design/methodology/approachMixed qualitative methods: 33 semi-structured interviews with senior care and health leaders; a computer-based self-assessment tool for Health and Wellbeing Boards; and desktop analysis of Joint Health and Wellbeing Strategies.Findings“Place-based partnership” is a motivating concept, embracing the agency of leaders in pursuing local strategies and solutions. The need for strong leadership was recognised. The opportunity for Integrated Care Systems to contribute to narrowing health inequalities was welcomed by building on local place-based models, maximising council expertise in managing population health and wellbeing in their areas.Research limitations/implicationsThe case study is a snapshot of a developing area at a time when further government guidance for Integrated Care Systems was pending. More specific analysis of place-based partnerships in the West Midlands in the context of Health and Wellbeing Boards and Integrated Care Systems would seem beneficial. In addition, further research of subsequent changes such as the Hewitt Review is also considered important.Practical implicationsThe review shows the assertion of “place” as a unifying concept for Health and Wellbeing Boards and Integrated Care Systems. It suggests closer involvement of leaders in children's services with local Health and Wellbeing Boards is needed.Social implicationsHealth and Wellbeing Boards and Integrated Care Partnerships share common aims of improving the health and wellbeing of local populations. Maximising integration especially on preventative approaches and fully engaging communities in health would have positive social impact.Originality/valueThe case study adds to the relatively less well-developed literature on Health and Wellbeing Boards and their link with Integrated Care Partnerships.
Lefèvre, Mélanie; Detollenaere, Jens; Zeevaert, Renate; Van de Voorde, Carine
2023 Journal of Integrated Care
doi: 10.1108/jica-05-2023-0031
Many countries have developed hospital-at-home (HAH) models to bring hospital services closer to home. Although some countries already have a long tradition of HAH for adults, paediatric HAH has been developed more recently. Specificities of paediatric care make it difficult to directly extend an adult HAH model to the paediatric population. The objective of this study is to compare the organisation of paediatric HAH in four countries: France, Australia (states of Victoria and New South Wales), the Netherlands and Belgium. Ultimately, lessons can be drawn for further development in the countries analysed and/or for implementation in other countries.Design/methodology/approachLegal documents and other grey literature were analysed to describe the legal context for the provision of paediatric HAH in the selected countries. In addition, semi-structured in-depth interviews were conducted with key informants from paediatric HAH organisations in these countries, addressing the following topics: historical background, legal framework, functioning of HAH models, workforce, number of services, profile of children, type of care activities, funding, coordination with other providers and quality of care. Results were reviewed by a content expert from the respective country.FindingsOrganisational differences were highlighted in terms of coordinating actor (hospital or home nursing care services), decision-making process, range of clinical conditions treated, territorial organisation, qualifications and expertise of the team members, medical expertise, financing, responsibilities, etc.Originality/valueThere is no single preferred model for the provision of HAH care for children. There is a large variety in almost all aspects of organisation. There are, however, also some common characteristics across the different models. Notably, paediatric expertise of nurses within the HAH team was considered indispensable in all programmes.
2023 Journal of Integrated Care
doi: 10.1108/jica-06-2023-0039
This paper aims to provide a response to the previously published paper on “Gerontocracy”.Design/methodology/approachThis paper views care services through the lens of safeguarding, risks and responsibility in contradistinction from the largely economic and cost relevant argument put forward in the original paper.FindingsThis paper articulates the contribution of informal carers to integrated care solutions solely from an economic perspective overlooks the wider human and social dimensions of care provision in society.Originality/valueEngaging in the wider debate about the status, contribution of informal carers to care solutions highlights the complexity of the carers' role in society which should evoke a more holistic debate of this important topic.
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