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Qualitative Evaluation of Solihull’s Integrated Care Programme

Background and Aims

The Integrated Care and Support Solihull (ICASS) Programme was launched in 2014 and aims to deliver sustainable and high quality integrated health and social care services to the people of Solihull (a metropolitan borough in the West Midlands, England) through a long-term strategic approach.

Solihull's integrated care programmeThe programme consists of three ‘workstreams’: Prevention and Early Intervention, Out of Hospital Care and Hospital Transformation. These are each associated with a number of specific integrated care projects. ICASS activities have focused on developing a system approach to managing and delivering the programme with most project implementations to begin in the summer of 2015. The Strategy Unit was commissioned by ICASS to characterise progress of the programme in early 2015, and place this in the context of the evidence-base in order for ICASS to refine programme management and implementation. The study design was co-produced with the ICASS director to ensure its relevance.

Findings

We found system leadership of ICASS and collaborative working at senior level to be the programme’s well-recognised strength. Improvements could be made by system leaders engaging others to both lead and deliver the integrated care projects, within and across individual organisations. Particular emphasis was needed to engage Primary Care more widely and incorporate service user and carer views more consistently. The governance of the programme was deemed sufficient; however individual organisations’ accountability to the ICASS programme, financial risk-sharing, workforce development and information sharing across the patient pathway still needed further consideration. For example, whilst a regular meeting of Finance Directors had been set-up through ICASS to facilitate transparency and understanding of different organisational financial positions, a mechanism to integrate finances for ICASS purposes was still lacking.

Methodology

We conducted a rapid review of the literature which focused on: integrated care measurements; reported outcomes; and enablers and barriers to successful integration. We also conducted thirteen semi-structured interviews with ICASS Programme Board members. This included senior representatives from health and social care organisations, commissioners and providers as well as the voluntary sector and service users. The interviews were transcribed and the data thematically analysed and mapped against the eight Advancing Quality Alliance (AQuA) Integrated Care domains of system level integration.

Lessons

Triangulated findings from the evidence and the interviews highlighted the need for consistency and system alignment in delivering ICASS with all stakeholders, and not limiting promotion to the senior programme management tier. Findings revealed potential for partner organisations to embed ICASS within their own organisations by promoting leadership and training for improvement know-how and personal effectiveness in middle management and frontline tiers.

Feedback

The ICASS director completed the Strategy Unit’s feedback survey and indicated that the service provided by the Strategic Transformation team for this project was very important in effecting change/ supporting a significant decision. She also rated the technical knowledge and skills of our team in relation to the requirements for this project as excellent.

Impact

The knowledge transfer of the triangulated findings from the qualitative study was shared with the ICASS programme in report and presentation format (May 2015). This demonstrated to the ICASS programme board where implementation efforts needed to be more concentrated. The ICASS programme is the main component of Solihull’s Urgent and Emergency Care Vanguard and the Strategy Unit is the local evaluation partner for this Vanguard. As such further mixed methods evaluation will be undertaken as part of this. A paper describing Phase 1 of the evaluation was accepted for inclusion at the World Congress on Integrated Care and was presented by Dr Abeda Mulla of the Strategy Unit as an oral communication in November 2015 in Mexico City. This paper was also shortlisted for the Integrated Care Award at the conference.

 

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