New Ways of Working to Manage and Improve Quality in Integrated Care Systems in England

Document Type : Original Article

Authors

1 Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK

2 Nuffield Department of Population Health, University of Oxford, Oxford, UK

3 Personal Social Service Research Unit, University of Kent, Canterbury, UK

4 Picker Institute Europe, Oxford, UK

5 Department of Experimental Psychology, University of Oxford, Oxford, UK

6 Cicely Saunders Institute, King’s College London, London, UK

7 Nuffield College, University of Oxford, Oxford, UK

Abstract

Background 
Integrated care systems (ICSs) in England were formally established in July 2022 to coordinate the planning and delivery of health and care services. A key responsibility was to address the quality of these services. Our study aimed to examine how ICSs approach this responsibility and to identify opportunities and barriers experienced in their early establishment and development.
 
Methods 
A sample of four ICSs were recruited to participate. Interviews and meeting observations were undertaken in two phases (before and after the inception of ICSs) around 12 months apart. A total of 112 interviews were carried out with senior figures in the four ICSs supplemented by observation of relevant meetings and analysis of relevant documents.
 
Results 
Regarding quality, ICSs demonstrated several new ways of working. They set-up new structures for quality governance and created whole-system strategies for quality centred on major responsibilities regarding population health and health inequalities. These strategies required new and relevant metrics to assess quality and outcomes and a greater focus upon co-production in the development of services. They aimed to strike a fine balance between longstanding requirements for quality assurance and new responsibilities for quality improvement (QI). New approaches were underpinned by new collaborations between system partners extending beyond healthcare to include Local Authorities (responsible for social care and public health) and local communities.
 
Conclusion 
To address the many challenges of quality, ICSs have created new ways of working cultivating different kinds of collaborative relationships compared to established hierarchical, siloed and top-down ways of working prior to their formation. A focus on improving population health and reducing inequalities has required a shift from “here and now” urgent problem-solving to working with longer timelines. Such changes require patience in the context of political pressure to devote efforts to more salient problems such as waiting lists. 

Keywords

References

  1. Garin N, Koyanagi A, Chatterji S, et al. Global multimorbidity patterns: a cross-sectional, population-based, multi-country study. J Gerontol A Biol Sci Med Sci. 2016;71(2):205-214. doi:1093/gerona/glv128
  2. Heeringa J, Mutti A, Furukawa MF, Lechner A, Maurer KA, Rich E. Horizontal and vertical integration of health care providers: a framework for understanding various provider organizational structures. Int J Integr Care. 2020;20(1):2. doi:5334/ijic.4635
  3. Lewis RQ, Checkland K, Durand MA, et al. Integrated care in England - what can we learn from a decade of national pilot programmes? Int J Integr Care. 2021;21(4):5. doi:5334/ijic.5631
  4. Stokes J, Shah V, Goldzahl L, Kristensen SR, Sutton M. Does prevention-focused integration lead to the triple aim? An evaluation of two new care models in England. J Health Serv Res Policy. 2021;26(2):125-132. doi:1177/1355819620963500
  5. NHS England (NHSE). Five Year Forward View. Leeds: NHS England; 2014.
  6. NHS Providers. STPs and Accountable Care: Background Briefing. NHS Providers; 2018.
  7. Baxter S, Johnson M, Chambers D, Sutton A, Goyder E, Booth A. The effects of integrated care: a systematic review of UK and international evidence. BMC Health Serv Res. 2018;18(1):350. doi:1186/s12913-018-3161-3
  8. NHS England (NHSE). Integrated Care Systems: Design Framework. NHS England; 2021.
  9. Crocker H, Kelly L, Harlock J, Fitzpatrick R, Peters M. Measuring the benefits of the integration of health and social care: qualitative interviews with professional stakeholders and patient representatives. BMC Health Serv Res. 2020;20(1):515. doi:1186/s12913-020-05374-4
  10. A Shared for Those Working in Health and Care Systems Developed by the National Quality Board Commitment to Quality. National Quality Board; 2021.
  11. Shah A. How to move beyond quality improvement projects. BMJ. 2020;370:m2319. doi:1136/bmj.m2319
  12. Green J, Thorogood N. Qualitative Methods for Health Research. SAGE Publications; 2018.
  13. Juran JM. The quality trilogy. In: Wood JC, Wood MC, eds. Joseph M. Juran: Critical Evaluations in Business and Management. Routledge; 2005.
  14. NHS England (NHSE). Core20PLUS5 - An Approach to Reducing Healthcare Inequalities. NHS England; 2022.
  15. Darzi A. High Quality Care for All: NHS Next Stage Review Final Report. London: Department of Health; 2008.
  16. Malley J, Fernández JL. Measuring quality in social care services: theory and practice. Ann Public Coop Econ. 2010;81(4):559-582. doi:1111/j.1467-8292.2010.00422.x
  17. Exworthy M, Blane D, Marmot M. Tackling health inequalities in the United Kingdom: the progress and pitfalls of policy. Health Serv Res. 2003;38(6 Pt 2):1905-1921. doi:1111/j.1475-6773.2003.00208.x
  18. Ling T, Brereton L, Conklin A, Newbould J, Roland M. Barriers and facilitators to integrating care: experiences from the English Integrated Care Pilots. Int J Integr Care. 2012;12:e129. doi:5334/ijic.982
  19. Sanderson M, Allen P, Osipovic D, Petsoulas C, Boiko O, Lorne C. Developing architecture of system management in the English NHS: evidence from a qualitative study of three integrated care systems. BMJ Open. 2023;13(2):e065993. doi:1136/bmjopen-2022-065993
  20. Ostrom E. Governing the Commons: The Evolution of Institutions for Collective Action. Cambridge University Press; 1990.
  21. Waring J, Bishop S, Black G, et al. Navigating the micro-politics of major system change: the implementation of sustainability transformation partnerships in the English health and care system. J Health Serv Res Policy. 2023;28(4):233-243. doi:1177/13558196221142237
  22. Vindrola-Padros C, Ledger J, Hill M, Tomini S, Spencer J, Fulop NJ. The special measures for quality and challenged provider regimes in the English NHS: a rapid evaluation of a national improvement initiative for failing healthcare organisations. Int J Health Policy Manag. 2022;11(12):2917-2926. doi:34172/ijhpm.2022.6619
  23. Edwards N, Buckingham H. Strategic Health Authorities and Regions: Lessons from History. Nuffield Trust; 2020.
  24. Kaufman BG, Spivack BS, Stearns SC, Song PH, O'Brien EC. Impact of accountable care organizations on utilization, care, and outcomes: a systematic review. Med Care Res Rev. 2019;76(3):255-290. doi:1177/1077558717745916
  25. Garzón-Orjuela N, Samacá-Samacá DF, Luque Angulo SC, Mendes Abdala CV, Reveiz L, Eslava-Schmalbach J. An overview of reviews on strategies to reduce health inequalities. Int J Equity Health. 2020;19(1):192. doi:1186/s12939-020-01299-w
  26. Dixon-Woods M, Martin GP. Does quality improvement improve quality? Future Hosp J. 2016;3(3):191-194. doi:7861/futurehosp.3-3-191
  27. Lalani M, Bussu S, Marshall M. Understanding integrated care at the frontline using organisational learning theory: a participatory evaluation of multi-professional teams in East London. Soc Sci Med. 2020;262:113254. doi:1016/j.socscimed.2020.113254
  28. Hammond J, Speed E, Allen P, McDermott I, Coleman A, Checkland K. Autonomy, accountability, and ambiguity in arm’s-length meta-governance: the case of NHS England. Public Manag Rev. 2019;21(8):1148-1169. doi:1080/14719037.2018.1544660

Files

History

  • Receive Date: 15 January 2024
  • Revise Date: 20 August 2024
  • Accept Date: 09 December 2024
  • First Publish Date: 11 December 2024

Share

How to cite

Statistics