38 Operational teams leads-stuck in the middle?

Abstract

Abstract Background Middle managers have a crucial role in implementing integrated care service models, but very little research has been undertaken on their experiences. A key element of the National Clinical Programme for Older People’s support for the implementation of the National Older Person’s Service Model is the establishment of Community Specialist Teams for Older People (CST-OP). These interdisciplinary teams are critical to supporting older people with complex care needs necessitating integrated care. Operational Team Leads (OTLs) are responsible for coordinating the interdisciplinary team effort to meet that aim. This research is focused on capturing OTLs experiences as they commence their roles in supporting inter-professional collaboration to achieve integrated care. Methods We employed a qualitative case study design. The unit of analysis was the process of OTLs establishing their roles over two-time points. A total of 18 OTLs participated in interviews (n = 11), and focus groups (n = 7) documentary summaries were reviewed. Results OTLs are creating networks to share knowledge to advance their work Key factors impacting some OTLs included a lack of induction and preparation for the role. They noted a need for national centralised resources and guidance, national standards development, education and networking and feedback loops. Locally there are some tensions in role clarity and clear reporting lines. Work is required to position the CSTs within community governance structures. Developing a team’s vision, mission and goals, building trust and ensuring psychological safety are necessary. Resources on how to undertake change were stressed. Recognition by OTLs of managing expectations of their role as they focus on shifting from acute to the community with some recruitment challenges, need for a shared ICT system, and enabling collaborative team spaces. Conclusion The role of managers within integrated care systems is evolving. There is an evidence gap in understanding the operations of implementing integrated care for older people. This research responds to these gaps and will be shared across the CSTs network.