Readiness Assessment Tool: Strengthening Implementation of Integrated Care

Abstract

Introduction: Optimity Advisors has developed an evidence-based Readiness Assessment tool to inform the implementation of an integrated health and care system and enable rapid system-wide sense-making in the context of high degrees of complexity. This tool was presented at ICIC 2016 and empirical data on application as a baseline assessment was provided. Delivering a sustainable integrated care system (ICS) is complex and challenging. The Readiness Assessment tool can support the initial phase of creating an ICS and assess the readiness of all provider partners to become an ICS. This tool identifies levels of integration by assessing the system against evidence-based criteria categorised into domains: Purpose and understanding: Partnerships Scope Population and patient focus Governance Finance & contracting Professional practice Care coordination Workforce Health Information Development of the tool: Last year we identified next steps for the tool including refining the risk scale, validating the domains, defining the metrics and expanding the tool. Building on the previous evidence reviews, over several months in 2016 our team of researchers have worked to refine the risk scale and validate the domains. Refined Risk Scale: When using the tool, the qualitative and quantitative data collected for each domain is reviewed and scored based on a risk scale. The risk scale has been reduced from 6 levels to 4 as testing it with clients showed 6 was making an artificial distinction resulting in unnecessary complexity. The scale of 1 – 4 is used to summarise the result of assessment. High scores reflect high levels of integration readiness. With this in mind, the progress descriptions have been reviewed and updated to reflect each domain’s specifics. Based on these changes to the risk scale, we now have a platform from which we are currently defining the metrics – this work will be ready for presentation in May 2017. Validating the Domains: We recognised in 2015/16 there was a potential for overlap between domains that may impact important interdependencies or duplications. The two domains that have been removed include Resilience and Cultural Readiness. Resilience was removed as it is an outcome of integration rather than a critical success factor. Cultural readiness was found to be assessed by other domains. Case Study: In 2016 Optimity Advisors used the Readiness Assessment toolkit when supporting the development of one of the Sustainability and Transformation Plans (STP) in South East England. This was the first time 15+ organisations in this footprint had worked together. The readiness assessment tool was used to do a rapid system assessment of the state of readiness across the footprint and to inform the implementation planning required by NHS England. The readiness assessment was conducted over 8 weeks with input from key stakeholders, using qualitative and quantitative data collection including participant observation, document review, population data analysis and stakeholder co-production. The outcome was shared with the STP delivery team and formed the basis of an actionable and prioritised programme of work to deliver the triple aim for the health and care economy. One of the areas that was identified as high risk and requiring significant investment in implementation was the in the domain of patient and population focus. Engagement with the local population and current health and care users was very limited. Without considerable effort in this area, the partners risk designing integrated services without reference to the patient and service user other than on paper. We will share the early implementation lessons of this programme of work and how the readiness tool has informed this at the conference in May 2017.