Understanding integrated care at the frontline using organisational learning theory: A participatory evaluation of multi-professional teams in East London.

Mirza Lalani,Martin Marshall,Sonia Bussu

doi:10.1016/j.socscimed.2020.113254

Abstract

Integrated care has been proposed as an organising principle to address the challenges of the rising demand for care services and limited resources. There is limited understanding of the role of learning in integrated care systems. Organisational Learning (OL) theory in the guise of 'Learning Practice' can offer a lens to study service integration and reflect on some of the challenges faced by multi-professional teams in developing a learning culture. The study presents findings from two qualitative evaluations of integrated care initiatives in three East London boroughs, England, undertaken between 2017 and 2018. The evaluations employed a participatory approach, the researcher-in-residence model, to coproduce findings with frontline staff working in multi-professional teams in community care. Thematic analysis was undertaken using an adapted version of the 'Learning Practice' framework. The majority of learning in the teams was single loop i.e. learning was mainly reactive to issues that arise. Developing a learning culture in the three boroughs was hindered by the differences in the professional and organisational cultures of health and social care and challenges in developing effective structures for learning. Individual organisational priorities and pressures inhibited both the embedding of learning and effective integration of care services at the frontline. Currently, learning is not inherent in integrated care planning. The adoption of the principles of OL optimising learning opportunities, support of innovation, managed risk taking and capitalising on the will of staff to work in multidisciplinary teams might positively contribute to the development of service integration.

Highlights

Health and social care systems in England are facing the unprece dented pressures of increasing needs from an ageing population, rising workload for an overburdened workforce and limited financial resources (Ham et al, 2011; Armitage et al, 2009)
Forward View which called for the funding of ‘Vanguard’ sites to test ‘New Care Models.’ (Nhse, 2014) One of these models, the multi-speciality community provider, advocated for GP practices to form networks and federations while working collaboratively with other health and social care providers, with the primary aims of reducing hospital admissions and moving care closer to the home (Turner et al, 2016)
For each theme or sub-theme, we provide examples from the data and show the extent to which multi-professional teams in each borough are practicing the principles of Organisational Learning (OL)

Summary

Introduction

Health and social care systems in England are facing the unprece dented pressures of increasing needs from an ageing population, rising workload for an overburdened workforce and limited financial resources (Ham et al, 2011; Armitage et al, 2009). Integrated care in England continued to evolve in the form of Sustainability and Transformation Plans in 2015, Accountable Care Organisations in 2017 and more recently Integrated Care Systems. Each of these developments were underpinned by a premise of transferring care away from hospitals (thought to be costlier) to supposedly less expensive community settings, as well as a more collaborative approach with planning of individual institutions complemented by place-based planning for local populations (Hammond et al, 2019)

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