To create effective healthcare requires connections between different roles and relationships. A good place to start is thinking about team work: small groups of people with complementary skills to deliver a key aspect of patient care.
A good summary of effective teams comes from Mickan and Roger (2000) who suggest that effective teams have a number of different elements. These include regular communication, coordination, interdependent tasks and shared norms or cultures about ways of working. These authors conclude:
“…there is a need to build and maintain effective teams to maximise the specialist skills of healthcare professionals in meeting complex patient needs… Patient care will ultimately be enhanced through the co-ordinated efforts of effective healthcare teams.”
Mickan and Roger (2000)
This summary, along with many others, captures some of the key ingredients for better working together.
There is now an even more pressing need to think about different ways for healthcare systems to work together particularly across organisations. A key example of this can be found in discussions and ideas related to integrated care: the bringing together of different organisations and people from across various boundaries to deliver patient and user-centred care.
Over the past 10 years or so there have been various attempts to better integrate services. A recent example has been new models of care in the NHS which have experimented with different approaches to organising across hospital, primary and community services.
These initiatives and many others can be found currently taking place in the NHS. As a result there is much optimism about the agenda however there remain a number of important challenges to achieving integration. Evidently, working within and across different groups is easier said than done. Key issues related to integrated care have been summarised by the national audit office (2017):
- Financial incentives: the way hospitals are paid for each patient seen or treated potentially encourages these hospitals to increase their activity. This method of payment can work against local systems trying to reduce hospital activity through integration.
- Workforce challenges: differences in working culture (the day to day way things get done), professional backgrounds and contractual terms and conditions across the health and local government remain barriers to integrating and developing the workforce.
- Information-sharing: legal restrictions for data-sharing between organisations along with the difficulty to track patients through different care settings, compare costs and establish whether integration was saving money remain key issues for integrated care
There are also wider debates about how far you can integrate services within environments that promote competition between different organisations.
Until these and other issues are resolved will integration be more an aspiration than reality?
Given these challenges, there have been some interesting contributions reflecting on how to make such integration happen. Evans and colleagues (2016) draw together important lessons associated with how to better integrate care:
Lesson 1: Change the Conversation from a focus on clarifying roles and defining performance metrics (“task-focused”) to a “communication-based” model which focuses on building strong relationships across various stakeholders to promote shared purpose, shared identity and consensus building
Lesson 2: Self-Reflect and Adapt to promote relationship-building which involves creating meaningful connections, trust and shared meaning among diverse individuals and groups.
Lesson 3: Allow for evolution in adapting integrated care models and interventions to the local contexts allowing for learning over time.