Independent evaluation of North East Hampshire and Farnham Yateley Integrated Care Teams: using the Normalisation Process Theory [NPT] framework to evaluate a new care model [NCM]: the Happy Healthy at Home [HHH] Yateley Integrated Care Team [ICTs

Abstract

Background: to achieve better patient centred care, greater efficiency, and improved health and well-being outcomes, the findings of successive reviews of successful integrated care systems recommended greater partnership working and new integrated models of care (Cameron and Lart, 2003; Banks, 2004; Williams and Sullivan, 2010; Ham and Curry, 2011; Rand Europe and Ernst and Young, 2012; NHS England, 2014; GovUK, 2015).

Aims and objectives: core and extended ICT members aim to provide enhanced out of hospital care involving both hospital based and community teams in order to enable service users to be pro-actively involved in their care. Patients and their care plans are reviewed during weekly multi-disciplinary team meetings [MDTs]. The team evaluation sought to understand the experience of the staff involved in developing and delivering the implementation of Yateley ICT and ascertain whether they were able to move from a “fragmented” to an “integrated” way of working and the extent to which the team was able to embed ICT in a long term sustainable way.

Methods: the conceptual framework was mixed methods (Plowright, 2015) informed by Normalisation Process Theory (May and Finch 2009), Force Field Analysis (Lewin, 1949; 1951) and Alexander (1985) team effectiveness as well as the NEHF Vanguard HHH ICT Logic Model. Data collection was by way of: non-participant observation of a regular multi-disciplinary team meeting [MDT] (n=9); a focus group that took place directly following the MDT (n=6), which included an anonymous survey and brainstorming and a ranking exercise; the same anonymous survey available electronically as a final opportunity to participate for those who could not attend the focus group (n=3). Data were analysed using the constant comparative method (Glaser and Strauss, 1967) and thematic analysis (Braun and Clarke, 2006).

Results: a number of key enabling factors were identified: access to patients’ records and dashboards; working in a good team of trusted people with a flexible length MDT; the ability to refer patients to other specialties; shared learning and ideas from other specialties and Vanguard funding. Optimal implementation of ICT was felt to be inhibited by insufficient resources. Poor information technology support (e.g. problems with Wi-Fi connection) and lack of integration across networks and patients’ records management systems [EMIS, Systm1, RIO, TIARA, IRIS, Hand Direct] were identified as the most important barriers. Other barriers were shared role/commitment to other agencies (e.g adult and social care, palliative care nurse, occupational therapy) and hence lack of availability to attend the weekly MDT and of integrating ICT into existing work. Less than optimal communication with Frimley Park (due to cultural differences) re IRIS and patient being discharged) was also underlined as an issue as were inappropriate referrals from various providers with no clear indication of what ICT could do for the patients. Concerns were expressed about the uncertain future of ICT and the impact that this had on the ICT team and on patients and carers.

Conclusion: together the team has moved from “fragmentation” to “integration” and is on track to embed the implementation of ICT in a long term sustainable way. This independent evaluation has provided opportunities for reflexive monitoring, an area which could benefit from improvement.

Recommendations: as a matter of priority NHS and the Vanguard programme management should sort the IT and Wifi issues, provide clearer directions, and help overcome other barriers to ICT. The team believed that ICT would be more worthwhile if it became more fully rather than partially integrated. To achieve full integration, they planned to have HCPs (one day per week) populating workstations at Oaklands medical centre one day a week or more to work even more closely together to achieve an integrated new care model.

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