Independent evaluation of North East Hampshire and Farnham [NEHF] Vanguard Happy Healthy at Home: using the NPT framework to evaluate the Enhanced Integrated Care Team [EICT] in Fleet

Abstract

Background To achieve better patient centred care, greater efficiency, and improved outcomes, the findings of reviews of successful integrated care systems (Williams and Sullivan, 2010; Ham and Curry, 2011; and the Five Year Forward View (NHS England, 2014; GovUK, 2015) recommended greater partnership working and new integrated models of care. EICTs [Enhanced Integrated Care Teams] aim to give GPs and other healthcare professionals access to a team of experts to identify those at risks and develop a care plan that include making or supporting referrals to EICTs and other health and social care services before tracking progress of patients and keeping GPs informed in order to try and reduce attendance to A&E and unplanned admissions.
Aims and objectives The team evaluation sought to understand the experience of the staff involved in developing and delivering the implementation of the EICTs in the Fleet locality (overseen by Salus Medical Services), including their views about enablers and barriers to embedding EICTs in daily routine practice 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. Data collection was by way of: non-participant observation of a regular multi-disciplinary team meeting [MDT] (n=10); a structured focus group directly following the MDT (n=9), and an anonymous survey (n=10) using a scale of 1 to 10 [not at all agree to completely agree]. Data were analysed using numerical analysis, NPT (May and Finch, 2009) and thematic analysis (Braun and Clarke, 2006).
Results The two top barrier categories with 29.6% of votes each were ‘IT and phones’ and ‘GP input/attitude’ followed by ‘competing demands on staff’ with 22.2%. The two top driver categories were ‘patient outcomes’ and ‘team/MDT’ and ‘worthwhileness’ each with 37.0 % of the votes followed by ‘winning over GPs’ with 14.8% of the votes. Team members agreed that they felt valued as team members [7.5] and that EICT had achieved its team goals [7.7]. The highest overall score for NPT questions was for key individuals drive EICTs forward and get others involved [cognitive engagement] [8.4] followed by team members can see potential value of EICT for their work [coherence] [8.3] and team members continue to support EICTs [cognitive engagement] [8.2]. The lowest overall score was for sufficient resources are available to support EICT [collective action] [5.6] and NHS/ Vanguard programme management team adequately supports EICT [collective action] [5.9] followed by team members can access information about and are aware of the effects of EICT [reflexive monitoring] [6.8]. The overall average for all four NPT domains and hence for all NPT/NoMAD questions was 7.5. Of the NPT four domains cognitive engagement [8.1] and coherence [7.7] had the highest overall score. This shows well aligned expectations and a good level of buy-in [cognitive engagement] due to key people driving things forward and in particular effective leadership from the clinical lead and the business manager. Reflexive monitoring [7.3] and collective action [7.0] were doing comparatively less well, mainly because of responses to questions about sufficient resources and support from NHS more senior management [collective action] which received scores of under 6 and accessing information about EICT and are aware of the effects of EICT [reflexive monitoring] with a score under 7.
Conclusion This pragmatic evaluation in real life setting undertaken with limited resources found that EICT NCM in Fleet is doing well in respect of team effectiveness and all NPT domains. Team members in EICT Fleet have a strong belief a belief in the value and benefit of EICTs and feel empowered to have been able to work without traditional boundaries for the benefit of patients. They feel that they are on their way to a culture shift. On the basis of available evidence, the EICT NCM in Fleet has led enable a move from “fragmentation” to “integration” and has in all likelihood embedded the implementation of EICT in routine practice. Team members are planning to undertake more proactive reviews and are planning for the team to be more fully integrated in future, including convincing GPs of the benefit of the EICT NCM and for GPs to attend the MDT.
Recommendations Team members recommended ensuring spider telephones worked, improving IT and IT support to achieve integration across networks and patients’ records management systems because this would facilitate team work and help optimise patient outcomes. Although team members know the impact of what they do insofar as they can monitor the progress of patients via the ‘tracker’, more widely accessible information about what EICTs do and the impact of what they do should be made available to the team and to others. This would help those external to EICTs to become more fully aware of the effectiveness and worthwhileness of EICTs. The team should be encouraged to continue to work to develop a more pro-active approach and wider organisational integration including the involvement of GPs.

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