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

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 Aldershot 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=15+4=19) a structured focus group that took place directly following the MDT (n=6), and an anonymous survey (n=8) using a scale 1-10 [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 barrier categories identified in the focus group were equally divided into ‘time pressures’, ‘staff shortage/competing demands on staff time’ and ‘IT (+IG) and phones’ [33.3% of the votes]. The top or most important drivers were ‘Team/MDT’ with half the votes, and ‘vision/no traditional boundaries’ [39%] followed by communications and leadership with an equal number of votes [11%] for both categories together. Overall, team members agreed that they felt valued as team members [7.8] and that EICTs had achieved its team goals [8.1] which included identifying individuals at risks and developing a care plan entailing referrals to other services (e.g. social prescribing/voluntary sector), a cultural shift in organisational integration and shared learning by working with partner agencies. The highest overall score for NPT questions was for team members can see potential value of EICT for their work [coherence] [8.8] closely followed by team members continue to support EICTs [cognitive engagement] [8.6]. The lowest overall score was for team members can access information about and are aware of the effects of EICT [reflexive monitoring] [6.1] and sufficient resources are available to support EICTs [collective action] [6.7].
Conclusion This pragmatic evaluation in real life setting undertaken with limited resources found that EICT in Aldershot is doing well in respect of team effectiveness and all NPT domains, but comparatively less well in relation to reflexive monitoring and collective action, especially with a handful of questions rated below 7. Team members had a strong belief a belief in the value and benefit of EICT Aldershot. Although on the road to a cultural shift due to breaking down barriers for the benefit of the care of patients, the team acknowledged that more progress had to be made and they planned to continue to work to develop a more pro-active approach and wider organisational integration.
Recommendations Improving IT and IT support and ensuring better integration across networks and patients’ records management systems as this would facilitate team work and help optimise patient outcomes. EICTs should be encouraged to make widely accessible all available information about what EICTs do and the impact of what they do. This would help those external to EICTs to become more fully aware of the effectiveness and worthwhileness of EICTs.

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