Independent evaluation of the Isle of Wight Vanguard My Life a Full Life Integrated Locality Services [ILS]: Using Normalisation Process Theory [NPT] framework to evaluate a new care model [NCM] and its team

Abstract

Background:
In line with the Five Year Forward View (NHS England, 2014), MLaFL aims to offer person centred care and support based on multi-specialist teams and GP clinical leadership to achieve prevention-based improved health and well-being outcomes that encourages self-care.

Aims and objectives:
The team evaluation sought to understand the experience of the staff involved in developing and delivering the implementation of ILS to understand the extent to which the team was able to embed the implementation of ILS in daily routine practice in a long term sustainable way and to ascertain the extent to which the team was effective and the goals of the ILS were felt to have been achieved.

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 MLaFL ILS Logic Model. Data collection took place in 2 different sites South Wight [ILS1] and North East Ryde [ILS2] and took the form of non-participant observation of a regular multi-disciplinary team meeting [MDT] [n=7 and n=11), a focus group that took place directly following the MDT (n=7 and n=8), which included an anonymous survey and brainstorming and a ranking exercise. Data were analysed numerically using the NPT framework (May and Finch, 2009) and thematic analysis (Braun and Clarke, 2006).

Results:
For both localities a number of key enabling factors were identified: teamwork/joint working with other agencies; person- centred care/helping people and less time from referral to action. Other key factors were progress in clarity of processes [ILS 1] and less time from referral to action [ILS2]. Optimal implementation of ILS was felt to be inhibited by a number of restricting factors: lack of time/capacity re MDT due to competing demands; unclear roles/processes; lack of buy in from other agencies, including little involvement from GPs and nurses [ILS1] and lack of funding [ILS2]. Team members strongly agreed they felt valued as team members, that they communicated effectively with each other, and that ILS meetings were productive with agreed actions. Most goals received positive or highly positive scores with team members agreeing or strongly agreeing that ILS team goals had been met. Although the ILS NCM was not completely there yet about saying your story only once, top scores were given for improved identification of safeguarding issues and more opportunity for shared learning from colleagues from different professions. Focus group discussions similarly underlined that ILS NCM had played a key role in supporting multi-agency working across the South Wight and North East and Ryde localities. The very few less positive NPT scores concerned resources, training and support. Most scores were positive. The highly positive scores showed strong agreement that the ILS NCM was worthwhile, team members valued the effect of ILS on their work and were open and willing to work in new ways. Cognitive engagement and reflexive monitoring were the NPT domains with the highest overall average scores showing a very good level of buy in from team members and experiential learning and reflection.

Conclusion:
This was a pragmatic evaluation of a small pilot implementation of a NCM in a real life setting using a mixed methods approach with a validated conceptual framework demonstrated that, although collective action could benefit from improvement, ILS 1 and ILS 2 appeared to be effective and were on track to become embedded in daily routine practice. Both ILS teams had moved from “fragmentation” to “integration”, demonstrating a good potential for sustainability in the long term and being on track to embed the implementation of ILS in a long term sustainable way.

Recommendations
As a matter of priority IT problems should be sorted out with better integration across networks and patients’ records management systems. There should be more of a reciprocal process between ILS and senior leadership. The ILS teams should continue to access all available information about ILS and its effects in order to take steps to optimise the effectiveness and worthwhileness of ICT. ILS would be even more worthwhile if it became more fully integrated with a more pro-active approach and include an even greater range of professionals, including GPs.

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