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

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 Farnborough 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=14+4=18); a structured focus group directly following the MDT (n=8), and an anonymous survey (n=12) 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 barrier categories identified in the focus group were divided into four categories: lack of understanding by those external to EICT [54.1% of the votes] ‘time pressures/staff shortage’ i.e. competing demands on staff [29.1%]; ‘IT (+IG) and phones’ [12.5%]; and funding [4.1%]. The driver categories were more equally divided into four categories: patient outcomes [29.1% of the votes]; ‘Team/MDT’ [25%]; ‘worthwhileness’ [25%]; and ‘flexibility/autonomy’ [20.8%]. Overall, team members agreed that they felt valued as team members [8.5] and that EICTs had achieved its team goals [8.8] which included the highly positive increasing the number of intensive early interventions with care plans entailing referrals to other services (e.g. social prescribing/voluntary sector) [9.1] a cultural shift in organisational integration [8.5] and shared learning by working with partner agencies [9.0]. The highest overall score for NPT questions was for team members continue to support EICTs [cognitive engagement] [9.2]; followed by team members can see potential value of EICT for their work [coherence] [9.0] closely followed by team members are open and willing to work in new ways [cognitive engagement] [8.9] and feedback about EICTs can be used to improve it in future [reflexive monitoring] [8.9]. The lowest overall score was for EICT is distinct from previous ways of working [coherence] [7.4], team members can access information about and are aware of the effects of EICT [reflexive monitoring] [7.5] and NHS/ Vanguard programme management team adequately supports EICT [collective action] [7.5] and sufficient resources are available to support EICT [collective action] [7.6]. Conclusion This pragmatic evaluation in real life setting undertaken with limited resources found that team members in EICT Farnborough have a strong belief a belief in the value and benefit of EICTs and feel empowered by having been able to work flexibly and autonomously without traditional boundaries for the benefit of patients. On the basis of available evidence, the EICT Farnborough NCM has moved from “fragmentation” to “integration” and has embedded the implementation of EICT in routine practice, in all likelihood in a long term sustainable way. Although the team strongly agreed that they achieved shared learning by working with partner agencies and that a culture shift was felt to have happened due to the breaking down of traditional barriers for the benefit of the care of patients, team members pointed out that they wanted more pro-active reviews and even wider organisational integration in the future. Recommendations 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, including senior managers, to become more fully aware of the effectiveness and worthwhileness of EICTs. 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.

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