Hilary Brown

Interprofessional workplace learning: a catalyst for strategic change?

Abstract The integrated care development programme (ICDP) was a continuing interprofessional educational programme for health and social care managers and commissioners. Multi-professional strategic teams from a single locality participated in university and workplace-based learning activities centred on the development of an integrated business plan to address a local priority for improvement. The evaluation used participant self-assessment, semi-structured interviews and group discussions to assess achievement of expected impacts on the participants, their organisations and partnerships, and patient/service user outcomes. The findings indicate that whilst those employed in management and commissioning roles had considerable experience of working across professional and agency boundaries they derived individual benefits from a workplace IPE programme. The principles of design and delivery developed in pre-registration and clinician/practitioner IPE courses also applied to those working at a more strategic level. Organisational impacts were reported, but 6 months post-programme evidence was not yet available of significant improvements in patient outcomes and /or financial efficiencies. Individual motivation, team dynamics and support from line managers all affected the extent to which individual and organisational impacts were achieved.

Designing whole-systems commissioning: Lessons from the English experience

The primary aims of this study were to identify determinants of successful strategic commissioning and to assess the overall state of current knowledge. It involved a review of the published literature and interviews with those involved in strategic commissioning in England. The combined evidence from these two sources suggests that structural solutions alone cannot deliver effective relationships and will not be effective when relationships are neglected. There is a prior requirement for staff, partner, and political buy-in. Work is required to ensure the right balance and distribution of commissioning skills and competencies. It is important to note here that many of the skills needed for strategic commissioning may be found in partner agencies (including providers), so organizational boundaries must be seen as porous as the new commissioning/provider roles emerge and are refined. Finance and incentive alignment are also crucial to ongoing strategic commissioning since organizations that contribute to the achievement of multiple outcomes will expect funding streams to recognize and reward these achievements. Overall, while evidence and evaluation are important, in a rapidly changing environment there are no clear-cut guidelines for success and there is an equal need for experimentation and flexibility.

Integrated care in action: A practical guide for health, social care and housing support

The authors offer the view that “integration is concerned with a fluid set of interactions between individuals accessing services ... professionals who support them, and organisations and policy contexts” and set about providing tools to support those interactions and the actors at large (p. 8). This theme is woven throughout the various chapters based upon the building blocks which, the authors argue, are integral in the success of an integrated care initiative.

Contextual Factors Influencing Cost and Quality Decisions in Health and Care: A Structured Evidence Review and Narrative Synthesis

Background: Decisions affecting cost and quality are taken across health and care but investigation of the mediating role of context in these is in its infancy. This paper presents a synthesis of the evidence on the contextual factors that influence ‘decisions of value’ – defined as those characterised by having a significant and demonstrable impact on both quality and resources – in health and care. The review considers the full range of resource/quality decisions and synthesises knowledge on the contextual drivers of these. Methods: The method involved structured evidence review and narrative synthesis. Literature was identified through searches of electronic databases (HMIC, Medline, Embase, CINAHL, NHS Evidence, Cochrane, Web of Knowledge, ABI Inform/Proquest), journal and bibliography hand-searching and snowball searching using citation analysis. Structured data extraction was performed drawing out descriptive information and content against review aims and questions. Data synthesis followed a thematic approach in accordance with the varied nature of the retrieved literature. Results: Twenty-one literature items reporting 14 research studies and seven literature reviews met the inclusion criteria. The review shows that in health and care contexts, research into decisions of value in health and care is in its infancy and contains wide variation in approach and remit. The evidence is drawn from a range of service and country settings and this reduces generalisability or transferability of findings. An area of relative strength in the published evidence is inquiry into factors influencing coverage and commissioning decisions in health care systems. Allocative decisions have therefore been more consistently researched than technical decisions. We use Pettigrew’s (1985) distinction between inner and outer context to structure analysis of the range of factors reported as being influential. These include: evidence/information, organisational culture and governance regimes, and; economic and political conditions. Conclusion: Decisions of value in health and care are subject to range of intersecting influences that often lead to a departure from narrow notions of rational decision-making. Future research should pay greater attention to the relatively under-explored area of technical, as opposed to allocative, decision-making.

Interprofessional Education – a potential bridge over the commissioner–provider divide?

Introduction: English health and social care policy has moved to a commissioning model in which public sector bodies are responsible for developing mixed provider markets that can respond to current and future needs. Underpinning this model is an assumption that commissioners will be able to use their position as monopoly purchasers to ensure both quality and efficiency from providers. In reality though their power to achieve change in health care in particular has been limited, due to a combination of market dominance by key providers, insufficient contracting capacity and the destabilizing effects of frequent restructuring. Thus it can be argued that health care commissioning has had little positive impact as yet, but has acted to introduce additional boundaries connected with separate purchaser-provider organizations, different commissioning approaches between health and social care, and the emergence of a new ‘profession’ of commissioning to add to current inter-professional conflicts. To address the inter-organizational barriers within the new English system a range of strategic initiatives have or are being introduced, including a ‘duty’ on statutory health and social care bodies to promote integration, a new board within each locality to co-ordinate integrated commissioning and develop a shared plan to respond to identified need, and the development of national indicators that reflect on patient and service users’ experience of integrated services. Whilst clearly relevant, arguably these initiatives do not directly address barriers to integrated which may result from the key strategic players coming from different professional backgrounds. Such inter-professional issues are well-established in relation to clinical practice, and there is the potential for them to also be present at a strategic level. Based on a pilot programme, this article reflects on the presence of such barriers at a strategic level and the potential of inter-professional education (IPE) to be a means to enable commissioners and providers to work collaboratively on shared priorities. Theory & Methods: The Integrated Care Development Programme (ICDP) brought together teams of commissioners, provider managers, and senior clinicians to work on a local priority for integration. Based on principles and theories of IPE the programme was a mixture of taught content relating to integrated working and group work in which the locality teams used the theory