Assessing progress in managing and improving quality in nascent integrated care systems in England.

Autor:	Lalani M; Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK., Sugavanam P; Nuffield Department of Population Health, University of Oxford, Oxford, UK., Caiels J; Personal Social Service Research Unit, University of Kent, Canterbury, UK., Crocker H; Nuffield Department of Population Health, University of Oxford, Oxford, UK., Gunn S; Picker Institute Europe, Oxford, UK., Hay H; Picker Institute Europe, Oxford, UK., Hogan H; Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK., Page B; Department of Experimental Psychology, University of Oxford, Oxford, UK., Peters M; Nuffield Department of Population Health, University of Oxford, Oxford, UK., Fitzpatrick R; Nuffield Department of Population Health, University of Oxford, Oxford, UK.
Jazyk:	angličtina
Zdroj:	Journal of health services research & policy [J Health Serv Res Policy] 2024 Apr; Vol. 29 (2), pp. 122-131. Date of Electronic Publication: 2023 Nov 01.
DOI:	10.1177/13558196231209940
Abstrakt:	Objectives: In 2022, England embarked on an ambitious reorganisation to produce an integrated health and care system, intended also to maximise population health. The newly created integrated care systems (ICSs) aim to improve quality of care, by achieving the best outcomes for individuals and populations through the provision of evidence-based services. An emerging approach for managing quality in organisations is the Quality Management System (QMS) framework. Using the framework, this study assessed how ICSs are managing and improving quality. Methods: Four ICSs were purposively sampled, with the data collected between November 2021 and May 2022. Semi-structured interviews with system leaders ( n =60) from health and social care, public health and local representatives were held. We also observed key ICS meetings and reviewed relevant documents. A thematic framework approach based on the QMS framework was used to analyse the data. Results: The ICSs placed an emphasis on population health, reducing inequity and improving access. This represents a shift in focus from the traditional clinical approach to quality. There were tensions between quality assurance and improvement, with concerns that a narrow focus on assurance would impede ICSs from addressing broader quality issues, such as tackling inequalities and unwarranted variation in care and outcomes. Partnerships, a key enabler for integration, was seen as integral to achieving improvements in quality. Overall, the ICSs expressed concerns that any progress made in quality development and in improving population health would be tempered by unprecedented system pressures. Conclusion: It is unclear whether ICSs can achieve their ambition. As they move away from an assurance-dominated model of quality to one that emphasises openness, learning and improvement, they must simultaneously build the digital infrastructure, staff expertise and culture to support such a shift. Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu