The challenges of delivering universal and integrated care - evidence to inform policy implementation in Ireland and internationally
| Autor: | Sara Burke, Maebh NiFhalluin, Steve Thomas, Tadhg O'Shea, PJ Harnett, Sarah Barry, Maria B. Boyce |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2019 |
| Předmět: |
lcsh:R5-920
uhc Health (social science) Sociology and Political Science business.industry Service delivery framework Health Policy ic Change management Context (language use) Participant observation system change Public relations Integrated care Political science Health care National Policy Leadership style implementation lcsh:Medicine (General) business |
| Zdroj: | International Journal of Integrated Care; Vol 19: Annual Conference Supplement 2019; 545 International Journal of Integrated Care, Vol 19, Iss 4 (2019) |
| ISSN: | 1568-4156 |
| Popis: | Policy and System Change Context: The paper describes insights into implementation challenges associated with integrated care as a national policy component of Universal Health Care in Ireland. It addresses an international audience by linking universal and integrated care development with the policy implementation literature in complex adaptive health and social care systems. Study Design and Methods: It outlines findings from two literature reviews on change in complex health and social care systems, one of them a systematic review that situates integrated care in the universal health care policy context. We also present findings, including operational and strategic insights on the challenges and opportunities of implementing integrated care from a) a participant online survey across seven pioneer sites and at national programme level, and b) an in-depth case study of integrated care implementation in Ireland over three pioneer sites. Case-data generated from November 2017 to June 2018 at national and pioneer-site levels include initial research co-design discussions, exploratory and elite interviews, workshops, documentary review, participant observation and feedback. Outline Findings: Systematic and literature review findings address methodologies, conditions and competencies for implementation (including collaboration, distributed decision-making, mindset-shifts and leadership styles in complex systems). System-level mechanisms for better patient access, information sharing, and effective functionality are also highlighted. The survey and case study research evidences similar challenges around provider skills and competencies, managing patient access and pathways, and the creation of organisational systems to underpin new service delivery designs. The question of organisational adaptability is critical here for successful system reform outcomes such as positive change management, quality of care and sustained learning for person-centered care. Practical and Policy Relevance: Learning how demonstrator (pioneer) site initiatives and discrete programmes can grow locally, as well as scale more broadly for translation as common discourses, approaches, and buy-in is critical to meet the challenges of integrated care as a key plank of universal healthcare. The paper usefully describes policy implementation challenges from a grounded, complex, whole-of-system perspective. |
| Databáze: | OpenAIRE |
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