This cross-cutting theme draws upon organisation science as a necessary component of service delivery/implementation science. Since our proposed ARC-WM is slanted to tackle generic service issues the topic of integration emerges as a critical issue across all our research themes, particularly across health and social care. All themes, and most identified projects, cross multiple clinical services and sector domains, including primary and social care. However, integrated care has proved difficult to realise in practice. We examine potential solutions to the integrated care challenge at multiple levels:
- Organisational level: Improving integration of care requires changes in pathways of care, which invokes a need for workforce role change. This in turn brings in consideration of human relationships, resource re-allocation, new modes of leadership and accountabilities, knowledge mobilisation, and greater patient and carer involvement, alongside a need to enact strategy collaboratively across organisations. Our work is thus well-aligned to objectives of Sustainability and Transformation Partnerships and will enable us to explore factors affecting cross sectoral working in depth.
- Individual level: Integrated care invokes need for behavioural change from professionals, managers developing and delivering care and also from patients and carers. While knowledge of barriers to change are well understood, much more work is required on how to influence individuals when services are undergoing change.
- Technological level: We will examine socio-technical factors that operate when digital technologies support integrated care through providing timely access to real time data to inform clinical decision-making; real time digital access to provide early warning, for example of hypothermia; and data integration to support strategic planning in health organisations.
We have worked closely together as research themes in the CLAHRC-WM and have learned how to work across organisational and clinical science.
Early and late aims:
We will work closely with the research themes at all stages in the development and evaluation intervention pathway as follows:
- At the selection stage we can produce the evidence of what it would take to make a success of a proposed intervention to avoid the type of failures that are endemic to underspecified, under-costed attempts to improve services.
- At the development phase we can integrate knowledge covering the three levels described above along with further skills (such as operations research).
- At the pilot stage we can provide early warning of the need to adapt services as a result of formative enquiry.
- We will contribute to qualitative data collection and theory development at the stage of mixed-methods evaluations.