Leadership of Integrated Health and Social Care Services

This research explores the lived experience of those individuals charged with leading the integration of health and social care services in Scotland. The research was primarily qualitative in nature – comprising of a qualitative survey of front-line managers of integrated health and social care services from a single partnership area. The survey explored the management and leadership tasks and activities expected of those leading health and social care teams. The research uncovers a sense that these new leadership positions are both overwhelming in the scope of tasks required and lack clarity in how these tasks should be undertaken. This highlights a need for coordinated support and training for staff who are charged with leading integrated health and social care teams. Three key recommendations have been drawn from the findings of this research: more support should be provided to managers working within these complex integrated systems; a joint training programme should be developed for managers across both partnering organisations and finally relevant policies and procedures should be compiled into one reference resource for managers of integrated services

Quality of working time in the police : the experience of shift extensification for officers and staff

This chapter examines the quality of working time within the police service, focusing on one particular dimension of working time, shift extensification. For the police service, demands for operational efficiency make shiftwork and unsocial working hours an expectation. However, extended shifts which are unpredictable are seldom formally recognised. The chapter proposes that, over time, such regular shift extensification leads to degradation in the quality of working time as a result of its consequences for employee work-life balance, wellbeing and health. It reports a study drawing from a survey of 3257 UK police officers and staff to examine the extent to which extended hours are an issue. The chapter presents analysis of 2198 open text comments across the range of occupations in order to enrich the understanding of how working time quality is affected by this form of unplanned shift extensification. The data allows us to reflect on the implications for working time quality in situations where employer-driven demands for short notice flexible scheduling are shifting the adjustment back on employees. It is argued that this pattern is increasingly evident in many front-line occupations in a range of contemporary contexts, including the public sector

Collaborative leadership in Integrated Care Systems; creating leadership for the common good

The COVID-19 pandemic has become a catalyst for change, but such change can only happen through collaborative leadership which maintains a focus on relationships and purpose rather than solely on outputs or outcomes. This conceptual article explores how health and social care integration has been offered as one potential solution to the challenge of health and social care transformation. Specifically, Integrated Care Systems in England are intended to provide regional governance, to provide public services in a coherent and robust way. We explore this development in relation to three key aspects: the macro-level global policy context; the meso-level organizational behaviour and culture; and the micro-level practice of individual leaders and managers. It is found that, whilst the organizational structure of Integrated Care Systems offers great promise, collaborative leadership is critical to realize truly resilient and sustainable collaborative relationships

Unpredictable working time, well-being and health in the police service

The unpredictability of working time is a seldom studied feature of employment. This paper proposes that unpredictability in scheduling is associated with greater employee work-life conflict and perceived stress. This, in turn, has implications for health behaviour (alcohol consumption, sleep disturbance) and symptoms (digestive and cardiovascular problems). Increasing employee control through flexible working arrangements (FWA) is examined as a potential moderator. We also examine the possibility that alcohol consumption exacerbates the negative effects of unpredictability on well-being and health. A survey of 1207 police officers, for whom working unsocial hours is commonly accepted, showed direct effects of unpredictability over and above nonstandard hours on digestive health, and indirect effects through well-being on sleep, digestive and cardiovascular health. In some cases, these indirect effects were reduced or absent with greater employee control through FWA, although this was not uniform. Alcohol consumption intensified the effects of unpredictability on well-being and some health outcomes. As well as highlighting unpredictability as a key dimension of working time quality, the findings reflect a tension between employer-centred scheduling strategies for enhancing workforce flexibility and HRM practices, such as FWA, which purport to provide employees with greater control and work-life balance

Patient acceptability of three different central venous access devices for the delivery of systemic anticancer therapy:a qualitative study

Objective: Three types of central venous access devices (CVADs) are routinely used in the delivery of intravenous systemic anticancer therapy (SACT): peripherally inserted central catheters (PICCs), subcutaneously tunnelled central catheters (Hickman-type devices) and totally implantable chest wall ports (Ports). This qualitative study, nested within a multicentre, randomised controlled trial, sought to explore patient acceptability and experiences of the three devices. Design: Eight focus groups were audio-recorded, transcribed and thematically analysed. Setting: Six outpatient cancer treatment centres in the UK. Participants: Forty-two patients (20 female, mean age 61.7 years) who had taken part or were taking part in the broader trial. Intervention: As part of the larger, randomised controlled trial, participants had been randomly assigned one of three CVADs for the administration of SACT. Results: Attitudes towards all three devices were positive, with patients viewing their CVAD as part of their treatment and recovery. Participants with PICCs and Hickmans tended to compare their device favourably with peripheral cannulation. By comparison, participants with Ports consistently compared their device with PICCs and Hickmans, emphasising the perceived superiority of Ports. Ports were perceived to offer unique psychological benefits, including a greater sense of freedom and less intrusion in the context of personal relationships. Conclusions: Patient experiences and preferences have not been systematically used to inform policy and practice regarding CVAD availability and selection. Our research identified patterns of patient device preferences that favoured Ports, although this was not universal. Results of this study could improve support for patients and offer greater scope for incorporating patient perspectives into decision-making processes. Trial registration number: ISRCTN44504648

New development: Responding to complexity in public services—the human learning systems approach

The challenges facing public services and non-profit organizations are complex and multi-faceted, confounding the orthodoxies of bureaucratic public administration and New Public Management approaches. This article discusses the merits and potential of the emerging ‘Human Learning Systems’ (HLS) approach to the funding, commissioning and management of public services as an alternative management logic. Building on prior introductory work, the authors analyse the current state of development, content and operation of HLS and its collaborative process, involving more than 300 organizations. Drawing on the experience of public and non-profit service professionals in adopting and experimenting with this approach, the authors found that HLS can provide a helpful and innovative conceptual frame to promote constructive engagement with complexity in public management theory and practice. IMPACT: Current approaches to public management based on principles of marketization, management and measurement are increasingly being seen to fail when faced with the complex world of public services. The Human Learning Systems (HLS) concept represents an alternative approach which embraces the complexity of the real world of organizations working to deliver services. Produced in collaboration with an emerging community of funders, managers and commissioners of services, HLS offers a framework which bridges academic complexity theory and the diverse contexts of practice. This article introduces HLS as a means to enable organizations, practitioners and service users to work together more effectively

New development: Learning communities—an approach to dismantling barriers to collective improvement

Public services operate in conditions of complexity. Practitioners and service users can never be certain of the impact or outcome of a course of action and, consequently, responsible failure must be supported. A new methodology for enabling public service professionals to navigate the complexity of their practice is introduced in this article: ‘learning communities’ (LCs). Drawing from developmental applications of this methodology, the authors describe how LCs provide environments for talking authentically about uncertainties and mistakes with the purpose of collective improvement, and draw parallels with similar methods of community co-creation. The way that LCs tackle two key elements of the public sector’s learning capacity noted in the literature—structure and culture—is explained

The Value of Health Technology Assessment: a mixed methods framework

Whilst much research has been undertaken on establishing what factors influence improved decision-making including good governance structures, expertise, political and institutional factors, resources and participation, how such influences on decision-making interact with local context and health systems, leading to impact on health outcomes, is less understood. The focus of our research is on the impact of Health Technology Assessment (HTA) as a tool for priority-setting with its explicit consideration of costs and benefits. Where evaluations have been undertaken, they mainly focus on processes or outcomes at the decision-making level, with impact on health outcomes rarely measured. Even in countries where HTA programmes are well established, evidence which identifies their outcomes and impact in terms of health gains is limited. For countries with greater capacity constraints, how decision-making interacts with ‘context’ leading to health outcomes is even less explored and arguably of critical importance. This research aims to provide a methodological framework and evidence base to: quantify the returns on investment in HTA; and produce explanatory programme theory that considers individual, interpersonal, institutional and systems-level components and their interactions on the mechanisms by which HTA impact can be optimised

Making Every Contact Count with seldom-heard groups? A qualitative evaluation of voluntary and community sector (VCS) implementation of a public health behaviour change programme in England

Making Every Contact Count (MECC) is a national, long-term public health strategy in England. It supports public-facing workers to use opportunities during routine contacts to enable healthy lifestyle changes. This paper reports the findings from an external evaluation of voluntary and community sector (VCS) delivery of MECC in the North East of England, which focused on engaging under-represented client groups. The study aimed to (a) Establish if (and how) MECC had impacted the workforce, including changes to staff knowledge, confidence and behaviour; (b) Identify benefits, challenges and unintended consequences; and (c) Explore outcomes for service users. A multi-stage qualitative design focused on understanding both process and outcomes. The study utilised three data collection methods, including a journey mapping workshop (n = 20), semi-structured interviews with delivery leads, VCS workers and volunteers who had accessed MECC training (n = 11), and focus group discussions with clients (n = 22). The findings illustrated positive early outcomes, including improvements in self-reported staff knowledge and confidence as well as emerging examples of organisational culture shift and individual behaviour change. Alongside this, the data provided a rich picture of barriers and challenges which are examined at different levels—national programme, local programme, VCS sector, partner organisation, worker and client. The research highlights clear successes of the VCS delivery model. However, it is presented as a ‘double-edged sword,’ in light of associated challenges such as sector-level funding uncertainty and accessibility of MECC resources to diverse client groups. The discussion considers issues related to the measurement and attribution of behaviour change outcomes for brief interventions, as well as fidelity, legacy and long-term sustainability challenges. The recommendations call for system-level analysis and comparison of different MECC implementation models, to improve our understanding of challenges, opportunities and programme reach for behaviour change intervention programmes—particularly in relation to seldom-heard client groups

New development: The emerging role of a 'learning partner' relationship in supporting public service reform

As public services face the limits of existing approaches to public management, emerging practices are highlighting the importance of continuous learning and service reform. While many approaches, methods and aids for learning exist, managers embracing complexity are making use of relational resources to scaffold their learning capacity-building. This article introduces the idea of ‘learning partnerships’: a set of nested learning relationships between public managers, consultants, and researchers and academics, which extends the literature on academic–practitioner collaborations and builds a relational mechanism for learning into the action learning action research (ALAR) and learning organization genres