Organisational Development to support integrated care in East London: the perspective of clinicians and social workers on the ground

Organisational Development (OD), with its focus on partnership working and distributed leadership, is increasingly advocated as an effective approach to driving change. Our evaluation of the impact of OD on delivery of integrated care in three London boroughs sheds light on how OD is being understood and implemented within health services, and what impact it is having on delivery of care. The findings presented here are based on a qualitative and participatory evaluation. We looked at how health and social care professionals communicated and coordinated delivery of care and evaluated the impact of current OD activities on the ground to evidence whether and to which degree they are enabling frontline staff to change their working routines towards greater coordination. Our findings highlight the limited reach and scope of a top-down approach to OD based on ad hoc coaching and staff engagement events, often delivered by external consultancies, and mostly focused at the senior management level. This approach fell short of enabling the creation of sustainable, integrated and collaborative organisations. Instead, some of the professionals that participated in our study tried to develop spaces that facilitated ongoing dialogue and mutual support among professionals on the ground. Initiatives of bottom-up OD such as those described in this paper have greater potential to change working routines as they enable staff to move towards more collaborative and coordinated work. These findings contribute to the literature on OD in public services and highlight the benefits of a context-sensitive, pragmatic, and long-term approach to OD to help create sustainable collaborative organisations

Spatially-distributed coverage optimization and control with limited-range interactions

This paper presents coordination algorithms for groups of mobile agents performing deployment and coverage tasks. As an important modeling constraint, we assume that each mobile agent has a limited sensing/communication radius. Based on the geometry of Voronoi partitions and proximity graphs, we analyze a class of aggregate objective functions and propose coverage algorithms in continuous and discrete time. These algorithms have convergence guarantees and are spatially distributed with respect to appropriate proximity graphs. Numerical simulations illustrate the results.Comment: 31 pages, some figures left out because of size limits. Complete preprint version available at http://motion.csl.uiuc.ed

(Dis)integrated care? Lessons from East London

Introduction: This paper examines one of the NHS England’s Pioneers programmes of Integrated Care, which was implemented in three localities in East London, covering the area served by one of the largest hospital groups in the UK and bringing together commissioners, providers and local authorities. The partners agreed to build a model of integrated care that focused on the whole person. This qualitative and participatory evaluation looked at how an ambitious vision translated into the delivery of integrated care on the ground. The study explored the micro-mechanisms of integrated care relationships based on the experience of health and social care professionals working in acute and community care settings. Methods: We employed a participatory approach, the Researcher in Residence model, whereby the researcher was embedded in the organisations she evaluated and worked alongside managers and clinicians to build collaboration across the full range of stakeholders; develop shared learning; and find common ground through competing interests, while trying to address power imbalances. A number of complementary qualitative methods of data generation were used, including documentary analysis, participant observations, semi-structured interviews, and coproduction workshops with frontline health and social care professionals to interpret the data and develop recommendations. Results: Our fieldwork exposed persistent organisational fragmentation, despite the dominant rhetoric of integration and efforts to build a shared vision at senior governance levels. The evaluation identified several important themes, including: a growing barrier between acute and community services; a persisting difficulty experienced by health and social care staff in working together because of professional and cultural differences, as well as conflicting organisational priorities and guidelines; and a lack of capacity and support to deliver a genuine multidisciplinary approach in practice, despite the ethos of multiagency being embraced widely. Discussion: By focusing on professionals’ working routines, we detailed how and why action taken by organisational leaders failed to have tangible impact. The inability to align organisational priorities and guidelines on the ground, as well as a failure to acknowledge the impact of structural incentives for organisations to compete at the expense of cooperation, in a context of limited financial and human resources, acted as barriers to more coordinated working. Within an environment of continuous reconfigurations, staff were often confused about the functions of new services and did not feel they had influence on change processes. Investing in a genuine bottom-up approach could ensure that the range of activities needed to generate system-wide cultural transformation reflect the capacity of the organisations and systems and address genuine local needs. Limitations: The authors acknowledge several limitations of this study, including the focus on one geographical area, East London, and the timing of the evaluation, with several new interventions and programmes introduced more or less simultaneously. Some of the intermediate care services under evaluation were still at pilot stage and some teams were undergoing new reconfigurations, reflecting the fast-pace of change of the past decade. This created confusion at times, for instance when discussing specific roles and activities with participants. We tried to address some of these challenges by organising several workshops with different teams to co-interpret and discuss the findings

Panel 2: Resilient Foresight: Contemporary Solutions for Future Issues

Moderator: Dr. Sonia Hirt, Dean & Hughes Professor in Landscape Architecture & Planning, UGA CE+D Panelists: Blake Hudson, Dean & Professor of Law, Cumberland School of Law Shelley Saxer, Laure Sudreau Endowed Professor of Law, Pepperdine Caruso School of Law John Travis Marshall, Associate Professor of Law, Georgia State University College of Law Mark Nevitt, Associate Professor, Emory University School of Law This panel’s discussion will involve planning today for tomorrow’s uncertainties in light of an evolving climate and regulatory regime. Dean Blake Hudson will discuss his scholarship, Resilient Forest Management and Climate Change. Specifically, Dean Hudson will argue, among other things, how, in light of climate-induced deforestation, society “must craft law and policy responses to help forests adapt more quickly.” Professor Shelley Saxer’s scholarship, Building Climate Resilience with Local Tools, will argue in favor of “mitigation and adaptation strategies that should inform rebuilding efforts” after disruptive disasters. Professor John Travis Marshall will highlight his scholarship, States in an Era of Climate Change: Hurricane Michael and Opportunities to Advance Rural Resilience to Natural Hazards. In so doing, Professor Marshall will suggest ways that communities “might move quickly following a disaster event to jumpstart long-term transformative housing recovery.” Professor Mark Nevitt will, again, draw upon his insurance retreat scholarship to discuss how insurers and regulators can aid in planning today for tomorrow’s uncertainties. Throughout the discussion, Dean Sonia Hirt, renowned environmental planner and Guggenheim Fellow, will pose questions to maximize the applicability of the conversation to attendees’ respective legal practices. The panel will conclude with approximately ten minutes of audience question and answer

Understanding integrated care at the frontline using organisational learning theory: a participatory evaluation of multi-professional teams in East London

Integrated care has been proposed as an organising principle to address the challenges of the rising demand for care services and limited resources. There is limited understanding of the role of learning in integrated care systems. Organisational Learning (OL) theory in the guise of ‘Learning Practice’ can offer a lens to study service integration and reflect on some of the challenges faced by multi-professional teams in developing a learning culture. The study presents findings from two qualitative evaluations of integrated care initiatives in three East London boroughs, England, undertaken between 2017 and 2018. The evaluations employed a participatory approach, the researcher-in-residence model, to coproduce findings with frontline staff working in multi-professional teams in community care. Thematic analysis was undertaken using an adapted version of the ‘Learning Practice’ framework. The majority of learning in the teams was single loop i.e. learning was mainly reactive to issues that arise. Developing a learning culture in the three boroughs was hindered by the differences in the professional and organisational cultures of health and social care and challenges in developing effective structures for learning. Individual organisational priorities and pressures inhibited both the embedding of learning and effective integration of care services at the frontline. Currently, learning is not inherent in integrated care planning. The adoption of the principles of OL optimising learning opportunities, support of innovation, managed risk taking and capitalising on the will of staff to work in multidisciplinary teams might positively contribute to the development of service integration

Text messaging and brief phone calls for weight loss in overweight and obese English- and Spanish-speaking adults: A 1-year, parallel-group, randomized controlled trial.

BACKGROUND:Weight loss interventions based solely on text messaging (short message service [SMS]) have been shown to be modestly effective for short periods of time and in some populations, but limited evidence is available for positive longer-term outcomes and for efficacy in Hispanic populations. Also, little is known about the comparative efficacy of weight loss interventions that use SMS coupled with brief, technology-mediated contact with health coaches, an important issue when considering the scalability and cost of interventions. We examined the efficacy of a 1-year intervention designed to reduce weight among overweight and obese English- and Spanish-speaking adults via SMS alone (ConTxt) or in combination with brief, monthly health-coaching calls. ConTxt offered 2-4 SMS/day that were personalized, tailored, and interactive. Content was theory- and evidence-based and focused on reducing energy intake and increasing energy expenditure. Monthly health-coaching calls (5-10 minutes' duration) focused on goal-setting, identifying barriers to achieving goals, and self-monitoring. METHODS AND FINDINGS:English- and Spanish-speaking adults were recruited from October 2011 to March 2013. A total of 298 overweight (body mass index [BMI] 27.0 to 39.9 kg/m2) adults (aged 21-60 years; 77% female; 41% Hispanic; 21% primarily Spanish speaking; 44% college graduates or higher; 22% unemployed) were randomly assigned (1:1) to receive either ConTxt only (n = 101), ConTxt plus health-coaching calls (n = 96), or standard print materials on weight reduction (control group, n = 101). We used computer-based permuted-block randomization with block sizes of three or six, stratified by sex and Spanish-speaking status. Participants, study staff, and investigators were masked until the intervention was assigned. The primary outcome was objectively measured percent of weight loss from baseline at 12 months. Differences between groups were evaluated using linear mixed-effects regression within an intention-to-treat framework. A total of 261 (87.2%) and 253 (84.9%) participants completed 6- and 12-month visits, respectively. Loss to follow-up did not differ by study group. Mean (95% confidence intervals [CIs]) percent weight loss at 12 months was -0.61 (-1.99 to 0.77) in the control group, -1.68 (-3.08 to -0.27) in ConTxt only, and -3.63 (-5.05 to -2.81) in ConTxt plus health-coaching calls. At 12 months, mean (95% CI) percent weight loss, adjusted for baseline BMI, was significantly different between ConTxt plus health-coaching calls and the control group (-3.0 [-4.99 to -1.04], p = 0.003) but not between the ConTxt-only and the control group (-1.07 [-3.05 to 0.92], p = 0.291). Differences between ConTxt plus health-coaching calls and ConTxt only were not significant (-1.95 [-3.96 to 0.06], p = 0.057). These findings were consistent across other weight-related secondary outcomes, including changes in absolute weight, BMI, and percent body fat at 12 months. Exploratory subgroup analyses suggested that Spanish speakers responded more favorably to ConTxt plus health-coaching calls than English speakers (Spanish contrast: -7.90 [-11.94 to -3.86], p < 0.001; English contrast: -1.82 [-4.03 to 0.39], p = 0.107). Limitations include the unblinded delivery of the intervention and recruitment of a predominantly female sample from a single site. CONCLUSIONS:A 1-year intervention that delivered theory- and evidence-based weight loss content via daily personalized, tailored, and interactive SMS was most effective when combined with brief, monthly phone calls. TRIAL REGISTRATION:ClinicalTrials.gov NCT01171586

Government‒business relations in multilevel systems: the effect of conflict perception on venue choice

In multilevel systems, organised interests, including business firms, can pursue their political goals at different levels. At the same time, national systems of interest representation provide important incentive structures for corporate political behaviour. In this context, corporate political strategy is guided by firms’ perceptions of their relationship with policy-makers. If this relationship is under strain in one venue, firms shift their lobbying effort to alternative venues, subject to constraints reflecting national institutional legacies. Using survey data on 56 large German and British firms, the article investigates empirically how perceptions of government‒business relations and national systems of interest representation interact to shape the political behaviour of large firms in multilevel systems. The analysis shows that perceived conflict with public authorities at the national level leads to increased business lobbying at the EU level. Furthermore, national types of interest representation shape relative business engagement at the EU level as well as the readiness of firms to shift venue

Government‒business relations in multilevel systems: the effect of conflict perception on venue choice

In multilevel systems, organised interests, including business firms, can pursue their political goals at different levels. At the same time, national systems of interest representation provide important incentive structures for corporate political behaviour. In this context, corporate political strategy is guided by firms’ perceptions of their relationship with policy-makers. If this relationship is under strain in one venue, firms shift their lobbying effort to alternative venues, subject to constraints reflecting national institutional legacies. Using survey data on 56 large German and British firms, the article investigates empirically how perceptions of government‒business relations and national systems of interest representation interact to shape the political behaviour of large firms in multilevel systems. The analysis shows that perceived conflict with public authorities at the national level leads to increased business lobbying at the EU level. Furthermore, national types of interest representation shape relative business engagement at the EU level as well as the readiness of firms to shift venue

Engaging with care: ethical issues in Participatory Research

This paper contributes to the literature on ethics in Participatory Research (PR) by looking at the Researcher-in-Residence model and its application within health services research in three East London boroughs. The Researcher-in-Residence is embedded in the organisation to enable knowledge mobilisation and knowledge coproduction. Whereas negotiation of different types of expertise to coproduce evidence might raise issues of power differentials, the embedded nature of the role also requires careful negotiating of relationships. As the researcher is immersed in the context under evaluation, the boundaries between the researcher and the participants’ everyday working life can become blurred. The paper explores these ethical issues and suggests that, whereas the requirements of ethics committees, based on an ethics of principle, at times fail to offer appropriate guidelines for this methodological approach, an ethics of care based on relationships can offer a complementary framework to address some of the thorny challenges that emerge from everyday practice in PR