Leadership for integrated care: A case study

Purpose. Integration of health services involves multiple interdependent leaders acting at several levels of their organisation and across organisations. This paper explores the complexities of leadership in an integrated care project and aims to understand what leadership arrangements are needed to enable service transformation. Design/Methodology/Approach. This case study analysed system and organisational leadership on a project aiming to integrate primary and specialist care. To explore the former, the national policy documents and guidelines were reviewed. To explore the latter, the official documents from the transformation team meetings and interview data from seventeen healthcare professionals and commissioners were analysed using thematic analysis with the coding framework derived from the comprehensive and multilevel framework for change. Findings. Although integration was supported in the narratives of the system and organisational leaders, there were multiple challenges: 1) insufficient support by the system level leadership for the local leadership, 2) insufficient organisational support for (clinical) leadership within the transformation team, and 3) insufficient leadership within the transformation team due to disruptions caused by personnel changes, roles ambiguity, conflicting priorities, and insufficient resources. Practical implications. This study provides insights into the interdependencies of leadership across multiple levels and proposes steps to maximise the success of complex transformational projects. Value. This study’s practical findings are useful for those involved in the bottom-up integrated projects, especially the transformation teams’ members. The case study highlights the need for a toolkit enabling local leaders to operate effectively within the system and organisational leadership contexts.

The barriers and facilitators to managing diabetes with insulin in adults with intellectual disabilities: A systemised literature review

Background: People with intellectual disabilities are more likely to have diabetes and may require additional support to manage it. Insulin treatment is complex and there are health inequalities facing people with intellectual disabilities which affect optimal diabetes management. This review aimed to identify barriers and facilitators to managing diabetes with insulin for adults with intellectual disabilities. Method: PPI was integral to the development of the research question. A systemised review was conducted across CINAHL, the British Nursing Index and MEDLINE. Thematic analysis was used to synthesise data and PRISMA guidelines were followed. Results: Barriers and facilitators to managing diabetes with insulin for people with intellectual disabilities were identified in relation to three key themes: 1. The individual, 2. Other people, 3. Environmental/social factors. Conclusions: People with intellectual disabilities who use insulin, require education, support, and a person-centred approach to facilitate supported self-management. More training for their supporters is needed and further research is recommended

Local enhanced services: Is a lack of outcome data affecting diabetes care?

The Local Enhanced Service (LES) is a popular commissioning tool to boost the quality of health care. Primary care providers are invited to participate in the LES and offered financial incentives. There are many LESs for Diabetes across the UK, creating opportunities for comparing their variation in content and determining best practice. However, little is known about the individual LESs and their outcomes. Calling on mostly unpublished Clinical Commissioning Groups’ documents, this paper discusses the current practice in Diabetes LESs and highlights a need for their systematic evaluation

Population health management in diabetes care: combining clinical audit, risk stratification, and multidisciplinary virtual clinics in a community setting to improve diabetes care in a geographically defined population. An integrated diabetes care pilot in the North East Locality, Oxfordshire, UK

Background: Disparities in diabetes care are prevalent, with significant inequalities observed in access to, and outcomes of, healthcare. A population health approach offers a solution to improve the quality of care for all with systematic ways of assessing whole population requirements and treating and monitoring sub-groups in need of additional attention. Description of the care practice: Collaborative working between primary, secondary and community care was introduced in seven primary care practices in one locality in England, UK, caring for 3560 patients with diabetes and sharing the same community and secondary specialist diabetes care providers. Three elements of the intervention included 1) clinical audit, 2) risk stratification, and 3) the multi-disciplinary virtual clinics in the community. Methods: This paper evaluates the acceptability, feasibility and short-term impact on primary care of implementing a population approach intervention using direct observations of the clinics and surveys of participating clinicians. Results and discussion: Eighteen virtual clinics across seven teams took place over six months between March and July 2017 with organisation, resources, policies, education and approximately 150 individuals discussed. The feedback from primary care was positive with growing knowledge and confidence managing people with complex diabetes in primary care. Conclusion: Taking a population health approach helped to identify groups of people in need of additional diabetes care and deliver a collaborative health intervention across traditional organisational boundaries

Conducting research into assaults on mental health nurses during COVID-19: A reflection on a professional and ethical dilemma

This article describes and reflects upon ethical dilemmas encountered during the data collection phase of a doctoral study exploring the experiences of mental health nurses who have been assaulted by patients in secure settings. It considers the researcher's position as an ‘insider’ and highlights the potential for this status to influence assumptions, conflicts and decisions in relation to ethical considerations. The projection of the researcher's own emotional experience onto participants is recognised to be a significant factor, emphasising the importance of reflection and reflexivity during the process. The dilemmas discussed are situated in and influenced by the context of the COVID-19 pandemic

Delivery and organization of diabetes care: integrated care

Services for diabetes mellitus are currently often delivered across primary, community and specialist services managed by separate organizations, driven by different priorities, outcome measures and budgets, and supported by incompatible IT systems. Integrated care has been proposed as a solution to improve the fragmentation of diabetes services. Integrated diabetes care is the coordination of services around a patient supported by integration of the health system. In essence, diabetes integration is the whole health community joining in partnership to own the health outcomes of people with diabetes in their local area. This article examines what integration means to diabetes care, ranging from generalist to specialist diabetes care

A human rights-based framework for qualitative dementia research

Background and objectives: People living with dementia have historically been excluded from qualitative research and their voices ignored due to the perception that a person with dementia is not able to express their opinions, preferences and feelings. Research institutions and organizations have contributed by adopting a paternalistic posture of overprotection. Furthermore, traditional research methods have proven to be exclusionary towards this group. The objective of this paper is to address the issue of inclusion of people with dementia in research and provide an evidence-based framework for dementia researchers based on the five principles of human rights: Participation, Accountability, Non-discrimination and equality, Empowerment and Legality (PANEL). Design: This paper adapts the PANEL principles to the research context, and uses evidence from the literature to create a framework for qualitative research in people with dementia. This new framework aims to guide dementia researchers in designing studies around the needs of people with dementia, to improve involvement and participation, facilitate research development and maximize research outcomes. Results: A checklist is presented with questions related to the five PANEL principles. These questions cover ethical, methodological and legal issues that researchers may need to consider while developing qualitative research for people with dementia. Conclusions: The proposed checklist offers a series of questions and considerations to facilitate the development of qualitative research in patients with dementia. It is inspired by current human rights work of recognized dementia researchers and organizations who have been directly involved in policy development. Future studies need to explore its utility in improving participation, facilitating ethics approvals and ensuring that outcomes are relevant to people with dementia

Barriers and facilitators to integrating primary and specialist healthcare in the United Kingdom: a narrative literature review

Many national policies propose integration between primary and specialist care to improve the care of people with long-term conditions. There is an increasing need to understand how to practically implement such service redesign. This paper reviews the literature on the barriers to, and facilitators of, integrating primary and specialist healthcare for people with long-term conditions in the UK, with the aim of informing the development and implementation of similar initiatives in integration. MEDLINE and CINAHL databases were searched and 14 articles discussing factors hindering or enabling integration were identi-fied. The factors were extracted and synthesised and key lessons were tabulated. Successful integration of care requires synchronised changes on different levels, a well-resourced team, a welldefined and evidence-based service, agreed and articulated new roles and responsibilities, and a willingness among healthcare professionals to co-work and co-learn. Barriers to successful implementation of integrated care include a lack of commitment across organisations, limited resources, poorly functioning information technology (IT), poor coordination of fi nances and care pathways, confl icting objectives, and conflict within teams. The examples of integrated working provide insights into problems and solutions around interorganisational and interprofessional working that will guide those planning integration in the future

Mental Health in Higher Education; Faculty staff survey on supporting students with mental health needs

Purpose – The purpose of this paper is to examine how faculty staff on health and social care programmes support students with mental health issues. Design/methodology/approach – The study used a qualitative survey design to gain in-depth information on faculty staff experiences. Seventy-one faculty staff at two universities in the South East of England out of an eligible population of 115 staff responded to an anonymous online questionnaire which were thematically analysed. Findings – The findings indicated that faculty staff faced uncertainties in providing support to students with mental health needs. They reported tensions between their academic, professional and pastoral roles. There was a wide recognition that supporting students was physically and emotionally demanding for faculty staff and especially challenging when their roles and expectations were unclear. This was compounded by lack of explicit guidelines and an apparent severed connection between faculty staff and student support services. Practical implications – A need for clearly defined roles and responsibilities for faculty staff in supporting students with mental health needs including a review of their pastoral role were identified. The study reinforces the need for effective collaborative arrangements and collective decision making and clearer procedures in the planning and implementation of students’ personal support plans. A concerted effort into adopting a transpersonal approach which incorporates mental health staff awareness training, restorative spaces for reflection and supportive pathways for faculty staff are recommended. Originality/value – This paper provides rare empirical evidence of faculty staff views on their role in supporting students with mental health needs on health and social care programmes