Round up for May 2018

Lessons about the impact of new models of care

As the new models of care programme in England transitions to a new phase of place based systems of care, the Health Foundation highlights learning from this work about how systematic improvement should be designed and developed for impact.

The impact of redesigning urgent and emergency care in Northumberland report examines the impact of changes to A&E and urgent care services in Northumberland as result of collaborative work with the Northumbria Primary and Acute Care System (PACS) vanguard. The unexpected consequence that A&E attendance increased after redesign improved access highlights how outcomes in the short term may be something different to what is expected. This is echoed in the key messages from Nuffield Trust’s review of a wide range of initiatives implementing new models of care that were expected to impact on hospital use Shifting the balance of care: great expectations.

These findings highlight the risk of increasing demand for services when implementing new models and the crucial the role of effective targeting of the population group most ‘at risk’ for realising the intended benefits.


Developments in the implementation and evaluation of improvement at scale

The importance of taking time to adjust new models of care to the local context is also one of the key lessons highlighted in a report that draws on the experience across site leaders from the new care models programme. Some assembly required: implementing new models of care, explains 10 key lessons for those seeking to develop and implement systematic improvements. In addition to the time required for adaptation, which allows for experimentation and failure, the importance of building in capacity and capability for evaluation to facilitate this process is also highlighted.

The need for an adaptive and also co-productive approach to implementation and evaluation has also been highlighted in the experience of researchers evaluating integrated care which was discussed at Healthcare Improvement Scotland’s recent 6th Annual Research Symposium. The SUSTAIN project is an example of how an action-oriented approach is being used to evaluate improvement based on the Evidence Integration Triangle model, in which local stakeholders and research partners co-design and implement improvement at scale.

Developments in proactive and responsive care for older and frail people

Improving services for older people requires consideration of the quality and pro-activeness of care across multiple components and settings. A number of recent publications consider what is working to better support and manage the needs of older and frail people for continuing to live well.

  • Earlier identification and response to older people's complex needs

Understanding how inter-professional collaboration works as an important area of practice improvement

Inter-professional collaboration is understood to be an important area of practice improvement. A recent systematic review by Cochrane has identified that, although research on inter-professional collaboration is continuing to develop, there is still uncertainty about the effectiveness of this as a practice based intervention for improving clinical and patient outcomes. Further studies are expected in future that will help to reduce this uncertainty.

The findings from a realist review are help to reduce some of the uncertainty about how inter-professional collaborations works in the context of integrated care programmes for older adults with complex needs. This review included evaluations of integrated care programmes for older adults with complex care needs. The quality of multidisciplinary team relationships are identified as being a key way of explaining how the mechanisms and context of integration of care may interact to determine success. Quality in relation to relationships can be understood from this review as requiring cross-sector team working, and close collaboration for knowledge sharing that allows care to be better coordinated.