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Culture change in the public sector: insights
- Author:
- DRUMM Michelle
- Publisher:
- Institute for Research and Innovation in Social Services
- Publication year:
- 2012
- Pagination:
- 10p.
- Place of publication:
- Edinburgh
This publication focuses on the topic of organisational culture change in the public sector. The Christie Commission report (2011) on the future delivery of public services in Scotland called for major changes, stressing the need for public sector bodies to be built around people and communities, and to work together. This Insight examines definitions and approaches to organisational culture and how they relate to the public sector; the type of change that identifies as cultural; what the enablers are to culture change; and describe some of the challenges to changing cultures in the public sector. It examines the ‘Getting it right for every child’ (GIRFEC) Highland pathfinder national programme to identify generic characteristics of how culture change unfolds in an organisation. The Highlands pathfinder demonstrates the significant time (around 3 years) and planning that needs to go into the overall strategy and management of each initiative to achieve real transformational change. Key enablers to culture change include the need for a clear vision, to effectively communicate this vision, and for leaders who embody and demonstrate personal commitment to the change. The document also highlights that public sector organisations tend to adopt a hierarchical type of culture where control and stability is given precedence over innovation and risk taking.
Implementing services integration and interagency collaboration: experiences in seven counties
- Authors:
- PACKARD Thomas, et al
- Journal article citation:
- Administration in Social Work, 37(4), 2013, pp.356-371.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
This study discusses how human service agencies implemented systems to improve service coordination through structural integration or interagency collaborative service delivery systems. Two sets of agencies were studied: four structurally integrated county agencies and three freestanding departments that had engaged in extensive interagency collaboration. Interviews and focus groups were held with key stakeholders in each county (executive staff, program directors/middle managers, supervisors, frontline workers, and consumer group representatives). Findings identified integration and change leadership principles, including clear processes to implement a powerful vision, a strongly committed executive team, stakeholder involvement, and aggressive marketing of the goals. (Edited publisher abstract)
The quest for integrated health and social care: a case study in Canterbury, New Zealand
- Authors:
- TIMMINS Nicholas, HAM Chris
- Publisher:
- King's Fund
- Publication year:
- 2013
- Pagination:
- 64
- Place of publication:
- London
In New Zealand, care is funded out of general taxation, hospital care is free at the point of use, and there is usually a co-payment for visits to the GP. This report briefly describes the New Zealand health and social care system, but focuses on Canterbury, where developments have accelerated following the 2011 earthquake. Key enablers for change are identified: the creation of the vision; a sustained investment in providing staff and contractors with the skills needed to innovate, and supporting them when they do; and new forms of contracting. The report describes innovations contributing to integrated health and social care, chief of which being HealthPathways, which are local agreements on best practice that bring together hospital doctors and GPs to decide what the patient pathway for a particular condition should be. Other innovations are: Acute Demand Management System (ADMS) which is aimed at preventing hospital admission; and Community Rehabilitation Enablement and Support Team (CREST), aimed at reducing length of stay once in hospital, reducing the chances of readmission, and delaying admission to residential care. Also discussed are falls management, medication management, 24-hour general practice, the Electronic Request Management System (ERMS),, the Electronic Shared Care Record View (eSCRV), finance and perfomance. With the exception of HealthPathways, very little of what Canterbury has done has been invented locally: most are adaptations of lessons learned elseswhere: other parts of New Zealand, the United States and parts of the English NHS. Canterbury's experience is considered in the broader context of existing literature on what it takes to produce a high-performing health care organisation, including G Ross Baker's 10 key characteristics for high performing healthcare systems (2008). The report concludes that it is possible to provide better care for patients, reduce demand on the hospital, and flatten or reduce elements of demand across health and social care by improved integration, particularly around the interface between the hospital, primary care and community services. (Original abstract)
Barriers and facilitators to integrating care: experiences from the English Integrated Care Pilots
- Authors:
- LING Tom, et al
- Journal article citation:
- International Journal of Integrated Care, 12(3), 2012, Online only
- Publisher:
- International Foundation for Integrated Care
In response to the perceived need to provide better integrated care, in 2008 the Department of Health appointed 16 Integrated Care Pilots which used a range of approaches to provide better integrated care. The aim of this article is to report on part of the multi-method national evaluation of the 16 Integrated Care Pilots. Specifically, it describes a qualitative analyses aiming to identify barriers and facilitators to successful integration of care. Data were analysed from transcripts of 213 in-depth staff interviews, and from semi-structured questionnaires completed by staff at 6 points over a 2-year period. The findings show that many barriers and facilitators to integrating care are those of any large scale organisational change. These include issues relating to leadership, organisational culture, information technology, physician involvement, and availability of resources. However, activities which appear particularly important for delivering integrated care include personal relationships between leaders in different organisations, the scale of planned activities, governance and finance arrangements, support for staff in new roles, and organisational and staff stability. A 'routemap' is presented which identifies questions that providers may wish to consider when planning interventions to improve the integration of care.
"Bringing the future to life: Maureen’s postcard to Beryl"=North Wales Regional Single Point of Access Programme
- Author:
- MOORE Jane
- Journal article citation:
- Journal of Integrated Care, 23(4), 2015, pp.250-262.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to reflect on the journey so far for the North Wales Regional Single Point of Access (SPOA) through the lens of programme manager with views from the programme team. SPOA is the integration of access points to community health and social care services with strengthened links to the third sector, one SPOA in each of six local authorities in the Betsi Cadwallader University Health Board footprint. Design/methodology/approach: Kotter’s 8 step theory of change model (1996) supplemented by the organisational, cultural and professional and contextual factors from research that impact on integrated working between health and social care (Cameron et al., 2012); the focus is programme level. Findings: Kotter’s 8 step model is a useful tool for reflection on the factors identified in research that promote and hinder integrated working. Key messages and innovative ideas of interest for practitioners embarking on a similar “Quest”, including: “keep using your ‘levers for change’”, “Adopt and Adapt”, “right people in the right place”, “it’s ok to tweak your vision, ‘Make it mean something to everyone’, ‘accept and Adapt’, ‘Don’t sweat what you can’t affect’, ‘Find your allies – it’s better together’, ‘Celebrate ‘small wins’’, ‘The people’s voice drives change’ and ‘a sense of humour brings you through’”. Research limitations/implications: This is a personal reflection from the North Wales Regional SPOA Programme. Originality/value: It makes use of collaborative work focused on delivering a SPOA, helping others to learn from the struggle. (Publisher abstract)
Away from the past and to a sustainable future: how the UK's health and social care systems can be reformed to better align with the needs of today’s society
- Authors:
- SMITH Ian R., SMITH Stephen K.
- Publisher:
- Health Service Journal
- Publication year:
- 2015
- Pagination:
- 15
- Place of publication:
- London
This paper explores the nature of the crisis affecting the health and social care systems, suggesting that they are badly misaligned with the needs of the society they serve, its ageing population, the prevalence of chronic ill health, rising demand and fall in funding. The paper diagnoses the reasons behind this misalignment and posits a solution: the introduction of integrated care organisations (ICOs) closely aligned to academic health and science centres (AHSCs). It argues that ICOs will remove the artificial and unhelpful boundaries between different parts of the healthcare service, and between health and social care. They will meet the needs of a population which is living longer and with more chronic conditions, move care away from hospitals, and promote prevention and parity of esteem between mental and physical health. Through alignment of these organisations with academic health and science centres, meanwhile, it will be possible to improve clinical outcomes and deliver precision medicine – and to sustain the UK’s position as one of the world leaders in genetic medicine. The paper also identifies the barriers to instituting such a change and explains how they can be overcome. It concludes with a step by step route map to a better care system, through ICOs and AHSCs. (Edited publisher abstract)
Towards integrated care in Trafford: research report
- Authors:
- SHAW Sara, LEVENSON Ros
- Publisher:
- Nuffield Trust
- Publication year:
- 2011
- Pagination:
- 32p.
- Place of publication:
- London
This report tracks the development of the new integrated care system in Trafford. It examines the Trafford experience, with an emphasis on the process of change required to achieve integration, describing the main phases of work, and the successes and challenges associated with each. Important lessons from Trafford’s experience of developing a more integrated system include: integration can take a number of forms – ranging from loose collaborations to a full merger; meaningful collaboration across professional groups is vital – in Trafford, six multidisciplinary clinical panels are responsible for redesigning services, which are supported by a locally-tailored international leadership programme; relationship-building is key – this means it is possible to make progress on redesign even while structural issues are still being worked through; good information systems are vital – these underpin effective commissioning decision-making and performance monitoring; and meaningful change takes time – the Trafford experience suggests a minimum of a year, and probably more, particularly before the financial benefits are felt.
Change management in integrated care: what helps and hinders middle managers – a case study
- Author:
- LUNTS Phillip
- Journal article citation:
- Journal of Integrated Care, 20(4), 2012, pp.246-256.
- Publisher:
- Emerald
There is little published research on the role of middle managers in the delivery of health and social care integration. This study investigated what middle managers perceived as helping and hindering them in the delivery of change in one high-profile integration project. Interviews were held with 8 middle managers across health and social care organisations in Scotland. Findings indicated that middle managers possessed good project management and staff engagement skills and understood the challenges of integration. Time and capacity, changes in senior leadership and lack of role clarity were significant hindrances. There were indications that informal networks had allowed them to progress the project. Middle managers appear to possess change skills but lack understanding of how to apply them in complex environments. Dedicated time and awareness of complexity and leadership models may help middle managers to lead change within integration projects
Everyone's business: developing an integrated model of care to respond to child abuse in a pediatric hospital setting
- Author:
- CONNOLLY Sarah
- Journal article citation:
- Social Work in Health Care, 51(1), January 2012, pp.36-52.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
In paediatric hospitals, social work plays a central role in the prevention, identification, and management of child abuse. This article describes the development of an integrated model of social work service delivery to better respond to vulnerable and at-risk children. It is set in the Royal Children’s Hospital, a major paediatric hospital in Victoria, Australia. Developing this new model of service required strategic planning, consultation, and endorsement from senior hospital management. The aim of the model was to ensure a high quality, responsive social work service to children at risk of physical abuse or neglect. Other objectives included providing reduced duplication and increased efficiency, improved continuity of care, and to reduce the number of workers involved with each child. The change necessitated understanding of current research evidence, development of best practice guidelines, and effective communication with staff and external stakeholders. Policy development, implementation of practice guidelines, staff training, data collection, and service evaluation are described. The management approach included consultation with staff, building commitment to the need for change, addressing staff concerns, and providing a vision of enhanced client outcomes as a result of the change process. Challenges and barriers to change are discussed.
Transforming your care: a review of health and social care in Northern Ireland
- Author:
- HEALTH AND SOCIAL CARE BOARD
- Publisher:
- Health and Social Care Board
- Publication year:
- 2011
- Pagination:
- 142p., appendices
- Place of publication:
- Belfast
This review undertook consultation with the public, political representative and clinical and professional leaders to examine the quality and accessibility of health and social care services in Northern Ireland. It also examined the extent to which the needs of patients, clients, carers and communities are being met. The report begins by outlining the reasons why the health and social care system needs to change, based on the evidence collected. It the identifies 11 key reasons which support the need for change and provides a model for integrated health and social care to drive the future shape and direction of the service. The report details the impact of the new model across 10 areas of care (population health and wellbeing, older people, long-term conditions, physical disabilities, maternity and child health, family and child care, mental health services, learning disabilities, acute care and palliative and end of life care). It then describes the implications for the health and social care system, and explains who these changes will be implemented over a five year period. Appendices include a summary of online survey results and details of attendance at engagement events.