Joint working in community mental health teams: implementation of an integrated care pathway

Department of Psychology and Disability Studies, School of Health Sciences, RMIT University, Bundoora, Victoria, Australia.
Health & Social Care in the Community (Impact Factor: 0.86). 12/2004; 12(6):527-36. DOI: 10.1111/j.1365-2524.2004.00523.x
Source: PubMed


Abstract Integration of community mental health services is a key policy objective that aims to increase quality and efficiency of care. Integrated care pathways (ICPs) are a mechanism designed to formalise multi-agency working at an operational level and are currently being applied to mental health services. Evidence regarding the impact of this tool to support joint working is mixed, and there is limited evidence regarding the suitability of ICPs for complex, community-based services. The present study was set in one primary care trust (PCT) in Scotland that is currently implementing an ICP for community mental health teams (CMHTs) across the region. The aim of the study was to investigate professionals' experiences and views on the implementation of an ICP within adult CMHTs in order to generate learning points for other organisations which are considering developing and implementing such systems. The study used qualitative methods which comprised of individual interviews with three CMHT leaders and two service development managers, as well as group interviews with members of four adult CMHTs. Data was analysed using the constant comparison method. Participants reported positive views regarding joint working and the role of an ICP in theory. However, in practice, teams were not implementing the ICP. Lack of integration at higher organisational levels was found to create conflicts within the teams which became explicit in response to the ICP. Implementation was also hindered by lack of resources for ongoing support, team development and change management. In conclusion, the study suggests that operational systems such as ICPs do not address and cannot overcome wider organisational barriers to integration of mental health services. Integrated care pathways need to be developed with strategic input as well as practitioner involvement and ownership. Team development, education about integration and change management are essential if ICPs are to foster and support joint working in integrated teams.

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    • "An organisational culture affects the organisation's behavior at all levels (DiBella, 1996), and mainly the interactions between stakeholders. Collaboration between stakeholders is essential (Atkins and Walsh, 1997), as integration leads to the provision of better services and increases cost-effectiveness (Rees et al., 2004). In the case of a discharge programme this practice could attract different providers, aiming to be involved in the programme. "
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    ABSTRACT: This paper seeks to explore the development of a discharge programme in one learning disability hospital in Scotland. The study aims to concentrate on organisational developmental changes in that institution. The model of the management during the discharge programme was investigated. The aim of the study is to explore how the discharge programme developed, as seen under the lens of organisational change, in order to find out what kind of model of management is more suitable in similar programmes. A case study was employed. Data were collected by means of interviews. The interviews followed a structured format. The sample of the study had to be a purposive sample and the method of snowball sampling was used; finally, 28 interviews were conducted. A grounded approach was adopted for the data analysis. The software program QSR "NUD*IST" (version "N6") was used as a technical tool, in order to facilitate the data analysis. The findings of this study show that various management models were adopted in the four phases of the discharge programme. These different models represent a "quest" by the institution's management regarding the most appropriate model for managing the discharge programme. This study shows that this goes on continuously in organisations under transition until they settle down to a more permanent state. It was concluded that management models, which are composed of characteristics from the organic theory of organisational management, could apply in discharge programmes. The data gathered enabled the researcher to arrive at a model of management which is suitable for managing organisational changes in discharge programmes, the named "stakeholder management model".
    Journal of Health Organisation and Management 08/2011; 25(4):355-84. DOI:10.1108/14777261111155010 · 0.36 Impact Factor
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    • "Parker et al. (2005) found overall experiences of ICPs were generally positive but junior staff of all disciplines had more negative views than their more senior colleagues as they often perceived their clinical decision making was being curtailed. Despite evidence of positive attitudes towards clinical pathways, in some healthcare settings the recommended implementation and adherence to ICPs does not always follow (Rees et al., 2004; Parker et al., 2005). This may result in a lack of staff buy-in and negative attitudes towards their use (Cheah, 2000; Claridge et al., 2005, Parker et al., 2005). "
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    ABSTRACT: The purpose of this paper is to report on a study that explores healthcare professionals' experiences of the implementation of integrated care pathways (ICPs). This study used a phenomenological research approach with a purposive sample of ten multi-disciplinary healthcare professionals across two acute hospitals in Ireland. Data were collected via semi-structured interviews and analysed using Colazzi's framework. The findings of the study are presented under four themes: buy-in from all disciplines, multidisciplinary communication, service-user involvement, and audit of ICPs. These themes emanated from the questions asked at interview. The limitations of the study include the small sample size and the use of two different interviewers across the sites. The inexperience of the interviewers is acknowledged as a limitation as the probing of some questions could have been improved. In addition the themes of the findings were predetermined by the use of the interview guide. Changes in existing institutional structures and cultures are required when introducing ICPs. It is necessary for senior management in organisations to lead by example. They also need to identify where support can be offered, such as in the provision of an ICP facilitator, education sessions in relation to ICPs and the development of strategies to improve multi-disciplinary buy-in and participation. The findings of this study respond to a gap in the literature in Ireland on the experiences of healthcare professionals who have implemented ICPs. Key findings of the study are the perception that the doctor is pivotal in driving the implementation of ICPs, yet the doctor was not always interested in this responsibility.
    International Journal of Health Care Quality Assurance 06/2011; 24(5):334-47. DOI:10.1108/09526861111139179
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    • "At the organisational level, five papers described the legitimisation of a collaborative approach through a supportive institutional environment of leadership and a change management for linked mental health services [17,26,33,36,37]. In the IMPACT study by Blasinsky et al, key informants indicated that strategic organisational leadership for collaborative care was important for the sustainability of the collaborative service model [26]. "
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    ABSTRACT: Primary care services have not generally been effective in meeting mental health care needs. There is evidence that collaboration between primary care and specialist mental health services can improve clinical and organisational outcomes. It is not clear however what factors enable or hinder effective collaboration. The objective of this study was to examine the factors that enable effective collaboration between specialist mental health services and primary mental health care. A narrative and thematic review of English language papers published between 1998 and 2009. An expert reference group helped formulate strategies for policy makers. Studies of descriptive and qualitative design from Australia, New Zealand, UK, Europe, USA and Canada were included. Data were extracted on factors reported as enablers or barriers to development of service linkages. These were tabulated by theme at clinical and organisational levels and the inter-relationship between themes was explored. A thematic analysis of 30 papers found the most frequently cited group of factors was "partnership formation", specifically role clarity between health care workers. Other factor groups supporting clinical partnership formation were staff support, clinician attributes, clinic physical features and evaluation and feedback. At the organisational level a supportive institutional environment of leadership and change management was important. The expert reference group then proposed strategies for collaboration that would be seen as important, acceptable and feasible. Because of the variability of study types we did not exclude on quality and findings are weighted by the number of studies. Variability in local service contexts limits the generalisation of findings. The findings provide a framework for health planners to develop effective service linkages in primary mental health care. Our expert reference group proposed five areas of strategy for policy makers that address organisational level support, joint clinical problem solving, local joint care guidelines, staff training and supervision and feedback.
    BMC Health Services Research 03/2011; 11(1):66. DOI:10.1186/1472-6963-11-66 · 1.71 Impact Factor
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