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 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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    • "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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