An organisational level approach to integrated care: Models and Mechanisms

1. An organisational level approach to integrated care: Models and Mechanisms Petra Bywood Jodie Oliver-Baxter Lynsey Brown 13th International Conference on Integrated Care, Berlin 11-12 April 2013

2. Levels of integration

3. Aims To identify successful models of integrated primary health care and describe the mechanisms contained within them that can be applied in future organisational practice

4. Methods Literature review Electronic databases, grey literature,websites, organisation publications Search Terms Integration, integrated care Documents Publicly available Peer-reviewed articles, agreements, government documents, frameworks, reports

5. Primary Health Care in Australia • General practice (Divisions, Medicare Locals) • Community health • Aboriginal Community Controlled health services • Private allied health services • Health promotion, prevention, pharmacy, dental services, rehabilitation, aged care, patient support

6. Other meso level stakeholders • Acute care (hospitals) • Sub-acute care (rehabilitation, palliative care) & aged care facilities • Private medical specialists • Peak bodies • Non-health services (transport, social services) • Research organisations

7. Example of inter-organisational partnerships in South Australia • SA Health services • Public hospitals, metro/country health, environmental health, communicable disease control, epidemiology, health promotion, pathology, drug/alcohol, emergency/ambulance, organ donation • SA Health liaises with Departments of: • Education & child development; Families & communities; Planning & local government; Premier & Cabinet; Treasury & finance

8. Australian model of integrated care Medicare Locals (61) Forum to resolve problems Highlight integration in all partnerships ‘Whole of service’ approach Coordinate activities hospitals (Local Hospital Networks) Establish networks of stakeholders Enable secure communication; shared records

9. Mechanisms of integration: Stewardship Governance Jackson et al. (2008) MJA 188: S57-S60

10. Stewardship … Regulation Peak bodies monitor, advise, advocate Ensuring that practice and frameworks are consistent across organisations and agencies Sustainability Capacity to endure Changing demand for services Time to allow relationships to develop

11. Mechanisms of integration: Creating resources Partnerships: enable increased capacity Across providers/settings At government level With sectors outside health Little evidence of effectiveness ‘Success’ factors identified (evidence-free) history of collaboration mutual respect & trust good communication well-resourced clear goals …….

12. Creating resources … Data and Evidence Collected as part of regulation, funding agreements, performance measurement Conducting research to inform practice Need for appropriate measures of integration eHealth and telehealth Information technology resources Electronic health records Improved access and communication

13. Creating resources … Organisational culture Strong leadership; compatible beliefs, values Engagement and communication Shared goals Compatible connections, email, electronic records Knowledge translation and exchange Infrastructure Physical environment (co-location, virtual) Resources (human, financial)

14. Risks and unintended consequences • Perverse incentives: over-servicing, under-servicing, selective servicing • Change fatigue: resistance, conflict

15. Summary & conclusions Change current siloed approach Meso level integration is critical to macro and micro levels of integration Multiple actors at mesolevel - different objectives, values, cultures, resources; need to work together Managing complexity Realistic time/timeframes The ‘will’ and the ‘way’

16. PHC RIS – our location • PHC RIS website: http://www.phcris.org.au/index.php • Contact details: petra.bywood@flinders.edu.au Flinders University, Adelaide Adelaide, South Australia

17. Questions? • PHC RIS website: http://www.phcris.org.au/index.php • Contact details: petra.bywood@flinders.edu.au