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Does integrated governance lead to integrated patient care? Findings from the innovation forum

机译：整合治理会带来整合的患者护理吗？创新论坛的发现

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Good integration of services that aim to reduce avoidable acute hospital bed use by older people requires frontline staff to be aware of service options and access them in a timely manner. In three localities where closer inter-organisational integration was taking place, this research sought patients’ perceptions of the care received across and within organisational boundaries. Between February and July 2008, qualitative methods were used to map the care journeys of 18 patients (six from each site). Patient interviews (46) covered care received before, at the time of and following a health crisis. Additional interviews (66) were undertaken with carers and frontline staff. Grounded theory-based approaches showed examples of well-integrated care against a background of underuse of services for preventing health crises and a reliance on ‘traditional’ referral patterns and services at the time of a health crisis. There was scope to raise both practitioner and patient awareness of alternative care options and to expand the availability and visibility of care ‘closer to home’ services such as rapid response teams. Concerns voiced by patients centred on the adequacy of arrangements for organising ongoing care, while family members reported being excluded from discussions about care arrangements and the roles they were expected to play. The coordination of care was also affected by communication dif�culties between practitioners (particularly across organisational boundaries) and a lack of compatible technologies to facilitate information sharing. Finally, closer organisational integration seemed to have limited impact on care at the patient/practitioner interface. To improve care experienced by patients, organisational integration needs to be coupled with vertical integration within organisations to ensure that strategic goals in�uence the actions of frontline staff. As they experience the complete care journey, feedback from patients can play an important role in the service redesign agenda.
机译：旨在减少老年人可避免的急诊病床使用的服务的良好集成要求一线员工了解服务选择并及时使用它们。在三个进行组织间更紧密整合的地区，这项研究试图让患者对跨组织边界和跨组织边界接受的护理的看法。在2008年2月至2008年7月之间，使用定性方法绘制了18位患者（每个站点六位）的护理历程图。患者访谈（46）涵盖了健康危机之前，期间和之后接受的护理。对护理人员和一线员工进行了额外的采访（66次）。扎实的基于理论的方法显示了在预防医疗危机的服务使用不足的背景下，以及在发生医疗危机时依赖“传统”转诊模式和服务的情况下，综合护理水平很好的例子。可以提高从业者和患者对替代护理选择的认识，并扩大“离家更近”服务（如快速响应团队）的可用性和可视性。患者提出的担忧集中在组织持续护理的安排是否充分，而家庭成员报告说，他们被排除在有关护理安排及其预期作用的讨论之外。从业者之间的沟通困难（尤其是跨组织边界）以及缺乏促进信息共享的兼容技术也影响了护理的协调。最后，更紧密的组织整合似乎对患者/从业人员界面的护理影响有限。为了改善患者的护理水平，组织整合需要与组织内部的纵向整合相结合，以确保战略目标影响一线员工的行动。当他们经历完整的护理过程时，患者的反馈可以在服务重新设计议程中发挥重要作用。

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