Barriers and Facilitators to Workforce Changes in Integrated Care

Abstract

Introduction:The aim of the study is to investigate the barriers and facilitators to the implementation of workforce changes implemented as part of integrated chronic care interventions.Methods:We used a qualitative multimethod design that combined expert questionnaires, a systematic literature review, and secondary analysis of two case reports. Twenty-five experts, twenty-one studies and two case reports were included in the study.Results:Most barriers related to problematic delivery structures, health professionals’ skills and enthusiasm, IT, funding, culture and cooperation and communication. Most facilitators related to health professionals’ motivation and enthusiasm, good delivery structures, communication and cooperation, IT, patients, leadership and senior management. Overall, similar categories of barriers and facilitators were found.Discussion:We recommend that future research focusses on more complex designs including multiple data sources, as these are better able to capture the complexity of interventions such as integrated care. We recommend that health managers and policy-makers should invest in delivery structures and skills and motivation of health professionals to improve the implementation of workforce changes in integrated chronic care interventions.Conclusion:The added value of the present study lies in its provision of information on which factors might mitigate the success of an intervention, which helps to prevent premature conclusions of ineffectiveness for complex interventions.

The Odyssey of Integration: Is Management its Achilles’ Heel?

“…Leadership was traditionally conceptualised as primarily focussed on those in senior positions but more recent thinking emphasises distributed leadership across multiple management levels [6,7], and indeed the contribution of other stakeholders such as clinicians and those with lived experience [8,54,55]. Supportive and engaged leadership by managers is seen to make a positive contribution but neglect or resistance by leaders present major risks to the achievement of successful outcomes [1,4,[9][10][11][12][13]54]. Evaluations of individual programmes also reflect the importance of proactive management to successful implementation [e.g.…”

“…In addition to specific management functions, many of the general enablers of integrated care fall wholly or largely under the remit of managers. These include shared patient records, pooling of budgets, team-based processes, co-location, partnership governance, opportunities for development, person-centric quality improvement, and introduction of new roles [4,10,[16][17][18][19]. Such enablers commonly require both strategic and operational management within specific management functions such as finance, human resources, information technology.…”

Unknown makes unloved—A case study on improving integrated health and social care in the Netherlands using a participatory approach

“…These inconsistent findings could be due to the heterogeneous nature of integrated care initiatives (Amelung et al, ; Busetto, Luijkx, & Vrijhoef, ), differences in outcome measures (Hoogendijk, ) or because implementation of these initiatives is a complex process (Mayo‐Wilson et al, ). Indeed, many enabling and constraining contextual factors regarding the implementation of integrated care initiatives have been identified, such as professionals' skills and motivation, organisational culture, funding or IT‐systems (Busetto, Luijkx, Calciolari, Ortiz, & Vrijhoef, ; Cameron, Lart, Bostock, & Coomber, ; Mackie & Darvill, ).…”

User Profiles of Healthcare Professionals in a Chronic Obstructive Pulmonary Disease Care Pathway

“…Nolte et al [27] argue that chronic disease care needs are unlikely to be met by the traditional fragmented model of care. Therefore, a new model of care needs to be implemented in order to accommodate the shift in care delivery processes and emergent stakeholder needs [23].…”