Implementing Care Aims in an integrated team

Abstract

This article reports the findings of a pilot study exploring the impact of implementing Care Aims in an integrated community health team. It describes the main findings and discusses the factors which appeared to impact on the implementation and use of the Care Aims approach in these teams.Care Aims is increasingly being used as a model of care within NHS services, particularly by Allied Health Professionals. The model has been traditionally used in uni-professional teams rather than integrated teams.This case study suggests Care Aims has potential to support integrated team working. In this study clinicians perceived Care Aims was a model that could improve care for patients, support professionals working together and support self-management. However it is unclear whether it was Care Aims itself or the training and discussion that took place that enabled this team to develop and agree more consistent working practices.Similar to previous studies, this study has shown how team and professional culture can influence how team members work together and provide care in an integrated way. Team and professional cultures Page 2 of 23 are also shown to influence how team members approach and embrace that change. As such Care Aims may be more challenging to some staff groups to implement. IntroductionIntegrated care continues to be a priority particularly for older people with multiple morbidities. Key messages in a recent report by Goodwin et al (2014) included that the starting point should be a clinical/service model designed to improve care for people; professionals needing to work together in multidisciplinary teams (with clearly defined roles) and that success is more likely if there is a specific focus on working with individuals and informal carers to support self-management.Care Aims is increasingly being used as a model of care within NHS services, particularly by Allied Health Professionals. Care Aims is a model of practice developed by Kate Malcomess (Malcomess, 2005a) which is designed to support clinicians demonstrate evidence-based practice through systematic reflection. Care Aims focuses on the impact and outcomes of care and requires clinicians to identify their main reason for intervening.This study offers a new approach to studying Care Aims in the context of integrated care as opposed to previous work which has been undertaken in uni-professional services such as Speech and Language Therapy and Learning Disabilities.The authors wanted to understand the impact of Care Aims on integrated team working and explore whether Care Aims had the potential to facilitate integrated team working as there appeared to be Page 3 of 23 parallels between Care Aims and some of the key messages supporting integrated team working and care.This paper reports the results of a pilot case study that is part of a wider research project exploring the effect of culture and context on integrated team working for allied health professionals working in primary care settings.There are many definitions of integrated team work...

Implementing the care aims approach in children's services: a quality improvement pilot study

“…The focus of Care Aims is on impact and outcomes of care and it encourages evidence-based decision making and for clinicians to identify their main reason for intervening (Waterworth et al, 2015). The Care Aims framework has also been described in various ways.…”

“…Malcomess (2005a;2005b;2015) the developer of framework describes it as an approach for service improvement based on the premise of most good and least harm, within the resources available (Malcomess, 2015). Others have described it as a mechanism to capture the reason to treat which can be used alongside therapy outcome measures (John, 2011), as a framework for managing workloads based on identifying impact and intended outcomes in planning intervention, and as a model of practice to support clinicians to demonstrate evidence-based practice through systematic reflection (Waterworth et al, 2015).…”

“…Previous research has largely focused on uni-professional teams working predominantly in allied health professionals (Waterworth et al, 2015;Mowles et al, 2010;Stansfield 2011). For example, McCarthy et al (2001) report on an audit that was implemented to ensure uniformity of the implementation of Care Aims definitions across speech and language therapies in the South West Thames region in the UK.…”

“…Care Aims is a population-based, person-centred approach to provision of care based on the principal that all public services have a duty to do the most good and least harm for the most number of people in the populations they serve, within the resources they have available. It is increasingly being employed as a model of care within NHS services, particularly by allied health professionals and traditionally used in uni-professional teams (Waterworth et al 2015). Care Aims provides a strategy that encompasses managing a service, informing the population, empowering the workforce around the service user, and supporting the person and their family to manage their own lives wherever possible (Malcomess, 2005a, b).…”

Understanding the Importance of Therapeutic Relationships in the Development of Self-Management Behaviours After Cancer Rehabilitation: A Qualitative Mixed-Methods Study

“…Framework, has been found to be beneficial in supporting a consistent personcentred, SM approach to practice. This framework provides professionals with a common language for articulating reasoning behind some of the challenges discussed earlier, including managing participants' low motivation or readiness for change, negotiating boundary setting and dissolution of therapeutic relationships (Waterworth, Willcocks, Selfe, & Roddam, 2015).…”