Integrating care between an NHS hospital, a community provider and the role of commissioning: the experience of developing an integrated respiratory service

Research output: Contribution to journalArticle (Academic Journal)peer-review

Abstract

Objectives
An integrated respiratory service was commissioned in 2016 in a UK region to support patients with chronic obstructive pulmonary disease. The service brought together the respiratory department of a National Health Service hospital and a not-for-profit community provider. This paper evaluates: (a) the perceived efficacy of integrated working between the organisations from the perspective of staff; and (b) the relationship between commissioning and integration of the services.

Design
Semi-structured interviews with staff from the three organisations involved in the integrated respiratory service. Staff were purposefully sampled. The interviews were audio recorded, transcribed and analysed thematically.

Setting
Secondary care respiratory unit; community provider of respiratory care; and a clinical commissioning group.

Participants
Nineteen interview participants: nine from the community provider; eight from the hospital; and two from the clinical commissioning group.

Results
Staff identified lack of integration between the organisations characterised by: poor communication, lack of trust, absence of shared information technology, and ineffective integrative initiatives. The commissioning process created barriers to integration including: contractual limitations which prevented pathway development, absence of agreed clinical governance arrangements, and lack of recognition of community work undertaken by hospital staff. Positive working relationships were established over time as staff recognised the skills that each had to offer.

Conclusions
The commissioning process underpinned the relationship between the organisations and contributed to distrust and negative perceptions of the ‘other’. Commissioning an integrated service should incorporate dialogue with stakeholders as early as possible and before the contract is finalised to develop a bedrock of trust.
Original languageEnglish
JournalBMJ Open
Publication statusAccepted/In press - 14 Nov 2020

Keywords

  • Delivery of Health Care, Integrated
  • Qualitative research
  • Pulmonary Disease, Chronic Obstructive

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