Evaluation of a multidisciplinary adult integrated respiratory service in the UK.

Abstract

Rationale, aims and objectives: Care integration, particularly for patients with long-term chronic conditions has been viewed as a key imperative for service improvement over the last decade [1]. In common with other industrialised nations, major care providers such as the National Health Service (NHS) in the United Kingdom (UK) have undertaken service evaluation to identify factors for effective integrated care in the context of increasing demand but also cost-constraints. The aim of this paper is to report on an early process evaluation of a newly established Adult Integrated Respiratory Service (AIRS) in three localities in England. Method: Applied qualitative methods using semi-structured interviews with clinical practitioners (n=19) plus focus group with service users (n=5). University research ethics approval was secured. Findings: Despite finding staff commitment and enthusiasm for a new regional approach, as well as a very positive acclaim from service users, the study highlighted personal and organisational issues and concerns during the first four months of service implementation. The analysis revealed four inter-related themes: service in transition; resistance to change; communication; and challenges to integrated working. The findings support conceptual and organisational elements of integrated care described elsewhere [2, 3]. The role of leadership and change management in the successful implementation of integrated care is explored. Conclusions: The findings from a regional adult integrated respiratory service evaluation in England highlights the potential of collective leadership with authentic involvement of all stakeholders to effect successful change to build locally owned models for integrated care. Further longitudinal research would yield valuable insights as the service evolves.