Integrating care between an NHS hospital, a community provider and the role of commissioning: the experience of developing an integrated respiratory service.
Integrating care between an NHS hospital, a community provider and the role of commissioning: the experience of developing an integrated respiratory service.
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DOI：
10.1136/bmjopen-2020-040267
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发表时间：
2020-12-21
期刊：
影响因子：
2.9
通讯作者：
Dodd J
中科院分区：
文献类型：
--
作者：
Banks J;Stone T;Dodd J
2016年，英国一个地区委托了一项综合呼吸服务，为慢性阻塞性肺病患者提供支持。这项服务汇集了一家国家卫生服务医院的呼吸科和一家非营利社区提供者。本文评价：（1）从员工的角度来看，两个机构之间的综合工作的效果如何;以及（2）委托提供服务与综合服务之间的关系。与参与综合呼吸服务的三个机构的员工进行半结构式访谈。工作人员被有目的地抽样调查。对访谈进行了录音、转录和专题分析。二级护理呼吸病房;呼吸护理社区提供者;和临床调试组。19名访谈参与者：9名来自社区提供者; 8名来自医院，2名来自临床调试组。工作人员发现，组织之间缺乏整合，其特点是：沟通不畅，缺乏信任，缺乏共享信息技术和无效的整合举措。委托过程造成了整合的障碍，包括：合同限制，阻止路径的发展，缺乏商定的临床治理安排和缺乏对医院工作人员所从事的社区工作的认可。随着时间的推移，随着员工认识到每个人所能提供的技能，建立了积极的工作关系。委托过程巩固了组织之间的关系，并助长了对“他人”的不信任和负面看法。在委托提供综合服务时，应在合同最后敲定之前尽早与利益攸关方进行对话，以建立信任的基础。
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: (1) the perceived efficacy of integrated working between the organisations from the perspective of staff and (2) the relationship between commissioning and integration of the services. Semistructured 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. Secondary care respiratory unit; community provider of respiratory care; and a clinical commissioning group. Nineteen interview participants: nine from the community provider; eight from the hospital and two from the clinical commissioning group. 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. 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.
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影响因子：
4.1
作者：
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