Joint working in community mental health teams: implementation of an integrated care pathway
Joint working in community mental health teams: implementation of an integrated care pathway
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DOI：
10.1111/j.1365-2524.2004.00523.x
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发表时间：
2004-11-01
影响因子：
2.4
通讯作者：
McKechnie, L
中科院分区：
文献类型：
--
作者：
Rees, G;Huby, G;McKechnie, L
整合社区精神卫生服务是一项旨在提高护理质量和效率的关键政策目标。综合护理途径（ICP）是一种机制，旨在使多机构在业务层面的工作正规化，目前正在应用于精神卫生服务。关于这一工具对支持联合工作的影响的证据好坏参半，关于综合比较方案是否适用于复杂的社区服务的证据有限。本研究是在苏格兰的一个初级保健信托基金（PCT）中进行的，该信托基金目前正在为整个地区的社区精神卫生团队（CMHTs）实施ICP。这项研究的目的是调查专业人员在成人CMHT中实施ICP的经验和观点，以便为正在考虑开发和实施此类系统的其他组织提供学习点。本研究采用质性研究方法，包括对三位CMHT领导者和两位服务发展经理的个人访谈，以及对四位成年CMHT成员的小组访谈。使用常数比较法分析数据。与会者报告了对联合工作和比较方案在理论上的作用的积极看法。然而，在实践中，各小组并没有执行比较方案。缺乏整合，在更高的组织层次上被认为是在团队内部产生冲突，这成为明确的回应比较方案。执行工作也因缺乏持续支助、团队发展和变革管理所需的资源而受到阻碍。总之，研究表明，操作系统，如ICP不解决，不能克服更广泛的组织障碍，整合精神卫生服务。综合护理途径需要制定战略投入以及从业者的参与和所有权。如果综合比较方案要促进和支持在综合小组中联合工作，就必须进行小组发展、关于一体化和变革管理的教育。
Integration of community mental health services is a key policy objective that aims to increase quality and efficiency of care. Integrated care pathways (ICPs) are a mechanism designed to formalise multi-agency working at an operational level and are currently being applied to mental health services. Evidence regarding the impact of this tool to support joint working is mixed, and there is limited evidence regarding the suitability of ICPs for complex, community-based services. The present study was set in one primary care trust (PCT) in Scotland that is currently implementing an ICP for community mental health teams (CMHTs) across the region. The aim of the study was to investigate professionals' experiences and views on the implementation of an ICP within adult CMHTs in order to generate learning points for other organisations which are considering developing and implementing such systems. The study used qualitative methods which comprised of individual interviews with three CMHT leaders and two service development managers, as well as group interviews with members of four adult CMHTs. Data was analysed using the constant comparison method. Participants reported positive views regarding joint working and the role of an ICP in theory. However, in practice, teams were not implementing the ICP. Lack of integration at higher organisational levels was found to create conflicts within the teams which became explicit in response to the ICP. Implementation was also hindered by lack of resources for ongoing support, team development and change management. In conclusion, the study suggests that operational systems such as ICPs do not address and cannot overcome wider organisational barriers to integration of mental health services. Integrated care pathways need to be developed with strategic input as well as practitioner involvement and ownership. Team development, education about integration and change management are essential if ICPs are to foster and support joint working in integrated teams.