Integrating health and social care—bringing together the different staff who deal with the same local community—is a good example of a policy that sounds like a no-brainer to help achieve better care outcomes. Indeed, most people don’t even realise that health and social care are funded and overseen separately.
But as with many things in public services, reorganisation is actually very difficult to do in practice. Different delivery organisations, legal frameworks and funding arrangements have created a disjointed system.
The need to deliver better integrated health and social care services is getting more and more acute. People increasingly have multiple long-term health conditions, rely on a range of services, and want to have just one visit rather than repeat appointments with different professions asking the same questions. Significant cuts to social care funding compound the need for increased integration.
Traditionally, local and central government have tried to integrate services in one of two ways:
- From the top-down, through more joined-up budgeting (e.g. the Better Care Fund) or by bringing together different commissioning and delivery organisations to jointly plan their services (e.g. sustainability and transformation partnerships, or STPs).
- From the bottom-up, through trying to define what joined-up care should look like for residents (e.g. this animation from the Kings Fund).
In this post, we focus on how behavioural science can make integration work by concentrating on the people who work in the new integrated services.
A behavioural approach
What does integration mean day-to-day for busy frontline health and care staff? How can we help GPs, district nurses, social workers, therapists and others create a more integrated model of care, and how can behavioural science help? We have recently completed two projects which explore these questions. The first is a project we did for the Health Foundation. We reviewed evidence from the behavioural science and organisational behaviour literature and developed a number of potential behavioural solutions to improve integration.
The second project was in Greater Manchester, one of the regions at the forefront of integrated care in England. We visited integrated community (or ‘neighbourhood-level’) teams in four boroughs across Greater Manchester to explore how behavioural science could help newly co-located teams to work more effectively together.
Small changes to the way meetings are structured can have a big impact on the quality of team decisions
Based on these two projects, we think there are a range of ways behavioural science can help make it easier for staff from different health and social care services to work closely together. These include:
- Making small changes to meetings. Meetings between people from different professions (like huddles and multi-disciplinary team meetings) are core to many models of integration. These meetings provide space for different professionals to come together to jointly plan and deliver care. There is good evidence that small changes to the way meetings are structured can have a big impact on the quality of team decisions. Limiting the number of cases discussed, having different people chair the meeting (to disrupt traditional power dynamics) and creating a way for views to be fed in anonymously could all improve the quality of these meetings.
- Encouraging people to say “thanks”. In a small study, someone who received a thank you note from a colleague who they had helped was twice as likely to help the same person again. Within health and care integration, staff and teams could be encouraged to say thank you (express their gratitude) to colleagues from other professional backgrounds to encourage future collaboration.
- Increasing trust and social contact. Research often identifies a lack of understanding and trust between staff from different professional backgrounds as a key barrier to integration. Traditionally, some change programmes have approached this by running one-off development days bringing staff together to talk about what they do. However, we think that building trust involves increasing unplanned interactions, or ‘collisions’ between staff over time. Sharing the same office helps, but many health and care professionals spend little time behind a desk (as they spend more of their time with residents). Social contact needs ‘designing in’ if integration is to be a success (e.g. by actively encouraging staff to do regular joint visits with colleagues from a different professional background).
- Make it easy for people to know who they should be talking to. In all the teams we visited in Greater Manchester, it was very difficult for staff to know which of their colleagues were working with the same resident. Integrated IT systems will help, but it will take some time for these to be up and running. In the meantime, why not automatically connect staff who are working with the same resident by email or text? We think sending an email with a list of who else is working with the same residents that you are, with a prompt to talk to those colleagues, may have a transformative effective. We are pleased to say that we hope to test this in Greater Manchester soon.
Traditional policy approaches, including reform of the funding, design and delivery of health and care systems, are important in integrating teams. Behavioural science can provide new tools to support change. In some cases health and care teams may be using some of these approaches without realising the evidence that backs up what might be thought of as softer approaches.
For more in-depth analysis and recommendations on integrated care take a look at our report from the project in Greater Manchester.
We are pleased to announce that we have recently joined the New Local Government Network (NLGN) and are looking forward to making contacts with a wide range of local organisations to find our more about what they’re already doing. We will be hosting an NLGN Innovation Exchange in Manchester in November to talk about integration with a focus on health and social care.