An exploration of culture and context for Allied Health Professionals using Care Aims in integrated community teams: A case study approach

Abstract

Background
Integrated team working is increasingly being used as a model of care within NHS Services. Whilst the integration agenda has evolved over time with increasing recognition of the continuum integration can refer to, consistent use of language and terminology has remained a challenge. The factors influencing integrated team working could be perceived as aspects of team, organisational and professional culture but there is a lack of studies formally assessing culture within an integrated team. Case studies also seldom appeared to include Allied Health Professionals with the reasons for this unclear.
Care Aims is also being increasingly used as a model of care within NHS services particularly by Allied Health Professions yet the evidence base appears sparse, particularly exploring the use of Care Aims in an integrated team.
Aim
The overall aim of this study was to explore the effect of culture and context on integrated team working for Allied Health Professions in community settings.
Methodology
This exploratory study took place in two parts. The first part of the study investigated the Care Aims approach and the effect of culture and context for integrated team working for Allied Health Professionals in primary care settings and comprises of four case studies.
The second part of the study evaluated and compared the case studies with other relevant models for promoting integrated team working for Allied Health Professionals (AHPs) in community settings.
Data collection was primarily qualitative using both questionnaires and semi-structured interviews based on the critical incident technique. The Team Climate Inventory (TCI) and Organisational Culture Assessment Instrument (OCAI) were used to explore culture and climate to provide supplementary contextual information. The individual case studies were analysed using thematic networks. Cross case analysis was employed to identify themes for comparison.
Findings
The cross case analysis identified ten categories that appeared to influence integrated team working. Some of these categories were similar to themes identified in the literature exploring facilitators and barriers to integrated team working, such as leadership, staff roles and responsibilities, vision and professional culture. However different categories also emerged e.g. service type, team climate and relationship with the patient. The interdependency between the categories is also apparent, with philosophy and approach to care influencing all. Where there was a less dominant biomedical approach to care teams appeared to work in a more integrated way.
Similarly, Care Aims implementation appeared to be influenced by similar factors. The approach to care pre-Care Aims and how the introduction of Care Aims was managed appearing most significant. The findings also appeared consistent with the evidence base for managing change.
This study also suggested parallels between extent of integrated team working and success of Care Aims implementation. The more integrated a team appeared to be, the more successful Care Aims implementation also was. Whether level of team integration or introduction of Care Aims was the more significant factor is unclear.
One of the challenges of this study has been to identify other sufficiently detailed published case studies to enable comparative analysis. As a result of the comparative analysis in this thesis a framework for a minimum data set to enable cross case analysis of case studies exploring integrated team working is proposed. This will facilitate a better understanding of the evidence base. This study adds to the literature for integrated team working by exploring and comparing several integrated teams within the same organisation. Unlike previous studies, these case studies explicitly explored the role and impact for AHPs of working in an integrated team.
This study has led to the development of a framework to support implementation of Care Aims by identifying the potential barriers and facilitators to implementing Care Aims. This could support teams to identify those areas which may benefit from greater attention and support during implementation. This study also adds to the limited evidence base for Care Aims by exploring the implementation and use of Care Aims in integrated teams and undertaking a comparative analysis of teams in the same organisation.