The Researcher-in-Residence evaluation of the Waltham Forest and East London Collaborative (WELC) integrated care pioneer programme
By Nathan Davies, on 6 January 2016
In this post we hear from Laura Eyre who talks about her unique role of Researcher-in-Residence for an integrated care programme.
I am a social scientist with expertise in linguistics and interpretive policy analysis. I started working as a Research Associate at UCL and as the Researcher-in-Residence with the Waltham Forest and East London Collaborative (WELC) integrated care programme in September 2014. In my role as Researcher-in-Residence I am responsible for the qualitative evaluation of the development and delivery of integrated care in East London. I work closely with managers, clinicians and front line staff responsible for the delivery of one of the largest and highest profile integrated care ‘pioneer’ programmes in the UK. The overall aim of the evaluation is to use both established evidence and evidence generated by the research to optimise delivery of the programme objectives. I present strategic and operational teams with nationally and internationally relevant research evidence and help them to interpret it for the programme. In addition, I am carrying out a process-oriented and formative evaluation using ethnographic methods of data generation and a critical discourse analysis methodology. The protocol for the evaluation was recently published in BMJ Open.
The integration of health and social care has been central to the thinking of policymakers in the UK since the 1960s. Today, integration is widely accepted as ‘a demand-driven response to what generally ails modern day healthcare: access concerns, fragmented services, disjointed care, less than optimal quality, system inefficiencies, and difficult to control costs’ (Kodner, 2009). In the quests to both enhance efficiency and reduce fragmentation within, and across, health and social care services, integration is seen as ‘a principle driver of reform’ (ibid). In May 2013, localities were invited by NHS England along with national partners to express their interest in becoming integrated care ‘pioneers’. Fourteen localities were successful in their applications to become pioneers for integrated care; they were tasked with leading the development and thinking on the successful integration of health and social care ‘at scale and pace’ to inform national policy development.
Existing literature has had a limited impact on integrated care policy and practice and many questions about integrated care remain, particularly in relation to the processes by which integration can be most effectively achieved. Understanding the processes by which integration is (or is not) achieved across a system must require as much attention as the outcomes of integration if integrated care is to ‘become the norm in the next five years’. There is a need to explore not only what works in the integration of health and social care, but also how integrated care can most successfully be implemented and delivered. Embedding research expertise in an integrated care programme using the Researcher-in-Residence model can add value to the currently available evidence and to practitioners working to develop and implement integrated care programmes in applied settings.
The Researcher-in-Residence model
The Researcher-in-Residence model (Marshall et al. 2014, Eyre et al. 2015), designed by researchers and practitioners from across the UK, is based on the principles of participatory research. The model has three defining characteristics: (1) the researcher is embedded within and an integral part of the programme or team that is the object of the research; (2) the researcher is explicit about the expertise that they bring to the programme, for instance in understanding established evidence and theory, evaluating the impact of interventions and using complex data; and (3) the researcher is willing and able to negotiate their expert knowledge with practitioners in order to increase its impact on practice.
We are gaining new insights into the complex realities of the development and implementation of integrated care programmes at a specifically local level. Whilst staff throughout the programme are unified in their belief that integrated care is ‘the right thing to do’, a significant disconnect has been identified between the strategic intent of the programme and the operational delivery of integrated care. Furthermore the programme is often rationalised as a technical intervention, an approach which has placed insufficient emphasis on the critical change management components vital to a large scale transformation programme: leadership, relationships, trust, behaviours and culture change. Findings and recommendations from the evaluation are beginning to influence the design and delivery of the programme as it continues to develop.
Research Associate, UCL / Researcher in Residence, WELC integrated care programme