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Table 2 ‘Whole system’ engagement

From: Integration of research and practice to improve public health and healthcare delivery through a collaborative 'Health Integration Team' model - a qualitative investigation

Concept type: Process related
Short definition: Identifying and actively seeking to engage organisations and people who play a part in the health and social care economy related to the long-term conditions or public health issue at the centre of the HIT being formed.
Function Data extracts
Dealing with challenging issues which cross organisational and sector boundaries. ‘[Those coming together in the nascent HITs] realised they were grappling with different ends of the same issue and actually they had a lot they could share’ (Participant 1, academic)
I think there’s great strength in having the whole system involved because that is how people’s lives work and that’s how we’ll get out of the mess we’re in.’ (Participant 7, senior commissioner)
Making research more relevant and deliverable. ‘I bought into the notion that if you have service providers and commissioners and researchers all together, and then you design research which is going to meet the needs of the commissioners and the service, you’re more able then to deliver the findings of the research … So I just bought the notion that it would be more relevant and more deliverable. That’s why I supported it.’ (Participant 7, senior commissioner)
Key aspects
Facilitated by the structured, iterative application process. ‘We were delighted to hear that the work involved in putting the application together has already facilitated new connections and new conversations: this is exactly what we want to achieve.’ (Feedback document to HIT, 2014)
Creating a new space in which ideas could be discussed and explored without concerns about invading other organisations’ territory or individuals’ agendas. ‘I think they have created conversations across the city and legitimised conversations between different organisations, not just academics and the service, but also between different parts of the service’. (Participant 6, academic)
Would we have succeeded without the HIT? The answer is I don’t know in all honesty. I would have thought we would have got to a certain level without question because of the energy and the drive that was being created. What the HIT’s done is mandated what we were doing and it has opened doors as a results of just having, not just of having a label, but of having an opportunity that has been mandated by the wider [health community]. That was really important and really was a step change in our speed of development.’ (Participant 5, HIT director, clinical academic)
Changing norms about who should be included. ‘If I think of the 360 degree segments, I was probably covering around 90 degrees; maybe 100 degrees if we’re being optimistic, of the key people that we really needed to include in something that was going to look at such a challenging area. … Now I think I wouldn’t even conceive of doing something like this without including all the players, and we’re constantly thinking of other people we should include.’ (Participant 10, HIT director, clinical academic)
‘Our ambition is that this policy should underpin a culture shift such that PPI [Patient and Public Involvement] is embedded at all levels, including commissioning, decision making and policy rather than being limited to the logistics of service delivery and questions of patient satisfaction’. (HIT application document, 2012)
Involvement of commissioners – going beyond previous collaborations between academics and large providers. ‘What I think is really strong about the HIT model is that involves commissioners and when you go to other places and you look at what they’re doing, they tend to be less strong about having the whole system in the room. So typically you tend to see a lot of evidence of working with acute, but not necessarily mental health, not local authority and not commissioners.…. So I think that’s an incredibly important point that if you’ve got commissioners at the heart of it and in some of these leadership roles, it looks very different.’ (Participant 7, senior commissioner)
Meaningful and timely involvement and engagement of patients and public(s). ‘So how do we infiltrate the real decision making spaces within the organisation so public voices are actually being heard where decisions are really being made?’ (Participant 3, academic)