A recent paper in JAMA discusses the issue of collaboration across institutions. I single this paper out because our forthcoming ARC West Midlands will place an emphasis on such cross-institution collaboration. For example, our ‘Mental Health’ theme, led by Professor Swaran Singh, seeks to improve mental health services for young people across the educational and healthcare divide; while our ‘Acute Transitions in Care’ theme, led by Professor Daniel Lasserson, focuses on people with acute illness who might be cared for at home rather than in the hospital. Our ‘Chronic Conditions’ theme, led by Professor Christian Mallen and Dr Gill Combes, focuses on improving integration across sectors through multi-disciplinary teams. All of these themes will include social care and its interface with health, working with the Department of Social Work and Social Care, led by Professor Robin Miller.
The above JAMA article gives a nice example of the need for collaboration in the management of childhood asthma. Primary care is positioned to ensure that the appropriate medicines are prescribed, provide health education to schools, and detect early signs of deterioration, while social services can visit homes to identify mould. There is evidence that service delivery interventions that bring these services together can reduce hospitalisation by 50%. But how to achieve inter-sectoral working – that is the question!
Our ARC will draw on evidence regarding how to achieve inter-sectoral working:
First, we are inspired by the brilliant work on factors that facilitate or impede cross-institutional collaboration by the Nobel Prize winner Elinor Ostrom. Her work, carried out in the context of fisheries, farms and industry, is described in a previous News Blog.
Second, our ‘Organisational Sciences’ cross-cutting theme has done ground-breaking work on how Ostrom’s principles play out among the various health care ‘tribes’ and what can be done to forestall problems when designing integrated services. Again, examples were given in a recent News Blog.
Third, our CLAHRC West Midlands has carried out an overview of systematic reviews on the topic.
We have established a mechanism to integrate our work programme with that of Sustainability and Transferability Partnerships (STPs) and with our Academic Health Sciences Network (AHSN), and to form collaborations with other organisations pursuing this topic, including other ARCs. We wish to integrate the study of integration! Our ARC seeks a leadership role in the critical over-arching theme of ‘collaboration and investigation of care between organisations whose individual short-term interests are not necessarily served by such integration.’
— Richard Lilford, CLAHRC WM Director
- Stout SS, Simpson LA, Singh P. Trust Between Health Care and Community Organizations. JAMA. 2019.
- Damery S, Flanagan S, Combes G. Does integrated care reduce hospital activity for patients with chronic diseases? An umbrella review of systematic reviews. BMJ Open. 2016; 6(11): e011952.
- Ostrom E. Beyond Markets and States: Polycentric Governance of Complex Economic Systems. Am Econ Rev. 2010; 100(3): 641-72.
- Lilford RJ. Sustainability and Transformation Partnerships: Why They Are So Very Interesting. NIHR CLAHRC West Midlands News Blog. 27 July 2018.
- Lilford RJ. How Theories Inform Out Work in Service Delivery Practice and Research. NIHR CLAHRC West Midlands News Blog. 21 September 2018.
- Watson SI & Lilford RJ. Essay 1: Integrating Multiple Sources of Evidence: a Bayesian Perspective. In: Challenges, solutions and future directions in the evaluation of service innovations in health care and public health. Southampton (UK): NIHR Journals Library, 2016.