Shared Values and Vision most important of nine pillars of Integrated Care

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Shared Values and Vison was perhaps the most important of the nine pillars of Integrated Care, Mr. Joe Ryan, National Director of Operational Performance and Integration with the HSE, told the HMI West Regional Meeting on March 2, 2022.

“Our behaviours, how we work together will achieve far more integration than any organisational structure, albeit the right structures can help to sustain integrated behaviours and initiatives. We are already doing it in islands of excellence, where natural leaders have had courage and encouragement to  strive to do the right thing.  We must wade in behind these projects and initiatives and work with our policy and lawmakers to build the necessary infrastructure to sustain and grow these,” he said.

Mr. Joe Ryan
Mr. Joe Ryan

He was speaking on “Integration of health and social care services across acute community and national support services – Opportunities and Challenges.”

As National Director of Operational Performance and Integration with the HSE, Mr. Ryan has responsibility for overall health and social care performance monitoring, reporting and support to the system in driving improvement and integration of services. In addition to this, he holds national responsibility for Emergency Planning and Management, Health Identifiers Service, Environmental Health and EU & North/South Operations. Arising from the pandemic response, he chairs the HSE Data and Information Governance Group and also leads the HSE’s data and legal response to the recent cyber attack. 

He has worked in health services for the past 15 years, primarily in the fields of improvement, reform and transformation of services. Prior to working in the public health and social care service, he spent 23 years in the multinational technology sector working in operations leadership roles with Adobe, Autodesk, Sykes and others.  He believes strongly in the power of combining expert insight with high quality data and information to drive optimal decision making and performance.

Elaine Prendergast Chair of HMI West Committee welcomed Mr. Ryan and HMI Council Member, Breda Crehan-Roche moderated the meeting.

Mr. Ryan said integrated operations was an integrated collaborative model where  Service Planning, Acute, Community and National Operations , Operational Performance and Integration and Patient and Service User Experience worked in a closely coordinated way that aimed to plan, implement, measure, report and act in a constant cycle of improvement.  

He  said we had to ask ourselves what we meant by integrated care. No matter where you were in the world, everybody had a different interpretation.

Mr. Ryan’s presentation focused on the International Federation for Integrated Care’s nine pillars of Integrated Care – Resilient Communities and New Alliances,  Workforce Capacity and Capability, People as Partners in Care, Transparency of Programme Results and Impact, Population Health and Wellbeing,  Aligned Payment and Systems, System Wide Governance and Leadership, Shared Values and Vision and Digital Solutions. 

Aligned payments system was different in every country and in Ireland we had almost a three tier system, private health insurance, medical card and people who paid cash for services.  “We are trying to drive an universal healthcare system but it is not as easy as it sounds and until we sort out eligibility (and that is not necessarily an universal system)   it will be difficult to implement.  Since the pandemic, we have been delivering elements of universal care in the areas of vaccination and GP diagnostics, for example, so it is possible when there is a need and a will.   However, at present eligibility is one of the barriers to integration.

“As we roll out the structures and care pathways of integrated care it is essential that eligibility for access to health and social care is clear.  This requires clarification of policy and legislation.”

He said the system wide governance and accountability pillar had examples of organisation of care that were already in place or were being put in place such as (FITT, CIT, Pathfinder, ECC) and many other local initiatives. These were fantastic initiatives that were yielding very positive results.

Digital solutions were universally recognised as essential to sustainable integrated care delivery.   The lessons learned from the pandemic were to keep it as simple as possible, while meeting the need.  Health Identifiers were a must and systems developed in the pandemic like the COVAX system and Digital Certs demonstrated that Health Identifiers really worked.  The Shared Care Record was probably the most essential tool to be developed to support integrated care.  Systems were in planning and development such as  Community Case Management System, ePharmacy/National Medicinal Products Catalogue that would facilitate integrated care. This needed to be part of an entire system network, including GP and public, voluntary, and private providers.

Mr. Ryan emphasised the importance of patient and service user engagement  in integrated operations and the co-design  and co-evaluation of services with partnerships in care.

“At the macro level, money is no longer the primary problem.  The real challenge is access to skills.  Last year we had the go-ahead to hire about 15,000 people, we managed to recruit about 5,500.”  

He said that to help recruit and retain staff, we needed to develop attractive roles across all of our services but particularly in the community and to provide research opportunities  and academic alliances for staff working in the community.   We should look at rotations across the acute and community services for staff.

“We also need population based funding and robust measurement and evaluation.   What isn’t measured doesn’t get done.  The Health System Performance Assessment Framework is a start toward a more holistic way of measuring the efficiency, effectiveness and the resilience of our health and social care system. This will be rolled out over the coming two years.

“There is a need for more research on what are the best indicators of Integrated Care in an Irish context. And I join with IFIC in calling for more research in this regard.”

Turning to system wide governance and accountability, Mr Ryan said leadership would be provided by initiatives under Slaintecare such as the Enhanced Community Care Programme, Community Health Networks, the Regional Health Authorities etc.  The challenge was to align these around the common goal of being patient and service user centred.

He ended by quoting  Dr Martin Luther King Jr on the subject of leadership:

“Courage is an inner resolution to go forward despite obstacles;
Cowardice is submissive surrender to circumstances.
Courage breeds creativity; Cowardice represses fear and is mastered by it.
Cowardice asks the question, is it safe?
Expediency asks the question, is it politic?
Vanity asks the question, is it popular?
But conscience asks the question, is it right? And there comes a time when we must take a position that is neither safe, nor politic, nor popular, but one must take it because it is right.”

HMI President, Mr. Tony Canavan thanked Mr. Ryan for his very interesting presentation and urged people to take the discussion forward. “I was particularly struck by two points.  Firstly, the point about building resilient communities. We have to stop seeing patients as  passive recipients of care and  more as partners. We need to shift to that partnership model. I think the community services have more practice at that then the hospital side. Secondly, I feel we are often good at measuring failure, but not so much at measuring our successes. I would like to see us beginning to also measure positive initiatives.”

The meeting was sponsored by GSK.