Introduction: understand and measure impact of integrated care
In this section of the guide How to... understand and measure impact of integrated care
Measuring success is key to performance management, service improvement and accountability. Health and care managers who have a considered, systematic and proportionate approach to monitoring and evaluation can:
- manage services more effectively
- focus efforts of staff and stakeholders across the system to work together to deliver impact
- build ownership, buy-in and support for greater integration and person-centred care.
This guide provides practical tools and tips on how to measure the impact of integrated health and care. It covers the following:
- articulating the outcomes
- identifying the right measures
- developing a monitoring and evaluation framework
- using results to continuously improve
In integrated care, measuring impact is complex. Compared to the private sector – or even to individual public service organisations – integrated care is never achieved by any one agency or person working in isolation. There are also very different definitions of what ‘success’ looks like among stakeholders across the system – from commissioners, providers and regulators to patients, service users, carers and community groups.
Engagement, consultation and co-production are critical to not only achieving integrated care but also to measuring impact. It is vital to work with stakeholders from start to finish, acknowledge and discuss competing priorities and trade-offs, and focus on finding answers to these key questions:
- What are the desired outcomes?
- What measures will be used to track progress and impact?
The answers to these questions are necessary to build and implement a strong approach to monitoring, performance management and evaluation. This, in turn, will help providers understand what works and what should be changed to deliver real, sustainable improvement in integrated, person-centred care.
When done well, monitoring and evaluation can drive successful delivery of integrated care. The range of outcomes and measures should be selected with that in mind. These should include: people’s experiences of care; care outcomes in terms of changes to people’s health and wellbeing; and better use of resources.Dr Nick Goodwin, CEO, The International Foundation for Integrated Care
- Work with partners and other stakeholders to build a shared view of what ‘good’ looks like, how to achieve this, how it should be measured and how learning should be used.
- Engage and listen to local populations from start to finish. Ask what ‘good’ looks like to them, include their views and experiences on progress and impact, and engage them in the process of analysing results and working out what that means for services, people and communities.
- Prioritise the most important measures when building a monitoring and evaluation framework. Use a mix of both quantitative and qualitative information and evidence. This should include a combination of local, regional and national measures.
- Use the evidence to drive improvement. Reflect on progress, learn about what works and what doesn’t, and build on this learning to find out what should be built upon, what should be improved and what should be prevented.
- It is a journey of discovery. And it is hard. Delivering change and measuring impact is an evolutionary process and it will be important to try, test, reflect and change as time progresses.
Engage, consult and co-produce with stakeholders from start to finish
Establish the outcomes to be achieved
Outcomes are the benefits that are delivered as a result of a service. They should reflect the collective aims across the partners and be articulated in terms of the intended impact on people, patients, communities and the system.
For example, this could be ‘equipping people to regain independence following hospital or other forms of healthcare’.
Identify the right measures
Measures set out how outcomes should be tracked to enable judgement on progress. Process measures assess how a service is being delivered and outcome measures assess the extent to which intended goals are achieved.
For example, this could be ‘50 per cent rise in people reporting that they have got the support they need following hospital discharge’ and ‘20 per cent reduction in readmissions’.
Develop a monitoring and evaluation framework
Monitoring refers to ongoing observation of progress and results.
Evaluation refers to the process of making judgements on success or failure, based on available monitoring data, new collated information and analysis of impact in relation to each of the measures.
Use results to continuously improve
Continuous improvement based on systematic use of evidence and insight helps to build ownership and buy-in for transformational change, scaling of initiatives and sustainability.