Exploring the Team Climate of Health and Social Care Professionals Implementing Integrated Care for Older People in Europe

Julie MacInnes; Erica Gadsby; Jillian Reynolds; Nuri Cayuelas Mateu; Manon Lette; Christina Ristl; Jenny Billings

doi:10.5334/ijic.5467

Figures & Tables

Table 1

Characteristics of the thirteen integrated care sites participating in the SUSTAIN project.

Country	Site-specific Identifier	Location	Integrated care initiative	Type of care service
Austria	AT1	Vienna	Gerontopsychiatric Centre	Dementia care
Estonia	EST1	Idu-Viru	Alutaguse Care Centre	Home nursing and rehabilitative care
EST2	Tallinn	Medendi	Home nursing
Germany	GER1	Uckermark	KV RegioMed Zentrum Templin	Rehabilitative care
GER2	Berlin Marzahn-Hellersdorf	Careworks Berlin	Home nursing and rehabilitative care
The Netherlands	NL1	West-Friesland	Geriatric Care Model	Proactive primary care
NL2	Arnhem	Good in one Go	Transitional care
Norway	NO1	Surnadal	Holistic Patient Care at Home	Home nursing and rehabilitative care
NO2	Sondre Nordstrand, Oslo	Everyday Mastery Team	Rehabilitative care and mastery of activities of daily living
Spain (Catalonia)	SP1	Osona	Severe Chronic Patients/Advanced chronic disease/Geriatrics	Proactive primary and intermediate Care
SP2	Sabadell	Social and health care integration	Proactive primary care
United Kingdom	UK1	Kent	Over 75 Service	Proactive primary care
UK2	Kent	Swale Home First	Transitional care

Table 2

Demographic characteristics of managers and professionals.

	Number(N=)	Percentage of Total(%)
Country (N = 244)
Austria	12	4.9
Estonia	26	10.7
Germany	23	9.4
Netherlands	22	9.0
Norway	33	13.5
Spain (Catalonia)	75	30.7
United Kingdom	53	21.7
Gender (N = 242)
Female	208	86
Male	34	14
Age (years) (N = 239)
18–24 years	2	0.8
25– 34 years	42	17.6
35–44 years	73	30.5
45–54 years	66	27.6
55–64 years	55	23.0
65+	1	0.4
Highest Educational level (N = 236)
Secondary	19	8.0
Vocational	28	11.9
Graduate certificate	30	12.7
Graduate diploma	51	21.6
Bachelors degree	53	22.5
Master degree	42	17.8
Doctoral degree	8	3.4
Other	5	2.0
Staff group (N = 244)
Managers (all)	36	14.8
Administrative & clerical	23	9.4
Allied health professional	32	13.1
Medical	35	14.3
Nursing	66	27.0
Social Work	44	18.0
Other (including voluntary)	8	3.3
Working hours (N = 238)
Full-time	179	75.2
Part-time	59	24.8

Table 3

Number of staff completing the TCI-14.

Country	Site	Baseline (N=)	Follow-up (N=)
Austria	AT1	7	8
Estonia	EST1	7	15
EST2	12	6
Germany	GER1	6	7
GER2	10	10
Netherlands	NL1	10	10
NL2	8	5
Norway	NO1	16	13
NO2	9	13
Spain (Catalonia)	SP1	51	34
SP2	11	10
United Kingdom	UK1	17	25
UK2	7	4
Total		171	160

[i] Mean total TCI-14 scores and mean sub-scores at baseline and follow-up are summarised in Table 4.

Table 4

Total TCI-14 Scores and sub-scale scores at each site.

Country	Site	Total TCI/Sub-scales	Mean (range) Baseline	Mean (range) Follow-up	Mean Difference	Effect size	Significance
Austria	AT1	Total TCI	3.67 (3.00–4.36)	4.21 (2.75–4.93)	0.54	0.33	0.13
		Vision	3.75 (2.75–4.50)	4.09 (3.00–4.75)	0.34	0.37	0.37
		Participative Safety	3.79 (3.00–4.75	4.31 (2.50–5.00)	0.53	0.4	0.21
Task Orientation	3.81 (3.33–5.00)	4.25 (3.00–5.00)	0.44	0.39	0.27
Support for Innovation	3.29 (3.00–4.00)	4.21 (2.67–5.00)	0.92	0.33	*0.01
Estonia	EST1	Total TCI	4.76 (4.57–4.86)	4.07 (3.36–4.86)	–0.68	0.12	*<0.01
		Vision	4.75 (4.75–4.75)	4.20 (3.25–5.00)	–0.55	0.13	*<0.01
		Participative Safety	4.68 (4.50–5.00)	4.20 (3.25–5).00	–0.48	0.16	*<0.01
	Task Orientation	4.76 (4.33–5.00)	3.87 (3.00–5.00)	–0.90	0.19	*<0.01
	Support for Innovation	4.86 (4.67–5.00)	3.93 (3.00– 5.00)	–0.92	0.20	*<0.01
EST2	Total TCI	4.52 (3.64–5.00)	4.28 (3.71–4.79)	–0.24	0.19	0.23
	Vision	4.65 (4.25–5.00)	4.38 (4.00– 4.75)	–0.27	0.16	0.13
	Participative Safety	4.54 (4.00–5.00)	4.35 (3.75–4.75)	–0.19	0.18	0.30
Task Orientation	4.19 (2.67–5.00)	3.89 (3.00–4.67)	–0.31	0.40	0.45
Support for Innovation	4.64 (3.33–5.00)	4.44 (4.00–5.00)	–0.19	0.22	0.39
Germany	GER1	Total TCI	4.64 (4.43–4.93)	4.33 (4.00–4.71)	–0.32	0.11	*0.01
		Vision	4.62 (4.25–4.75)	4.46 (4.25–4.75)	–0.16	0.11	0.16
		Participative Safety	4.96 (4.75–5.00)	4.50 (4.00–5.00)	–0.46	0.14	*0.01
	Task Orientation	4.44 (3.67–5.00)	3.86 (3.33–4.67)	–0.59	0.30	0.07
	Support for Innovation	4.44 (4.00–5.00)	4.38 (4.00–5.00)	–0.06	0.24	0.79
GER2	Total TCI	4.19 (3.64–4.64)	4.16 (3.86–4.57)	–0.03	0.14	0.81
	Vision	4.12 (3.75–4.50)	4.05 (3.75–4.75)	–0.08	0.13	0.58
	Participative Safety	4.40 (3.75–5.00)	4.45 (4.00– 4.75)	0.05	0.19	0.79
Task Orientation	4.23 (3.67–5.00)	4.13 (3.33–5.00)	–0.10	0.21	0.64
Support for Innovation	3.97 (3.00–4.67)	3.97 (3.00–4.67)	0.00	0.24	1.00
Netherlands	NL1	Total TCI	3.25 (1.79–4.86)	3.56 (2.07–4.21)	0.31	0.33	0.36
		Vision	3.62 (1.50–4.75)	3.67 (2.25–4.50)	0.05	0.37	0.89
		Participative Safety	3.12 (1.75–5.00)	3.67 (1.50–4.25)	0.54	0.43	0.23
	Task Orientation	2.90 (1.00–5.00)	3.30 (2.67–4.00)	0.40	0.38	0.31
	Support for Innovation	3.27 (2.00–4.67)	3.37 (2.00–4.33)	0.10	0.32	0.75
NL2	Total TCI	3.39 (3.00–3.80)	3.47 (3.07–3.93)	0.08	0.17	0.65
	Vision	3.00 (3.00– 3.00)	3.17 (3.00–3.50)	0.17	0.13	0.42
	Participative Safety	3.84 (3.00–4.50)	4.00 (3.25–5.00)	0.16	0.35	0.66
Task Orientation	2.83 (2.00–3.67)	3.07 (2.67–3.33)	0.23	0.22	0.30
Support for Innovation	3.46 (3.00–4.00)	3.47 (3.00–4.00)	0.01	0.24	0.97
Norway	NO1	Total TCI	3.85 (2.93–4.64)	3.95 (3.14–4.64)	0.10	0.19	0.61
		Vision	4.11 (3.00–4.75)	4.23 (3.75–4.75)	0.12	0.16	0.45
		Participative Safety	3.83 (2.50–4.75)	3.90 (3.25–5.00)	0.07	0.23	0.75
	Task Orientation	3.58 (2.33–4.67)	3.67 (2.33–4.67)	0.08	0.27	0.76
	Support for Innovation	3.77 (3.00–4.67)	3.90 (2.67–5.00)	0.13	0.24	0.59
NO2	Total TCI	3.77 (3.14–4.29)	3.63 (2.93–4.64)	–0.14	0.18	0.45
	Vision	3.92 (3.50–4.25)	3.62 (3.00–4.75)	–0.30	0.17	0.09
	Participative Safety	4.14 (3.5 0– 4.75)	4.00 (3.00–5.00)	–0.14	0.19	0.48
Task Orientation	3.70 (2.67–5.00)	3.64 (3.00–4.67)	–0.06	0.27	0.82
Support for Innovation	3.15 (2.33–4.33)	3.15 (1.67–4.33)	0.01	0.34	0.98
Spain (Catalonia)	SP1	Total TCI	3.82 (2.00–5.00)	4.04 (2.57– 5.00)	0.22	0.12	0.06
		Vision	3.99 (2.00–5.00)	4.29(2.25–5.00)	0.27	0.12	*0.02
		Participative Safety	4.03 (2.00–5.00)	4.15(2.25– 5.00)	0.12	0.14	0.39
	Task Orientation	3.74 (2.00–5.00)	3.96 (2.00–5.00)	0.23	0.16	0.16
	Support for Innovation	3.39 (1.67–5.00)	3.64 (2.00– 5.00)	0.26	0.16	0.11
SP2	Total TCI	3.97 (3.54–4.71)	4.47 (4.00–4.75)	0.50	0.13	*0.01
	Vision	4.09 (3.50–5.00)	4.53 (3.75–5.00)	0.43	0.18	*0.02
	Participative Safety	4.18 (3.00–5.00)	4.72 (4.00–5.00)	0.54	0.2	*0.01
Task Orientation	3.85 (3.00–4.33)	4.57 (4.00–5.00)	0.72	0.18	*0.01
Support for Innovation	3.64 (2.33–5.00)	4.00 (3.67–4.67)	0.36	0.26	0.18
United Kingdom	UK1	Total TCI	3.97 (3.07–5.00)	4.10 (2.64–4.85)	0.14	0.2	0.49
		Vision	3.97 (3.00–5.00)	4.18 (2.75–4.75)	0.21	0.18	0.25
		Participative Safety	4.09 (3.00–5.00)	4.24 (2.75–5.00)	0.15	0.2	0.46
	Task Orientation	3.94 (2.67–5.00)	3.98 (2.33–5.00)	0.04	0.25	0.87
	Support for Innovation	3.82 (2.67–5.00)	3.93 (2.00–5.00)	0.11	0.26	0.68
UK2	Total TCI	4.11 (3.64–4.64)	3.77 (3.43–4.14)	–0.34	0.23	0.17
	Vision	4.25 (4.00–4.50)	3.50 (3.00–3.75)	–0.75	0.2	*0.01
	Participative Safety	4.43 (3.75–5.00)	3.88 (3.75–4.00)	–0.55	0.19	*0.02
Task Orientation	3.76 (3.00–4.67)	3.83 (3.00–5.00)	0.07	0.51	0.89
Support for Innovation	3.86 (3.00–4.33)	3.92 (3.00–5.00)	0.06	0.49	0.90

[i] * significant at p < 0.05.

Table 5

Explanations for changes in the Vision sub-scale.

	Where Vision score increased (7 sites)	Where Vision score decreased (6 sites)
Thematic statements	Competent management/leadership, and key people with clear roles helped to push the initiative forward Strong collaboration to co-design the initiative and good continuity of team members over time Feedback to reinforce a shared vision and build confidence in the achievability of outcomes Careful planning to ensure feasibility, regular meetings, and additional measures to ensure good information sharing Maintenance of focus by declining participation in other projects Sense of urgency, political support, and support of management that enhanced motivation/enthusiasm	Weak or unstable leadership External constraints affecting the initiative Absence of clearly delineated roles and responsibilities for team members Lack of a strong communication plan, and failure to develop a common understanding of the initiative Focus of the initiative lost over time, or had to change to fit external constraints (leading to frustration).

Table 6

Explanations for changes in the Participative Safety sub-scale.

	Where Participative Safety score increased (8 sites)	Where Participative Safety score decreased (5 sites)
Thematic statements	Space and time was given to meet regularly and focus on the initiative The contribution of different team/staff members was recognised, with a sense that they can improve services by combining perspectives and efforts (developing co-responsibility) Leadership was non-hierarchical or shared between team members, with decisions made collaboratively or by consensus Team members had previous experience of working together, and got to know each other better as the initiative went on Professionals and managers referred to each other in positive terms Team members were committed, listened to each other and were willing to help each other when difficulties arose A shared sense of urgency and presence of the user perspective acted as a binding factor for developing trust and understanding Managers were motivated, well connected to stakeholders, and contributed meaningfully and collaboratively alongside staff	Some partners (such as operational level staff, external stakeholders or the public) were not as involved as they could have been, or were involved rather late The number of different teams involved, and the fragmented nature of them (in different locations, with different geographical areas, and working on different systems and to different schedules) hindered good communication and integration A historical and cultural separation of ‘health’ and ‘social care’ made it difficult to overcome a sense of ‘us’ and ‘them’, with some stereotyping and resentment on both sides Limited capacity/resources from one partner more than the other, stifled their ability to co-lead the initiative Inconsistent and limited involvement of staff, unfilled posts and staff changes disrupted interpersonal relations Lack of a dedicated manager for a period of time Staff felt they had limited ability/capacity to contribute to elements of the initiative

Table 7

Explanations for changes in the Task Orientation sub-scale.

	Where Task Orientation score increased (8 sites)	Where Task Orientation score decreased (5 sites)
Thematic statements	Time was devoted to jointly identifying weaknesses and potential improvements (ongoing appraisal and reflection), using feedback from the initiative evaluation Good planning and effective management was used to establish priorities, check tasks and ensure the initiative remained on track Multidisciplinary meetings were well attended and enabled professionals to openly and honestly discuss operational problems and solutions, exchange perspectives and collaborate There was good collaboration between steering group members who developed a trusting relationship, shared perspectives and jointly discussed options and decisions Operational level staff as well as higher managerial staff were present in the steering group, which assisted in the identification of improvements.	The service being improved was publicly subsidised and therefore quite defined/constricted (making it harder to question)

Table 8

Explanations for changes in the Support for Innovation sub-scale.

Where Support for Innovation increased (8 sites)

Thematic statements

Sufficient time to meet together and to discuss and develop ideas, and to implement the initiative
Goal of the improvement initiative remained a policy focus, and therefore something that all staff mobilised around
Staff worked hard within existing constraints to propose solutions of how to achieve their shared vision – they co-designed the initiative to help overcome acknowledged limitations
For staff who previously did not work together, or who were being asked to adopt new methods, a gradual adjustment was made towards new ways of working
‘Champions’ within the team influenced and facilitated change by demonstrating commitment, promoting innovation with passion and persistence, bringing together groups of different professions, and developing informal networks of support
Staff saw the value for the service user in the overall aims of the initiative
Good support from management, who helped to resolve some of the barriers
Staff were given a lot of trust and responsibility, with minimal micro-management
Experiencing positive results during the implementation process helped staff to become more enthusiastic about the initiative