Abstract
Introduction: Internationally, networks of healthcare and social care systems have worked in recent years towards varying degrees of integration to improve healthcare and social care outcomes for individuals and communities. The COVID-19 pandemic focused this attention further and led to these systems rapidly reassessing their integrated care practices around structure, impact, and accelerated partnership-working. The global pandemic therefore provided an opportunity to assess, in real time, partnership-working and its potential impact on integration. This exploratory study examines the effect of the pandemic on partnership-working in three distinct healthcare and social care systems.
Methods: The three locales studied were a metropolitan area in the midwestern United States, a comparable geographic area in the West Midlands region of the United Kingdom, and a similar health region in the Flemish Brabant province of Belgium. Leaders within healthcare delivery, public health, and social care organisations in the three locales were interviewed (n=21), having been identified by convenience sampling. Semi-structured interviews were undertaken in order to learn about partnership-working between healthcare and social care organisations before and during the pandemic. Interviews were transcribed and coded using a structured, thematic coding approach.
Results: The early stages of the pandemic prompted an increase in interorganisational partnership working, although the form of these partnerships varied between locales. Common themes appeared in all three locales: more intentional partnerships, temporary easing of bureaucratic regulations, and more streamlined communication. Divergent themes appeared in some interviews but were more pronounced in a particular locale: accelerated pace of work, more partnership goal-orientation, and reliance upon personal networks for partnership formation. Independent themes appeared primarily in one locale: temporary decrease in interorganisational competition, leadership voids undermining partnership-working, and local political forces and resource scarcity influencing partnership-working.
Integration exists in various evolving forms throughout the three locales, regardless of system architecture, policy, and financing. The pandemic necessitated many organisations to implement ad hoc partnerships and required many to rely upon existing relationships to promote integration for the needs of individuals and communities.
Conclusions: These findings suggest that the pandemic has altered the way that health and social care organisations approach integrated care and partnership-working. Opportunities for mutual learning and practice contributions exist regardless of international locale, and examining integration between locales may provide important information for leadership and sustainable partnership working post-pandemic.
Implications: Care organisations and systems need to establish defined structures and policies of organisational partnership-working. Additionally, there is a need for leadership training on partnership-working within communities. Still unknown is the sustainability of progress made in partnership-working. Key to the sustainability of partnership-working will be applying learnings from the pandemic.