Abstract
Background: Although Integrated Care is formalised in health policy in some countries committed to universal coverage, small, rural and/or remote municipalities face specific challenges as different sectors compete for a limited workforce, housing constrains inward recruitment, and the transport infrastructure limits access to specialised hospital services and diagnostic support located in larger, more distant municipalities. In small, rural or remote systems, it is even more crucial to embed workforce planning, education and technological innovation at the heart of a population based intersectoral network model to guarantee equity of access to comprehensive healthcare including specialist services.
Approach: This 60-minute workshop is led by the School of Public Health from the University of São Paulo, the University of the West of Scotland and IFICs Rural, Remote and Islands Special Interest Group. Contributors will share three short case studies that provide insights into the challenges and innovations experienced to transform the local reality in three different contexts in Brazil and Europe.
Two different integrated care initiatives in São Paulo State adopted a systematic inter-professional and inter sectoral educational (IPE) program: (Transforming Together in the North Coast Region, a partnership between the State Health Secretariat and IFIC Scotland; and system strengthening in the northeast as documented in the PhD thesis of Pereira, 2022). In both examples, frequent meetings of professionals from health, social development, education and housing teams enabled the workforce to reflect on their current roles and challenges and to co-design feasible actions, responsibilities and deadlines based on their local context, opportunities and workforce strengths. This Transforming Together approach has now been applied with Manx Care partners on the Isle of Man and adapted to enhance integrated care for older people in Malta.
All three experiences demonstrate the potential for IPE and collaboration to build workforce capability to co-design and deliver a more sustainable integrated network of care and support. Reflective practice and collaborative problem solving engaged health workers, managers and patient representatives in co-creating achievable and sustainable solutions for their context. The constructive, person-centred approach encouraged protagonism, active listening, sharing, collaborative leadership, horizontal relationships and co-design. Despite the different policy and funding context, there were similar success factors: collaborative multidisciplinary working; creating time and space for IPE and reflection on lived experiences to stimulate empathy and compassion; authentic sharing of strengths and challenges to build mutual trust and shared responsibility; shared learning from small changes; recognition of the potential and empowerment for each individual to act to privilege integrated care as a gold standard for the whole healthcare network.
Participants will reflect on the three case studies and share insights from their own context on how to build system resilience within metropolitan, urban or smaller integrated systems. Participants will discuss how IPE and collaboration has considerable potential to be replicated and woven through all integrated care learning systems.