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Assessing progress in managing and improving quality in nascent integrated care systems in England

Lalani, Mirza, Sugavanam, Priya, Caiels, James, Crocker, Helen, Gunn, Sarah, Hay, Harriet, Hogan, Helen, Page, Bethan, Peters, Michele, Fitzpatrick, Ray and others. (2023) Assessing progress in managing and improving quality in nascent integrated care systems in England. Journal of Health Services Research & Policy, . ISSN 1355-8196. E-ISSN 1758-1060. (doi:10.1177/13558196231209940) (KAR id:103883)


Objectives: In 2022, England embarked on an ambitious reorganisation to produce an integrated health and care system, intended also to maximise population health. The newly created integrated care systems (ICSs) aim to improve quality of care, by achieving the best outcomes for individuals and populations through the provision of evidence-based services. An emerging approach for managing quality in organisations is the Quality Management System (QMS) framework. Using the framework, this study assessed how ICSs are managing and improving quality.

Methods: Four ICSs were purposively sampled, with the data collected between November 2021 and May 2022. Semi-structured interviews with system leaders ( n=60) from health and social care, public health and local representatives were held. We also observed key ICS meetings and reviewed relevant documents. A thematic framework approach based on the QMS framework was used to analyse the data.

Results: The ICSs placed an emphasis on population health, reducing inequity and improving access. This represents a shift in focus from the traditional clinical approach to quality. There were tensions between quality assurance and improvement, with concerns that a narrow focus on assurance would impede ICSs from addressing broader quality issues, such as tackling inequalities and unwarranted variation in care and outcomes. Partnerships, a key enabler for integration, was seen as integral to achieving improvements in quality. Overall, the ICSs expressed concerns that any progress made in quality development and in improving population health would be tempered by unprecedented system pressures.

Conclusion: It is unclear whether ICSs can achieve their ambition. As they move away from an assurance-dominated model of quality to one that emphasises openness, learning and improvement, they must simultaneously build the digital infrastructure, staff expertise and culture to support such a shift.

Item Type: Article
DOI/Identification number: 10.1177/13558196231209940
Uncontrolled keywords: Public Health, Environmental and Occupational Health, Health Policy
Subjects: H Social Sciences
Divisions: Divisions > Division for the Study of Law, Society and Social Justice > School of Social Policy, Sociology and Social Research > Personal Social Services Research Unit
Funders: National Institute for Health Research (
SWORD Depositor: JISC Publications Router
Depositing User: JISC Publications Router
Date Deposited: 14 Feb 2024 16:30 UTC
Last Modified: 22 Feb 2024 09:45 UTC
Resource URI: (The current URI for this page, for reference purposes)

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