{"id":4937,"date":"2024-01-30T09:16:49","date_gmt":"2024-01-30T09:16:49","guid":{"rendered":"https:\/\/medicsvoices.com\/?p=4937"},"modified":"2024-01-30T09:16:56","modified_gmt":"2024-01-30T09:16:56","slug":"aine-carroll-healthcare-integration-and-improvement","status":"publish","type":"post","link":"https:\/\/medicsvoices.com\/aine-carroll-healthcare-integration-and-improvement\/","title":{"rendered":"\u00c1ine Carroll | Healthcare Integration and Improvement"},"content":{"rendered":"\t\t
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Promoting Integrated Care, Understanding Complexity, and Advocating for Women in Medicine<\/p>\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t

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\u00c1ine is Professor of Healthcare Integration and Improvement at University College Dublin, Ireland and a Consultant in Rehabilitation Medicine at the National Rehabilitation University Hospital in Dublin. She is Chair of the International Foundation for Integrated Care (IFIC) and Co-Director of IFICIreland.<\/p>\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t

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Prior to this, she was National Director of the Clinical Strategy and Programmes Division in the Health Services Executive in Ireland. During her tenure, Professor Carroll established the Integrated Care Programmes to promote coordinated care and teamwork across services and specialties, ensuring that care is provided effectively and seamlessly to patients as they move through the system. \u00c1ine is known internationally for her expertise in integrated care, whole system change, complexity and implementation. She is passionate about person centred coordinated care,complexity theory in healthcare and the power of stories.<\/p>\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t

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\u201cWe are wonderful systems of ‘organs’ but how we are currently design and provide our health care systems isn’t working for the whole of human beings. We recognized that we needed to start to do things differently and that brought me into the whole area of integrated care.\u201d<\/p>\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t

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What I really like your slightly oblique approach to traditional medicine. \u00c1ine, tell me about your career and your current job.<\/p>\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t

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\u00c1ine Carroll:<\/strong> My name is \u00c1ine Carroll and, by background, I am a Consultant in Neurological Rehabilitation Medicine at the National Rehabilitation Hospital in Dublin, but I also wear a number of other hats. I am Professor of Healthcare Integration and Improvement at University College Dublin and I’m also current chair of the International Foundation for Integrated Care (IFIC) \u00a0and, I’m co-director for the IFIC Ireland Hub. I have a lot of different interests. There’s a thread of integration that runs through them all but I’m also really interested, not just from an academic point of view but, in the practical application of knowledge to the day-to-day work that we do in health and care. So, I’m really interested in learning systems and health care being viewed as a complex adaptive system.<\/p>

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DMacA:<\/strong> Before we get on to changing the systems, tell me about integrated care and what it really means.<\/p>

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AC:<\/strong> Before I got very involved in IFIC, I was National Director of Clinical Strategy and Programs within our health system, which is the Health Service Executive, and at that time I would have been responsible for 35 clinical programs. Each of those programs was really important, really worthwhile, taking an evidence informed approach to how we were thinking about models of care. But each ‘organ’ had its own model of care and one of the things that I and colleagues came to realize is that we need to join things up. Our patients don’t present as a heart or a brain or a kidney. We are wonderful systems of ‘organs’ but how we are currently design and provide our health care systems isn’t working for the whole of human beings. We recognized that we needed to start to do things differently and that brought me into the whole area of integrated care. Even when you look at the literature in integrated care it is the most heterogeneous fuzzy thing imaginable. We’re not bound by any set definition, because it really does depend on your context, but having a shared understanding about what that means and, in its purest form, that means person centred coordinated continuous care that deals with the issues that matter to the individuals and their family.<\/span><\/p>\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t

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\u201cWe’re also born and raised in this notion of linearity and positivity so that A plus B equals C.\u00a0 Whereas, real life is messy, it is unpredictable, and we need to settle into that uncertainty and unpredictability if we are to get further faster.\u201d<\/p>\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t

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DMacA:<\/strong> An aspect of that is the integration with primary care, and primary care doctors would say that they focus on personalized coordinated care. How does that fit with your model of integrated care?<\/p>

AC:<\/strong> In the work that I’ve been doing, when you ask individual clinicians about how they provide care, the answer I get all the time is “sure, aren’t we doing that anyway”. Unfortunately, I wish that were true. But when we look at the evidence, and when we study how we’re currently providing our services, we’re not. I think it’s really important that we acknowledge that. There are some pockets of really good care and, when you talk about primary care, I immediately think about Ghent and the work of a Professor Jan De Maeseneer. (https:\/\/medicsvoices.com\/jan-de-maeseneer-a-primary-care-leader-in-europe-africa-and-the-us\/<\/a>). The man is a legend. I’m a complete Jan fan. If everyone in the world could receive Primary Care the way Jan De Maeseneer and his team provide it, our patients would be happier, families would be happier, we as clinicians would be happier.<\/p>

There are lots of really good examples of how to do this really well but, unfortunately, most of the time when we look at the evidence, it is disintegrated care, it is fragmented, and it’s certainly not organized around the needs of the people we proport to serve.<\/p>

DMacA:<\/strong> That brings us back to one of your other interests and that is system change. How do we make that happen?<\/p>

AC:<\/strong> Ah that’s the’ $64,000 question’. The IFIC nine pillars are, I think, a useful way of thinking about the areas that we need to consider when we’re thinking about integrated care. I’m going to concentrate just on integrated care and maybe then briefly touch on systems because, when integrated care happens in human systems, it happens for human beings who are human systems. So, the nine pillars are a very useful framework or a tool. These the things that we need to think about.<\/p>