The persistent problem of integrated care in English NHS hospitals

Abstract

Purpose-The purpose of this paper is to determine whether some aspects of the distinctive Mayo Clinic care model could be translated into English National Health Service (NHS) hospital settings, to overcome the fragmented and episodic nature of non-emergency patient care. Design/methodology/approach-The authors used a rapid review to assess the literature on integrated clinical care in hospital settings and critical analysis of links between Mayo Clinic's care model and the organisation's performance and associated patient outcomes. Findings-The literature directly concerned with Mayo Clinic's distinctive ethos and approach to patient care is limited in scope and largely confined to "grey" sources or to authors and institutions with links to Mayo Clinic. The authors found only two peer-reviewed articles which offer critical analysis of the contribution of the Mayo model to the performance of the organisation. Research limitations/implications-Mayo Clinic is not the only organisation to practice integrated, in-hospital clinical care; however, it is widely regarded as an exemplar. Practical implications-There are barriers to implementing a Mayo-style model in English NHS hospitals, but they are not insurmountable and could lead to much better coordination of care for some patients. Social implications-The study shows that there is an appetite among NHS patients and staff for better coordinated, multi-specialty care within NHS hospitals. Originality/value-In the English NHS integrated care generally aims to improve coordination between primary, community and secondary care, but problems remain of fragmented care for non-emergency hospital patients. Use of a Mayo-type care model, within hospital settings, could offer significant benefits to this patient group, particularly for multi-morbid patients. Introduction Despite attempts to provide complete and integrated services in English National Health Service (NHS) hospitals, many patients seem to receive fragmented and episodic care, resulting in multiple hospital attendances, reviews and shuffling between specialities. This cannot be good for patients or for efficiency. We aimed to compare models of care between an organisation reported to provide high-quality integrated clinical care (Mayo Clinic) and the situation in the English NHS, and to draw lessons which could improve patient care as well as patient and staff satisfaction.