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

Area of Science:

• Healthcare Management and Policy
• Quality Improvement Science
• Public Health Systems

Background:

• England initiated a major health and care system reorganization in 2022, establishing integrated care systems (ICSs).
• ICSs aim to enhance population health and care quality through evidence-based services.
• The Quality Management System (QMS) framework offers a structured approach to organizational quality management.

Purpose of the Study:

• To evaluate how integrated care systems (ICSs) are managing and improving quality.
• To assess the application of the Quality Management System (QMS) framework within ICSs.
• To understand the challenges and enablers of quality improvement in the new ICS structure.

Main Methods:

• Purposive sampling of four integrated care systems (ICSs).
• Data collection via semi-structured interviews with 60 system leaders and observation of key meetings (November 2021–May 2022).
• Thematic framework analysis based on the Quality Management System (QMS) framework.

Main Results:

• ICSs prioritize population health, reduced inequity, and improved access, shifting from traditional clinical quality focus.
• Tensions exist between quality assurance and improvement, with concerns that a narrow assurance focus may hinder addressing broader issues like inequalities.
• Partnerships are crucial for integration and quality improvement, but unprecedented system pressures may temper progress.

Conclusions:

• The success of ICSs in achieving their quality and population health ambitions remains uncertain.
• A transition from assurance-dominated quality models to those emphasizing openness, learning, and improvement is necessary.
• Successful implementation requires simultaneous development of digital infrastructure, staff expertise, and supportive organizational culture.