Author: McCormack B, Mitchell E A, Cook G, Reed J, Childs S
Journal: Journal of Nursing Management, 2008
Volume/pages: Vol 16, pp105-114

About the study
This paper reports on the second phase of a two-phase study. Phase one focussed on an in-depth literature review of whole system working with older people. Phase two compared and contrasted the data from the literature review with a specific whole system case study in order to understand the aspects of a whole system that enabled continuity of care for older people and those that did not.

Findings
The study found that access to services in the case study site seemed to depend more on issues within the system rather than the needs of the older person. Service fragmentation arose out of treating specific symptoms rather than the person as a whole. Although both service users and providers place emphasis on continuity of care it was found to be difficult to achieve and is largely impacted by poor communication between care settings and poor care coordination practices. The final finding was that personal autonomy and control over plans for the future were significant for maintaining psychological well being.

Key messages

• Whole systems working is dependant on clear communication channels, simplified information systems and effective coordination mechanisms.
• There’s a need to develop links between the wide range of changes being implemented within health and social care services in order to ensure that the experience of older people is held central to improvement strategies.
• For whole systems working to be effective, emphasis needs to be on lessening the demarcations between professional groups.
• A single care coordination system is essential to effective whole systems working.