Barriers and Enablers to Integration in the West Auckland Diabetes Service

Abstract

Background: The integration of services is widely considered an essential part of any solution to the growing problems associated with the burden of chronic conditions. The better integrate their diabetes service. One element to be considered is the way in which services are currently funded and contracted for, and whether this supports or hinders integration efforts. While there is an enormous body of international literature discussing integration, the area of contracting and funding for integration has received far less attention, and very little in New Zealand, to date. In order to facilitate integration through contracting and funding mechanisms it must first be understood what the current barriers and enablers to integration in the West Auckland diabetes service are. Aim: This thesis therefore aims to identify the barriers and enablers to integration as perceived by the relevant West Auckland stakeholders, and consider them in the context of contracting and funding mechanisms. Methods: A cross-sectional qualitative study design was used. Semi-structured interviews were performed with key stakeholders in the West Auckland locality. Participants included both primary and secondary care providers (Clinicians) and members from various levels of the WDHB funding and planning team (Planners). Inductive thematic analysis of the interview data was carried out and key perceived barriers and enablers to integration were identified. Results: The results illustrate five specific barriers to integration in the diabetes service in West Auckland: a lack of top-down leadership, historically siloed relationships, fragmented or misaligned funding, a lack of transparent data and historic system design tensions. A further overarching barrier was identified, namely, a lack of a whole-of-system approach to improving and implementing integration. Summary: The results illustrate that there are a number of barriers to integration in the current diabetes service in West Auckland. Contracting and funding issues do act as barriers, however their significance comes largely from their links to, and interactions with, other barriers, particularly those regarding leadership failings and relational divides. The key finding of this research is that the development of a whole-of-system approach to integration is likely to make the biggest impact to increasing integration in the diabetes service in West Auckland. This whole-of-system approach to service planning should include the West Auckland locality, WDHB and other public sectors. In practice this will be a challenging and long-term process but one which could ultimately produce a well-designed and sustainable service.