Implementation 1 was designed to address the following research question:
How do key stakeholders (commissioners, strategic partners) view the SICP, what do they expect from it and how is it aligned with their objectives and incentives?
The specific objectives were to explore and understand:
- how commissioners view the programme, what they expect from it and how it is seen in terms of their performance objectives
- how the programme is viewed by strategic partners such as the local authority and how it is sustained under financial pressure
- how the programme affects the work of the two foundation trusts, in particular how the integrated community and acute provider adapts to reductions in inpatient activity
- how the programme affects primary care, in particular general practice
- the extent to which the financial incentives (explicit and implicit) in the local health and social care system are aligned with the ambitions of the programme.
A qualitative approach was adopted to understand how the SICP was developed and how organisations were working together to transform care. Fieldwork took place from November 2014 to September 2016. Data collection included approximately 56 hours of non-participant observations of SICP programme meetings. A researcher attended meetings, including the Alliance Board, Study Steering Group and MDG meetings.
In addition, 28 interviews were carried out with professionals working across the four key stakeholder organisations associated with the SICP. Initially, 22 interviews were carried out in late 2014/early 2015 and six follow-up interviews were carried out with key stakeholders in 2016 to see how the SICP had developed, the factors that influenced the SICP and the relationships across the four key stakeholder organisations (Table 4). Documents, including operational plans and business cases, were collected from the SICP and relevant meetings to provide context.
| Data collection method | Number of interviews | Further information |
|---|---|---|
| Interviews | 28 in total (22 plus six follow-up interviews) | 6 with foundation trust staff (all senior managers or programme managers) 6 with CCG staff (GPs and senior managers) 6 with council staff (including senior management, management and public health) 1 with a GP provider organisation 3 with mental health trust staff (all senior managers) |
| Observations | 19 (around 56 hours) | Observations included:engagement eventsMDGsStudy Steering GroupAlliance BoardFinance GroupAdvisory BoardIntegrated Health and Commissioning Joint Committee |
The data from interviews and observations were coded in the same way and analysis of the data was facilitated by the computerised data analysis package NVivo version 10 (QSR International, Warrington, UK). Initial coding was carried out using a priori codes derived from our existing understanding of the issues associated with commissioning complex programmes. These were supplemented by inductive coding arising from the data. Analytical memos were written and discussed to develop a collective understanding of the issues represented in the data.
Findings relating to the commissioning of the programme were shared with the wider research team and further explored in interviews with those responsible for the implementation of the project.