Understanding integrated care at the frontline using organisational learning theory: A participatory evaluation of multi-professional teams in East London

Integrated care has been proposed as an organising principle to address the challenges of the rising demand for care services and limited resources. There is limited understanding of the role of learning in integrated care systems. Organisational Learning (OL) theory in the guise of 'Learning Practice' can offer a lens to study service integration and reflect on some of the challenges faced by multi-professional teams in developing a learning culture. The study presents findings from two qualitative evaluations of integrated care initiatives in three East London boroughs, England, undertaken between 2017 and 2018. The evaluations employed a participatory approach, the researcher-in-residence model, to coproduce findings with frontline staff working in multiprofessional teams in community care. Thematic analysis was undertaken using an adapted version of the 'Learning Practice' framework. The majority of learning in the teams was single loop i.e. learning was mainly reactive to issues that arise. Developing a learning culture in the three boroughs was hindered by the differences in the professional and organisational cultures of health and social care and challenges in developing effective structures for learning. Individual organisational priorities and pressures inhibited both the embedding of learning and effective integration of care services at the frontline. Currently, learning is not inherent in integrated care planning. The adoption of the principles of OL optimising learning opportunities, support of innovation, managed risk taking and capitalising on the will of staff to work in multidisciplinary teams might positively contribute to the development of service integration.