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A central tenant of the World Health Organisation Framework on Integrated People-Centred Health Services (2017) is reframing from health systems being designed around diseases and health institutions, towards health systems designed for and with people. South Eastern Sydney Local Health District (SESLHD) vision for Integrated Care is to develop a primary care-based system of person-centred care planning and coordination underpinned by client-care professional interactions that emphasises involvement, supported by multidisciplinary team care and appropriate care logistics (Stewart et al 2017). The SESLHD Integrated Care Action Plan (2015-18) has enabled progress in the 'middle-out' approach, focusing on building a shared narrative for Integrated Care and enhancing access to technical and functional enablers. In 2018, the focus for Integrated Care is evolving to meso-level activities, such as building stronger partnerships and encouraging innovation across SESLHD and Central and Eastern Sydney Primary Health Network (CESPHN). Neighbourhoods for Wellbeing (N4W) is a novel small-scale test of change, drawing on the principles of codesign. A partnership between SESLHD & CESPHN, it aims to better understand the environment, skills and mindsets for supporting the new and different relationships and conversations that are critical for ensuring health and social needs of the person are the key determinants and focus for 1. planned service improvement and innovation within local primary care services, and 2. empowering communities and generating momentum for broader social change. Adopting complexity science perspective for planning change within the dynamic and change repellent health and social systems (Braithwaite 2014), N4W will start by working locally and engaging in iterative cycles of appreciative inquiry and participative collective action. Participants will include a change-ready general practice, enrolled patients (the community members who regularly access the practice) and other local primary care services identified as stakeholders. Complementing CESPHN Person Centred Medical Neighbourhood program based on Bodenheimer's ten building blocks of high performing primary care (Bodenheimer, et al, 2014), N4W will advise and coach participants in working with person-centred improvement approaches and building capability for leading change together. N4W is framed within a salutogenic orientation, whereby it is proposed that each person has ability and access to internal and external resources to live well, and when supported by an enabling environment can use them in a way that promotes health and well-being (Antonovsky, 1996). A person's orientation is influenced by how they see and experience the world around them, this is unique to each person and their life. With the intent of encouraging people to consider the benefits of reframing or shifting their sense-making towards salutogenesis, requires a combination of cognitive, behavioural and motivational factors. Normalisation Process Theory (NPT) will ensure N4W evaluation rigorously explores each of these factors and their impact at an individual and collective level. This poster will illustrate the scope of the project, the methodology, the anticipated risks, knowledge capture strategies and the expected outcomes. As a place-based program of work, it is anticipated that the principles will be transferrable to other contexts and cultures. [ABSTRACT FROM AUTHOR]

Background: Integrated Care in Australia has mostly been implemented as micro-level initiatives rather than systemically, which has challenged its sustainability [1]. South Eastern Sydney Local Health District (SESLHD) and the Central and Eastern Sydney Primary Health Network (CESPHN) have sought to scale the benefits of existing micro-level strategies, such as inter-disciplinary coordination, coordination, and person-centred care, in order to increase population-level impacts and enhance sustainability. The focus of their joint Integrated Care Strategy has shifted towards implementation of meso- and macro-level integrated care programs [2]. This paper presents an overview of the evolution, implementation and evaluation of this novel program. About the IC Program: The centrepiece of the revamped Strategy is three interlinked programs, based on Bodenheimer's 10 building blocks [3]: 1) General Practice 2020:a quality improvement activity in general practice involving practice teams. 2) Care Coordination: a model of service involving Clinical Nurse Consultants and a social worker. 3) Talking Wellbeing:a co-produced salutogenic initiative based in general practice. Th objectives of these programs are to: Strengthen partnerships and integration. Support general practice to transition towards a person-centred medical neighbourhood (PCMN) model. Establish a sustainable, localised care coordination model. Build connections and experiences that enhance individual and collective wellbeing. The PCMN model is an Australian federal government initiative, similar to the health care home concept [4]. Desired outcomes of the PCMN are aligned with the quadruple aim [5]. Evaluation: The three programs will be evaluated at: (i) consumer, (ii) provider, and (iii) service levels. The overall analytic approach is informed by Normalisation Process Theory [6], with emphasis on the impact, acceptability, feasibility, sustainability, and scalability of the Strategy. Data will be collected at 6, 12 and 18 months points following implementation. Implications for Integrated Care: Lessons learnt from the evolution and and implementation of the three programs that make up the Strategy will have relevant to integrated care in other settings. References: 1- Angus L and Valentijn PP (2018). From micro to macro: assessing implementation of integrated care in Australia. Australian Journal of Primary Health. 24;59-65. 2- Stewart G, Bradd P, Bruce T, et al (2017). Integrated care in practice - the South Eastern Sydney experience. Journal of Integrated Care. Vol.25;No.1:49-60. 3- Bodenheimer T, Ghorob A, Willard-Grace R and Grumbach K (2014). The 10 building blocks of high-performing primary care. Annals of Family Medicine. Vol.12;No.2;166-171. 4- Grant R and Greene D (2012). The Health Care Home Model: Primary Health Care Meeting Public Health Goals. American Journal of Public Health. Vol.102;No.6:1096-1103. 5- Bodenheimer T and Sinsky C (2014). From Triple to Quadruple Aim: Care of the Patient Requires Care of the Provider. Annals of Family Medicine. Vol.12;No.6;573-576. 6- May CR, et al (2018). Using Normalization Process Theory in feasibility studies and process evaluations of complex healthcare interventions: a systematic review. Implementation Science. 13(1):80. [ABSTRACT FROM AUTHOR]