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Background: The implementation of Integrated Care poses many challenges at a macro, meso and micro level. This workshop aims to explore the role that a proven intervention like Integrated Care Pathways is playing in advancing cultural and organizational transformation towards integrated care. Worldwide there are a plethora of ICPs implementation initiatives offering a great opportunity for knowledge exchange and cross-boundaries learning, but the latest studies show a high degree of variability in the implementation of ICPs. Aims and Objectives: The Aim of this workshop is to offer the ICIC 2019 audience an opportunity to hear from the latest international advances on ICPs implementation and to reflect upon collectively. Specific objectives are: - To share the state-of-the-art evidence on ICPs - To present the latest analysis of ICPs implementation, variability, challenges and key learnings - To present key findings from a best practice intervention of ICPs implementation at a systemic level in Spain - To present key findings and understandings from an ICPs case study with cancer patients at a hospital in Ireland - To access an innovative example of ICPs technology-based implementation in cancer patients - To debate on the future role of research in ICPS as a technology to promote Integrated Care and inform practice - To inspire reflection on the crossroads between ICPs and Chronic Care, Population Health Management and healthcare prevention - To allow discussion on effective ways to engage patients participation in ICPs developments Format: The proposed format for the workshop consists of a 60 minutes session as part of the main conference stream. The workshop intends to be a step in the ongoing process of reflection on ICPs research, implementation improvement, performance analysis and patient engagement. Timings and speakers: 15 minutes. Massimiliano Panella (Italy). President of the European Pathway Association. Latest international evidence on ICPs implementation. 15 minutes. Carles Blay (Spain). Family Physician, ex-director of ICP strategy in Catalunya and Director of Medicine Faculty at Vic University. Key learnings from ICPs implementation in Spain 15 minutes. Ornela Bardhi (Albania). Marie Curie PhD Fellow at Cancer: Activating Technology for Connected Health. Understanding and mapping the Patient Journey in Cancer. 15 minutes. Open debate and conclusions. Coordinated by Elena Urizar, Deusto Business School Health. Target audience: Healthcare organization managers, policy makers, decision makers and implementation teams and researchers in the field of ICPs and integrated care. Learnings/Take away: The output of the roundtable will be relevant for informing research and practice on key aspects to improve ICPs implementation and on finding ways to include patient's participation in the development of ICPs. [ABSTRACT FROM AUTHOR]

Introduction: ICPs are a proven intervention to advance Integrated Care. However their implementation poses great challenges, among others, it needs alignment from micro, meso and macro management and the deployment of change management strategies. Description: The Center for Innovation and Change Management is playing a facilitating role in the Spanish NHS, supporting the implementation of ICPs in different regions, with a systemic perspective, through the generation of new knowledge, innovative change management strategies and the dissemination of good practices. Change: Based on Kaiser Permanent, Chronic Care Model, Berwick's Quadruple Aim for IC, population health management, and Kotter's Change Management Model. Population: The activities of the Center are addressed to supporting the work of decision makers, managers and multidisciplinary clinical teams who can drive the implementation of ICPs, in different organizations such as individual healthcare organizations, integrated care systems up a full Regional Health System. Timeline: Since January 2017 the Center has supported the structured implementation of ICPs Highlights: The Center has developed and validated with a multilevel group of experts two main toolkits, a Design and Implementation Guide and a Checklist to support the implementation of ICPs. In parallel, it has designed and developed a series of thematic workshops on integrated care, change management, teamwork, and leadership. The Center has reached out to more than 700 key implementers and offered training to over 100 decision makers, managers, and clinicians. The greatest achievements were reached in Comunidad Valenciana regional health system, where ICPs have been adopted by the Regional Health Authority as the blueprint for transformation, and have been included as a KPI on the commissioning agreements. In total, 8 ICPs have been implemented in the following diseases: Stroke, Diabetes, Coronary System, Agitated Patient, Asthma and Dyspepsia. Sustainability: It is too early to assess the sustainability of these strategies, however, it seems plausible to expect a high degree of long-term sustainability when this work is embedded in other management and governance tools, such as strategic plans, performance agreements, commissioning plans. Transferability: The SNS is decentralized in 17 regional systems with Chronic Disease Management strategies in place, facilitating the piloting and implementation of initiatives and offering an opportunity for cross-learning and knowledge exchange. The toolkits created have been developed by a multilevel group of experts, leaders of the main regions, and this, allows the proposed guidelines to have maximum applicability. Conclusions: - Facilitators are useful in accelerating the deployment of ICPs - Successful implementation requires the buy-in of the top leadership and alignment - Contextualization, transparency, and involvement from start are key for clinicians buy-in Discussion: successful ICP implementation requires a deep understanding of the local context and alignment between bottom-up and top-down. However in a NHS systems like the SNS bottom-up initiatives are often difficult to scale up and it is necessary to encourage change and alignment at the meso and macro level and top leadership support. Lessons: Where there is a methodology, change management training, facilitation and follow-up actions, deployment is faster and smoother. [ABSTRACT FROM AUTHOR]

Introduction: Integrated Care Pathways are a proven effective intervention to improve care coordination and quality of care, however their effective implementation presents important challenges and barriers at the clinical, meso and macro level. There is ample literature on actions and elements to be considered to ensure the success in the implementation of the ICPs, however they have not been ordered or systematized. This work develops a checklist to be applied in the implementation of ICPS with a systemic perspective, contemplating the actions to be developed at the macro, meso and micro levels. Theory: Checklists are an algorithmic listing of actions to be performed in a specific setting, to ensure that no step will be forgotten. Although a seemingly simple intervention, checklists have a sound theoretical basis in principles of human factors engineering and have been successfully applied in the health sector. On first place a checklist tool was created to support the implementation of ICPs based on a literature review, previous experiences on ICPs implementation in the Spanish contexts and a consensus by the core research team. Secondly, a multidisciplinary group of key opinion leaders 19, including practitioners, healthcare managers and policy makers from 9 Spanish regions validated and improved the tool for its successful application on a real setting. An individual reflection was followed by a moderated group discussion. Three aspects were evaluated: the validity of the proposed structure and approach, the utility of the checklist for the different and the content of the phases and items including proposals for improvement. Results: The tool has been created as a checklist comprising 25 items grouped in the following 7 phases: health policies, organizational readiness, awareness, leadership alignment, local deployment, support and evaluation & improvement. The final validated and improved version of the checklist including the 25 items will be presented at ICIC18. Discussions: The developed checklist has a high face-validity for more than 20 integrated care experts of different Spanish healthcare subsystems that consider it as a useful tool to help implementers to follow on a quick and simply way what things need to happen to successfully implement ICPs in a local context. However the checklist has still to be tested in real policy and practice. Conclusions: A checklist for guiding ICP implementation has been developed and validated for the context of the spanish health system that seems useful for other kind of systems but particularly in those NHS-like and with dominant public provision. Lessons: The application of checklists in healthcare management is possible and accepted by managers, although the approach cannot seem as mechanistic as in more structured, simple and sequential kind of interventions. Limitations: By standardizing the list of steps to be followed, and formalizing the expectation that every step will be followed this checklist has the potential to greatly minimize failures; however ICP implementation is a complex intervention where other complementary tools and change management approaches are required to ensure success. Suggestions: It would be recommended to pilot this checklist in different healthcare organisations and contexts. [ABSTRACT FROM AUTHOR]

Introduction: Integrated Care Pathways are a proven effective intervention to improve care coordination and quality of care, however their implementation presents important challenges and barriers at the clinical, meso and macro level. The literature identifies actions and elements to be considered that contribute to their effective implementation. However, their implementation is context-dependent, needing a systemic perspective to understand the barriers and elements that can facilitate its deployment in the Spanish National Health System. Theory: We understand ICPs as a pact between professionals and organizations from different healthcare areas that operate in the same territory and serve the same population affected by a specific health problem/s, to apply the criteria of good practice, optimize care circuits and plan responses to foreseeable scenarios. A qualitative research session was conducted with a multidisciplinary group of key opinion leaders 19, including clinicians, healthcare managers and policy makers from 9 different Spanish regions. Design thinking methodology was used to identify and agree upon key barriers and enablers for the implementation of ICPs from a macro, meso and micro perspective. The session was underpinned, by the knowledge gathered through systematic review and lessons learned from a best practice of ICPs implementation in Spain. Results: Structured list of key barriers and enablers at macro, meso and micro level for an effective implementation of ICPs. The identified barriers were: lack of systemic and integrative vision; clinical and social complexity of the patient, rigidity and work in silos, nonintegrated information systems; individualist professional culture, absence of transformational leadership, patient not located in the center, and lack of training. Enablers were also identified. Discussions: As the literature highlights, successful ICP implementation requires a deep understanding of the local contexts and alignment between bottom-up initiatives and topdown support. Conclusions: There are several issues preventing a larger deployment of ICPs in Spain: at macro level there is a general lack of strategic vision towards integrated care from a systems perspective, especially from a multisector approach. At meso level, the historical fragmentation of organizations poses a strong challenge towards care coordination. At the micro level a lack of clinical leadership and buy-in hinders the needed multidisciplinary and collaborative work. Strategic alignment, better information systems, improving data collection, continuous monitoring and evaluation, feedback looping to professionals, incentives and training healthcare professionals in communication and team-work skills were identified as facilitators. Lessons: Although coming from different regions and professional backgrounds, all participants have experienced similar problems with the implementation of ICPs. ICPs implementation go beyond the development of a booklet with a set of guidelines, they imply local agreements, cultural change and doing things differently. They need a strong sustained buy-in from every level, a leading core team, sufficient resources, and a continuous support to manage cultural change and adaptation to local context. Limitations: This research has been focused on a particular health system. Conclusions should be generalized with caution. Suggestions: Further research is needed to demonstrate if the conclusions of this study are applicable to other settings, particularly in non NHS-like systems. [ABSTRACT FROM AUTHOR]