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Please select the level of maturity per trait that reflects your care system.


Integrated care network: Nine traits   Adhoc Tactical Focused Strategic Pervasive
Level 1 Level 2 Level 3 Level 4 Level 5
1. Envisioning a patient-centered system   Care delivery is designed around organizations, a paradigm shift is needed which focuses on patient-centered integrated care The care system has a shared vision which promotes integrated care but is still organizationally focused The system can demonstrate that it designs and delivers integrated care pathways which improves patient outcomes Care pathways and networks demonstrate improved outcomes, patient experience and it reduces waste/cost The system is patient-centered, demonstrates system-wide improved outcomes and better population health management

 
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    Adhoc Tactical Focused Strategic Pervasive
Level 1 Level 2 Level 3 Level 4 Level 5
2. Engaging patients as co-designers   No patients were
involved in care design		 Patient is a client (e.g., represented by patient advocacy orgs, some quality-indicators used etc.) Patients are represented in the design process (e.g., on boards, consulted when new plans are released) Patients are influential in the design process (e.g., using PROMs or PREMs, inform the design of pathways, etc.) Patients are co-creators who are part of the design and decision-making process related to planning care across the full continuum

     
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    Adhoc Tactical Focused Strategic Pervasive
Level 1 Level 2 Level 3 Level 4 Level 5
3. Bold leadership manages the change   Focus on individual organization A move from a focus on the organization to the system Leaders work together to develop integrated care networks Leaders work together, develop integrated care networks, and collaborative relationships Strong, bold and visionary leadership and effective co-production underpin the whole process and leaders openly hold each other to account
 

 
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    Adhoc Tactical Focused Strategic Pervasive
Level 1 Level 2 Level 3 Level 4 Level 5
4. Care happens in the right setting   High levels of attendance and avoidable or inappropriate admissions at the hospital Demand management, referral management and discharge planning are in place Demand management, referral management and discharge plans schemes are measured and reduce avoidable attendances and admissions
 System wide working to deliver integrated care, improved patient pathways/
networks and joined-up data/IT		 Fully integrated system, care happens in the right setting and evidenced with real-time data, improved outcomes and reporting
       
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    Adhoc Tactical Focused Strategic Pervasive
Level 1 Level 2 Level 3 Level 4 Level 5
5. Draws on a broad array of partners   Little or no alignment. Stakeholders have informal and ad hoc relationships A mapping of the health and care system has been undertaken and joint working has been explored Stakeholders meet and have joint plans in place and deliver elements of care together A formal partnership/
alliance is in place, stakeholders are aligned and work collaborativel		 The partners deliver seamless integrated care, incentives are aligned and user satisfaction is high
       
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    Adhoc Tactical Focused Strategic Pervasive
Level 1 Level 2 Level 3 Level 4 Level 5
6. Incentives are aligned to the right outcomes   There is no scrutiny of cost efficiency or quality incentives linked to care There are ad hoc measures to try to reduce spend and/or improve quality Cost efficiency incentives (e.g., risk sharing, capitated budgets, etc.) are present Quality incentives (e.g., outcome measures, bonus payments for quality) are present Both cost efficiency and quality incentives are present in the system and encourage the right behaviors
       
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    Adhoc Tactical Focused Strategic Pervasive
Level 1 Level 2 Level 3 Level 4 Level 5
7. Uses technology to enable care delivery   Technology infrastructure and clinical systems are in place (EPR) but information is used in silos Health Information exchange (HIE) developed, and some information is used to make decisions/
plans on care delivery		 Insight is derived from the data to design and deliver effective targeted care, digital technology is used to enhance patient pathways Digital technology is used across patient pathways with real time data collected and used to improve patient care End to end integrated technology which supports predictive analytics, personalized medicine and interventions
       
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    Adhoc Tactical Focused Strategic Pervasive
Level 1 Level 2 Level 3 Level 4 Level 5
8. Building the workforce to deliver   There is understaffing and gaps in required knowledge and skills and no workforce system plan The system has the right skills and knowledge but is understaffed and doesn’t coordinate resources effectively The system still has staffing gaps but works together to provide the skills and knowledge and has developed a plan The system has the right mix of staff, knowledge and skills to deliver integrated care The system has the right mix of staff, knowledge and skills to deliver integrated care. Technology is used to take over tasks and skills where appropriate. Tasks moved to lower levels
       
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    Adhoc Tactical Focused Strategic Pervasive
Level 1 Level 2 Level 3 Level 4 Level 5
9. Good governance across an integrated care network Loose governance arrangements with lack of clarity on decision making, and slow decision making hampering progress Internal and external stakeholders are involved in the process of developing the strategic plan, to ensure alignment to broader interests Roles and functions of good governance are aligned and defined and agreement on level of governance Clear aspirations and KPIs in place, decisive action is agreed and taken Leaders hold each other to account with clear lines of accountability to optimize integrated care
       
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