{"id":{"repo_id":"exeter","oai_identifier":"oai:figshare.com:article/31834483"},"canonical_url":"https://search.dev.ndltd.org/etd/exeter/oai:figshare.com:article/31834483","repository":{"repo_id":"exeter","name":"University of Exeter","base_url":"https://api.figshare.com/v2/oai"},"display":{"title":"The implementation of integrated psychological medicine services in historically siloed acute healthcare systems: A study on the factors influencing implementation","abstract":"Integrated care is a crucial component of Western healthcare provision; however, its implementation within secondary acute care faces significant challenges and delivery remains inconsistent and under-theorised. Key challenges include fragmented service structures, contested conceptualisations of integration, and historically siloed healthcare systems, beliefs and infrastructure. UK healthcare policy emphasises the integration of physical and psychological care for individuals with co-occurring conditions and the achievement of parity of esteem between mental and physical health services. Despite long-standing recognition that patients frequently experience discontinuities in care (‘falling through the gaps’), empirical evidence is lacking relating to the sustained implementation of embedded psychological medicine models within acute hospital settings. In particular, staff experiences and the contextual factors influencing implementation have been insufficiently explored. This thesis aimed to develop an empirically grounded and theoretically informed understanding of factors influencing the implementation of integrated psychological medicine services in UK secondary care through two studies. I conducted a scoping review to synthesise existing literature on integrated care models and factors influencing their implementation. I undertook a qualitative ethnographic study exploring the real-world implementation of an integrated psychological medicine service-model within/across two acute hospital trusts, during a period of significant organisational and system-level disruption (COVID-19 pandemic). In the scoping review I synthesised 45 papers identifying key themes influencing implementation. Key barriers included resource constraints, professional beliefs/expectations surrounding the innovation, antiquated/incompatible information technology (IT) systems, and organisational infrastructure. Key enablers included staff co-location, supporting staff to deliver the innovation, communication and relationship-building across professional boundaries, and shared/integrated IT systems. I conducted a longitudinal ethnographic study informed by Implementation Science using online digital technology. I triangulated data collection methods 3 over 22-months (March 2022-December 2023) through attending 60 service meetings, semi-structured interviews with 12 staff members, and document analysis. Findings identified that implementation was shaped by interacting factors operating across multiple contextual levels. At the organisational (meso) level, limitations in infrastructure/IT, co-located physical space, and resourcing impeded integrated working. At the individual (micro) level, inconsistent professional language and negative beliefs about mental health hindered multidisciplinary communication and the integration of psychological care within the physical healthcare setting. At the wider/system (macro) level, historically disconnected mental and physical healthcare structures continued to hinder integration. Focusing on key factors influencing implementation, I developed three concepts to provide a contextually specific secondary acute care understanding of integration, integrated care and implementation. My analysis identified ‘clinical trust’ and ‘active participation’ as critical mechanisms underpinning the sustained implementation of the integrated psychological medicine service-model. The findings highlighted how healthcare staff adapted the service-model in response to contextual constraints to meet the needs of patients while working towards achieving parity of esteem, thus conceptualising integrated care as a dynamic and negotiated process. My research emphasises the need for organisations to actively support implementation efforts by providing resources to conduct ‘psychologically safe’ collaborative work to sustain an integrated physical and psychological service-model. I extended the conventional applications of an implementation science framework across my studies to capture the more participatory and facilitative implementation actions spanning established constructs to encompass multiple mechanisms impacting across system levels. Finally, my findings offer theoretical and practical implications for the implementation, adaptation and sustainability of integrated care innovations, within acute secondary care settings within the National Health Service.<p></p>","abstract_html":"Integrated care is a crucial component of Western healthcare provision; however, its implementation within secondary acute care faces significant challenges and delivery remains inconsistent and under-theorised. Key challenges include fragmented service structures, contested conceptualisations of integration, and historically siloed healthcare systems, beliefs and infrastructure. UK healthcare policy emphasises the integration of physical and psychological care for individuals with co-occurring conditions and the achievement of parity of esteem between mental and physical health services. Despite long-standing recognition that patients frequently experience discontinuities in care (‘falling through the gaps’), empirical evidence is lacking relating to the sustained implementation of embedded psychological medicine models within acute hospital settings. In particular, staff experiences and the contextual factors influencing implementation have been insufficiently explored. This thesis aimed to develop an empirically grounded and theoretically informed understanding of factors influencing the implementation of integrated psychological medicine services in UK secondary care through two studies. I conducted a scoping review to synthesise existing literature on integrated care models and factors influencing their implementation. I undertook a qualitative ethnographic study exploring the real-world implementation of an integrated psychological medicine service-model within/across two acute hospital trusts, during a period of significant organisational and system-level disruption (COVID-19 pandemic). In the scoping review I synthesised 45 papers identifying key themes influencing implementation. Key barriers included resource constraints, professional beliefs/expectations surrounding the innovation, antiquated/incompatible information technology (IT) systems, and organisational infrastructure. Key enablers included staff co-location, supporting staff to deliver the innovation, communication and relationship-building across professional boundaries, and shared/integrated IT systems. I conducted a longitudinal ethnographic study informed by Implementation Science using online digital technology. I triangulated data collection methods 3 over 22-months (March 2022-December 2023) through attending 60 service meetings, semi-structured interviews with 12 staff members, and document analysis. Findings identified that implementation was shaped by interacting factors operating across multiple contextual levels. At the organisational (meso) level, limitations in infrastructure/IT, co-located physical space, and resourcing impeded integrated working. At the individual (micro) level, inconsistent professional language and negative beliefs about mental health hindered multidisciplinary communication and the integration of psychological care within the physical healthcare setting. At the wider/system (macro) level, historically disconnected mental and physical healthcare structures continued to hinder integration. Focusing on key factors influencing implementation, I developed three concepts to provide a contextually specific secondary acute care understanding of integration, integrated care and implementation. My analysis identified ‘clinical trust’ and ‘active participation’ as critical mechanisms underpinning the sustained implementation of the integrated psychological medicine service-model. The findings highlighted how healthcare staff adapted the service-model in response to contextual constraints to meet the needs of patients while working towards achieving parity of esteem, thus conceptualising integrated care as a dynamic and negotiated process. My research emphasises the need for organisations to actively support implementation efforts by providing resources to conduct ‘psychologically safe’ collaborative work to sustain an integrated physical and psychological service-model. I extended the conventional applications of an implementation science framework across my studies to capture the more participatory and facilitative implementation actions spanning established constructs to encompass multiple mechanisms impacting across system levels. Finally, my findings offer theoretical and practical implications for the implementation, adaptation and sustainability of integrated care innovations, within acute secondary care settings within the National Health Service.&lt;p&gt;&lt;/p&gt;","abstract_has_math":false,"creators":["Sara Eddy (21039596)"],"institution":null,"degree_name":null,"degree_level":null,"degree_discipline":null,"degree_department":null,"school":null,"contributors":[],"advisors":[],"committee_chairs":[],"committee_members":[],"year":2026,"date_issued":"2026-03-10T00:00:00Z","date_published":"2026-03-10T00:00:00Z","updated_at":"2026-07-27T19:33:50Z","subjects":["Integrated Physical and Psychological care","Models of Integrated care","Psychological Medicine","Implementation","Adoption, Adaptation, Sustainment","Ethnography"],"languages":[],"rights":["All rights reserved","Open Access after 2031-03-09"],"rights_urls":[],"identifier_entries":[{"key":"dc:identifier","label":"Identifier","values":["10779/exe.31834483.v1"],"render_values":[{"text":"10779/exe.31834483.v1","href":null,"code":true}]}]},"links":{"outbound_url":null,"outbound_label":null,"outbound_source":null},"metadata_groups":[{"id":"people","label":"People","entries":[{"key":"dc:creator","label":"Author","values":["Sara Eddy (21039596)"]}]},{"id":"academic_context","label":"Academic Context","entries":[{"key":"dc:date","label":"Dc Date","values":["2026-03-10T00:00:00Z"]},{"key":"dc:relation","label":"Dc Relation","values":["https://figshare.com/articles/thesis/The_implementation_of_integrated_psychological_medicine_services_in_historically_siloed_acute_healthcare_systems_A_study_on_the_factors_influencing_implementation/31834483"]},{"key":"dc:type","label":"Dc Type","values":["Text","Thesis"]}]},{"id":"subjects_keywords","label":"Subjects and Keywords","entries":[{"key":"dc:subject","label":"Dc Subject","values":["Integrated Physical and Psychological care","Models of Integrated care","Psychological Medicine","Implementation","Adoption, Adaptation, Sustainment","Ethnography"]}]},{"id":"language_rights","label":"Language and Rights","entries":[{"key":"dc:rights","label":"Dc Rights","values":["All rights reserved","Open Access after 2031-03-09"]}]},{"id":"identifiers","label":"Identifiers","entries":[{"key":"dc:identifier","label":"Identifier","values":["10779/exe.31834483.v1"]}]},{"id":"additional","label":"Additional Metadata","entries":[{"key":"dc:description","label":"Description","values":["Integrated care is a crucial component of Western healthcare provision; however, its implementation within secondary acute care faces significant challenges and delivery remains inconsistent and under-theorised. Key challenges include fragmented service structures, contested conceptualisations of integration, and historically siloed healthcare systems, beliefs and infrastructure. UK healthcare policy emphasises the integration of physical and psychological care for individuals with co-occurring conditions and the achievement of parity of esteem between mental and physical health services. Despite long-standing recognition that patients frequently experience discontinuities in care (‘falling through the gaps’), empirical evidence is lacking relating to the sustained implementation of embedded psychological medicine models within acute hospital settings. In particular, staff experiences and the contextual factors influencing implementation have been insufficiently explored. This thesis aimed to develop an empirically grounded and theoretically informed understanding of factors influencing the implementation of integrated psychological medicine services in UK secondary care through two studies. I conducted a scoping review to synthesise existing literature on integrated care models and factors influencing their implementation. I undertook a qualitative ethnographic study exploring the real-world implementation of an integrated psychological medicine service-model within/across two acute hospital trusts, during a period of significant organisational and system-level disruption (COVID-19 pandemic). In the scoping review I synthesised 45 papers identifying key themes influencing implementation. Key barriers included resource constraints, professional beliefs/expectations surrounding the innovation, antiquated/incompatible information technology (IT) systems, and organisational infrastructure. Key enablers included staff co-location, supporting staff to deliver the innovation, communication and relationship-building across professional boundaries, and shared/integrated IT systems. I conducted a longitudinal ethnographic study informed by Implementation Science using online digital technology. I triangulated data collection methods 3 over 22-months (March 2022-December 2023) through attending 60 service meetings, semi-structured interviews with 12 staff members, and document analysis. Findings identified that implementation was shaped by interacting factors operating across multiple contextual levels. At the organisational (meso) level, limitations in infrastructure/IT, co-located physical space, and resourcing impeded integrated working. At the individual (micro) level, inconsistent professional language and negative beliefs about mental health hindered multidisciplinary communication and the integration of psychological care within the physical healthcare setting. At the wider/system (macro) level, historically disconnected mental and physical healthcare structures continued to hinder integration. Focusing on key factors influencing implementation, I developed three concepts to provide a contextually specific secondary acute care understanding of integration, integrated care and implementation. My analysis identified ‘clinical trust’ and ‘active participation’ as critical mechanisms underpinning the sustained implementation of the integrated psychological medicine service-model. The findings highlighted how healthcare staff adapted the service-model in response to contextual constraints to meet the needs of patients while working towards achieving parity of esteem, thus conceptualising integrated care as a dynamic and negotiated process. My research emphasises the need for organisations to actively support implementation efforts by providing resources to conduct ‘psychologically safe’ collaborative work to sustain an integrated physical and psychological service-model. I extended the conventional applications of an implementation science framework across my studies to capture the more participatory and facilitative implementation actions spanning established constructs to encompass multiple mechanisms impacting across system levels. Finally, my findings offer theoretical and practical implications for the implementation, adaptation and sustainability of integrated care innovations, within acute secondary care settings within the National Health Service.<p></p>"]},{"key":"dc:title","label":"Title","values":["The implementation of integrated psychological medicine services in historically siloed acute healthcare systems: A study on the factors influencing implementation"]}]}],"canonical_facts":{"dc:creator":["Sara Eddy (21039596)"],"dc:date":["2026-03-10T00:00:00Z"],"dc:description":["Integrated care is a crucial component of Western healthcare provision; however, its implementation within secondary acute care faces significant challenges and delivery remains inconsistent and under-theorised. Key challenges include fragmented service structures, contested conceptualisations of integration, and historically siloed healthcare systems, beliefs and infrastructure. UK healthcare policy emphasises the integration of physical and psychological care for individuals with co-occurring conditions and the achievement of parity of esteem between mental and physical health services. Despite long-standing recognition that patients frequently experience discontinuities in care (‘falling through the gaps’), empirical evidence is lacking relating to the sustained implementation of embedded psychological medicine models within acute hospital settings. In particular, staff experiences and the contextual factors influencing implementation have been insufficiently explored. This thesis aimed to develop an empirically grounded and theoretically informed understanding of factors influencing the implementation of integrated psychological medicine services in UK secondary care through two studies. I conducted a scoping review to synthesise existing literature on integrated care models and factors influencing their implementation. I undertook a qualitative ethnographic study exploring the real-world implementation of an integrated psychological medicine service-model within/across two acute hospital trusts, during a period of significant organisational and system-level disruption (COVID-19 pandemic). In the scoping review I synthesised 45 papers identifying key themes influencing implementation. Key barriers included resource constraints, professional beliefs/expectations surrounding the innovation, antiquated/incompatible information technology (IT) systems, and organisational infrastructure. Key enablers included staff co-location, supporting staff to deliver the innovation, communication and relationship-building across professional boundaries, and shared/integrated IT systems. I conducted a longitudinal ethnographic study informed by Implementation Science using online digital technology. I triangulated data collection methods 3 over 22-months (March 2022-December 2023) through attending 60 service meetings, semi-structured interviews with 12 staff members, and document analysis. Findings identified that implementation was shaped by interacting factors operating across multiple contextual levels. At the organisational (meso) level, limitations in infrastructure/IT, co-located physical space, and resourcing impeded integrated working. At the individual (micro) level, inconsistent professional language and negative beliefs about mental health hindered multidisciplinary communication and the integration of psychological care within the physical healthcare setting. At the wider/system (macro) level, historically disconnected mental and physical healthcare structures continued to hinder integration. Focusing on key factors influencing implementation, I developed three concepts to provide a contextually specific secondary acute care understanding of integration, integrated care and implementation. My analysis identified ‘clinical trust’ and ‘active participation’ as critical mechanisms underpinning the sustained implementation of the integrated psychological medicine service-model. The findings highlighted how healthcare staff adapted the service-model in response to contextual constraints to meet the needs of patients while working towards achieving parity of esteem, thus conceptualising integrated care as a dynamic and negotiated process. My research emphasises the need for organisations to actively support implementation efforts by providing resources to conduct ‘psychologically safe’ collaborative work to sustain an integrated physical and psychological service-model. I extended the conventional applications of an implementation science framework across my studies to capture the more participatory and facilitative implementation actions spanning established constructs to encompass multiple mechanisms impacting across system levels. Finally, my findings offer theoretical and practical implications for the implementation, adaptation and sustainability of integrated care innovations, within acute secondary care settings within the National Health Service.<p></p>"],"dc:identifier":["10779/exe.31834483.v1"],"dc:relation":["https://figshare.com/articles/thesis/The_implementation_of_integrated_psychological_medicine_services_in_historically_siloed_acute_healthcare_systems_A_study_on_the_factors_influencing_implementation/31834483"],"dc:rights":["All rights reserved","Open Access after 2031-03-09"],"dc:subject":["Integrated Physical and Psychological care","Models of Integrated care","Psychological Medicine","Implementation","Adoption, Adaptation, Sustainment","Ethnography"],"dc:title":["The implementation of integrated psychological medicine services in historically siloed acute healthcare systems: A study on the factors influencing implementation"],"dc:type":["Text","Thesis"]},"updated_at":"2026-07-27T19:33:50Z"}