Background
Increasing the diversity of the health and social care workforce leads to improved quality of care for patients, better patient adherence to medical and self-care regimes, and improved outcomes. This paper presents the details of the design, delivery, and evaluation of the Collaboraborative Targeted Outreach Programme (CTOP) which is a culturally competent outreach intervention developed from research and co-designed with people from diverse backgrounds living in Luton, Bedford and Milton Keynes (BLMK), three towns in the UK, to engage with young people, parents, career-switchers and underrepresented groups to improve knowledge, perceptions, status and the numbers of people choosing courses and careers in health and social care.
Approach
The CTOP intervention has been delivered at community events in BLMK. Integral to CTOP is an embedded culturally competent approach to community engagement, utilising bi-lingual community researchers from local communities who were able to develop tailored messages as trusted messengers. Attendees at all CTOP events took part in a healthcare professionals quiz and heard life stories from professionals from diverse backgrounds working in health and social care. School pupils also visited the simulation suite and library. University staff and health and social care professionals were available at all events to answer questions. The BLMK community and school pupils were also invited to watch a live performance of the CTOP play which was developed in collaboration with Komola Collective https://www.komola.co.uk/ and used storytelling to illustrate research findings which focus on the voices and lived experiences of young people, the community, and professionals from underrepresented groups on their views about the challenges and successes related choosing health and social care courses and careers.
Results
The CTOP intervention was able to recruit a wide range of people from diverse ethnic communities who are traditionally under-represented in the health and social care workforce with over 300 people attending the community events, 150 pupils from schools across BLMK also visiting the University of Bedfordshire and 200 people attended to watch the CTOP play by utilising a culturally competent approach to community engagement. The CTOP events were evaluated using a quantitative and qualitative approach and demonstrated that it raised the knowledge, perceptions, and status of health and social care courses and careers. All participants had positive views about attending the CTOP outreach events and said it was a good experience and raised their aspirations.
Implications
Overall the design and delivery of the CTOP intervention was effective in attracting underrepresented communities and engaging with young people, parents, and career-switchers to improve knowledge, perceptions, and status of courses and careers in health and social care. CTOP is underpinned by genuine community engagement and empowerment, which requires dedicated skills, time, and resources to ensure that diversity and inclusion in the NHS workforce becomes more of a reality rather than rhetoric leading to better health, better care, and better value.

Introduction: Researchers have found that shared decision-making with patients goes beyond clinical practice. Patient involvement in healthcare is evolving from being a consultant on an individual level to a partner in decision-making at the policy and governance levels. Most partnership methodologies focus on co-designing care that fits patients' needs and expectations rather than focusing on the initial step of the quality improvement cycle, which is diagnosis.
Objectives: The purpose of this study is to assess the effectiveness of the partnership in the co-diagnosis approach, through the design of a comprehensive audit tool that will be used by patient partners. Patients were empowered to act as quality professionals in the study, marking it as the first comprehensive research methodology applied at a specialty hospital in Lebanon.
Methods: A quasi-experimental study design without concurrent controls with 50 patients recruited as partners in co-diagnoses for auditing healthcare delivery processes based on accreditation standards.
Results: Findings revealed that the average fully met percentages resulted from the inpatient audit as per the priority focus areas were 65.8% Access to Care, 50% Finance, 73.8% Plan of Care, 75.45% Continuity of Care, 98.6% Patients and Family Rights, 80.5% Patient’s Safety, 64.5% Infection Prevention and Control, 95.6% Ethics and Attitudes, 96.4% communication, 53.55% other services, 81% Discharge. The mean inpatient audit score was M=106.96; SD 6.88 out of 120. Among the outpatient audit priority focus areas, the average of the fully met percentages were 68.2%% Access to Care, 54.5% Finance, 55.5% Patients and Family Rights, 70.45% Patient’s Safety, 62.7% Infection Prevention and Control, 94.9% Ethics and Attitudes, 94% communication, 59.1% Discharge. The outpatient audit score was M=69.18; SD 10.51 out of 84. Partners' characteristics were not significantly different among audit scores. Only the outpatient Audit Score for partners that performed the audit in OPD (mean: 74.8 points) was significantly higher than partners who performed the audit in other patient care units’ laboratory and MI (mean: 58.5 points) (mean: 63 points) respectively (p=0.005). We evaluated partners' experience through the PPEET. The mean of the PPEE score was M=54.96; SD 4.82. Out of 50 partners, 92.6% agree to strongly agree that there was communication and support for participation, 96.5% strongly agree with terms of sharing views and perspectives, 94.6% strongly agree with the positive impacts and influence of the engagement initiative, and 94% were satisfied with this engagement initiative.
Conclusion: Co-diagnosing partners introduced innovative perspectives for strengthening the healthcare system. The new approach must be tested in more depth before it can be determined whether it is superior to the conventional audit process.

Background
Most public health systems necessarily entail a division of responsibility between central and local authorities – with the relationship between levels defined through a combination of hierarchical, contractual and financial structures. The implementation of new policies and initiatives are increasingly devolved to local levels for adaption and implementation; but set within boundaries of broader central policy.
Collaborative Commissioning is an initiative of New South Wales, Australia with the vision to develop regional alliances between hospital and primary care authorities for implementing local integrated care. Each region is required to establish a case for entering the initiative; moving through formal phases of community consultation, feasibility and implementation. Joint governance committees and planning are a requirement of participation. We sought to determine how and why programs in each region converged and diverged and in terms of focus, ways of working and underlying principles in implementing the initiative.
Approach
We undertook document review, key informant interviews and key stakeholder workshops with program designers, managers, service providers and other stakeholders in 4 regions that had moved into the ‘feasibility’ phase of the initiative. We then developed a localised theory-of-change (ToC) for each region that was further refined with participants. To compare and contrast regions, we then identified the core focus as well as underlying theoretical assumptions across each ToC.
Results
As was an expectation of the central initiative, each of regions focused on a different target cohort based on mapped local need (e.g. older patients, diabetes, heart disease and urgent care). Local programs different significantly in terms of ways of working and underlying theory; which we stratified into 4 groupings. Group 1 developed local programs around identifying assumptions about process – specifically patient entry and flow. Group 2 focused on relationships (contractual, financial, professional) between various local service providers and identifying agents of change. Group 3 identified key equity problem clusters in unique local circumstances. Group 4 focused on balance between service supply and demand as well as risks to longer term sustainability. Overall, elements of local context that determined focus and underlying principes ranged from population characteristics; payment models, contracting and availability of service providers; equity; geography; experience with other integrated care initiatives and aligned resourcing; and interprofessional relationships.
Implications
Local implementation of central authority initiatives is highly dependent on a range of factors that stretches beyond local population need. This impacts on the extent to which the underlying purpose of devolution can be fulfilled.

In Ontario, the creation of Primary Care Networks (PCNs) within the larger framework of Ontario Health Teams (OHTs) is central to addressing the primary care physician (PCP) shortage in Canada. PCPs are joining together to form PCNs, in order to implement practical initiatives to address the growing shortage of PCPs and address the administrative burden on PCPs.
The integration of digital solutions, particularly AI-powered scribes, into PCNs within OHTs is a promising strategy to help alleviate the administrative burden on PCPs in Ontario, and is part of broader efforts to support PCPs to remain in practice.
To effectively address the PCP shortage, especially in underserved areas, digital tools like AI scribes must be scalable, thus investments are directed to multi-sectoral partnerships, to implement AI scribe initiatives. This has fueled the development of integrated and robust governance and accountability structures that are necessary to implement digital solutions quickly, effectively, and at scale.
As one of the PCNs in a multi-sectoral partnership for an AI scribe initiative, the East Toronto Family Practice Network (EasT-FPN) played a pivotal role as the lead integration partner- stewarding critical functions to enable system wide governance and leadership, and cross-organizational project planning, implementation, and evaluation.The EasT-FPN established a distributive leadership and multi-sectoral governance and organizational model, made up of strategic, executive and operational leaders from each partner organization. This includes PCN and OHT Executive Leaders; an academic institution; an organization that holds expertise in customizing and implementing digital solutions in family practices; and a medical technology company.Following a rapid plan-do-study-act (PDSA) cycle approach, the EasT-FPN established the formation of: 1) an inter-organizational governance structure, (2) operational structure, and (3) a funder- accountability structure, that is far from a command and control leadership and governance structure. Embedded within each of the 3 structures are clear decision-making processes, two-way communication channels, and clear project roles and responsibilities, to bring the project to full implementation within 6 months.
Far from command and control leadership, the EasT-FPN established a collaborative framework for the project that facilitates shared decision-making; the co-creation of project roles, two-way communication channels; a shared project vision; collective accountability mechanisms; the coordination and sharing of resources and expertise among project partners; and the co-design of the project’s implementation and evaluation strategies.Establishing multi-partner and sectoral governance and leadership structures, for implementing integrated care initiatives is a complex and challenging task. The success of these initiatives relies on aligning diverse stakeholders with varying interests, organizational goals, expertise, responsibilities, and resources. This oral presentation will share key learning points from the EasT-FPN’s journey of developing network governance structures for integrated initiatives, and share insights into challenges and solutions that can help refine governance in integrated care healthcare systems.