Table 1

Summary of ARC microsystem characteristics

Characteristic and operational definitionARC clinic application
Integration of information
Information is key, technology may be very helpful
The intervention was developed with oversight from a project steering group and patient and public engagement activities. We shared information about ARC with patients, clinicians, and senior leaders across primary and secondary care.
Microsystem routinely measures process and outcome data, feeds data back to providers, makes changes based on data
We measured patient-level outcomes using HNA and goal-attainment scores and collected qualitative feedback on the process and impact of attending the ARC clinic. We measured service-level outcomes in terms of uptake of rehabilitation referrals and HNA and care plan completion rates. We made iterative changes in response to the data.
Interdependence of the care team
Care provided by a multidisciplinary team, information is key to the relationship
The ARC clinic was developed as a Therapies-led intervention to be delivered alongside standard care. Communication between secondary and primary care (in terms of sharing HNA and care plans with GPs) was also promoted.
Supportiveness of the larger system
Microsystem views larger organisation as helpful
The organisation helped to shape the intervention. Senior NHS leaders and clinicians were consulted on the timing of the intervention and feedback was gathered on whether the proposed intervention would meet the identified quality improvement need.
Constancy of Purpose
Integration of the aim throughout the microsystem
The intervention was developed to complement and as a solution to support standard of care practice and to free up CNS clinical time for other duties as well as to enhance the quality of care.
Connection to community
Microsystem is a resource to the community, community is a resource to the microsystem
The project promoted patient engagement activities and worked closely with third sector services such as Maggie’s to connect to the wider community.
Investment in Improvement Resources made available for improvement (training, money, time)Funding was awarded to pilot the clinic for twelve months.
Alignment of role and training
Health professionals expected to work at the upper limits of education, training
A secondment opportunity was available to a senior AHP and training available as required.
  • AHP, allied health professional; ARC, Adversity-Restoration-Compatibility; GP, general practitioner; HNA, Holistic Needs Assessment.