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Orozco-Levi M, de Jesús Pérez V. Precision Solutions: A Strategy to Improve Medical Care for Patients With Pulmonary Hypertension in Latin America. Chest 2024; 165:669-672. [PMID: 38461017 DOI: 10.1016/j.chest.2023.10.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 09/25/2023] [Accepted: 10/26/2023] [Indexed: 03/11/2024] Open
Affiliation(s)
- Mauricio Orozco-Levi
- Respiratory Department, Hospital Internacional de Colombia-Fundación Cardiovascular de Colombia, Bogotà, Colombia; Pulmonary Circulation Department, Latin American Thoracic Association (ALAT), Bogotà, Colombia; Asociación Colombiana de Neumología y Cirugía de Tórax (ASONEUMOCITO), Bogotà, Colombia; Universidad de Santander (UDES), Bogotà, Colombia
| | - Vinicio de Jesús Pérez
- Division of Pulmonary, Allergy, and Critical Care Medicine, Stanford University, Stanford, CA.
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Elkhuizen SG, Vissers JMH, Mahdavi M, van de Klundert JJ. Modeling Patient Journeys for Demand Segments in Chronic Care, With an Illustration to Type 2 Diabetes. Front Public Health 2020; 8:428. [PMID: 33014961 PMCID: PMC7493672 DOI: 10.3389/fpubh.2020.00428] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 07/14/2020] [Indexed: 11/18/2022] Open
Abstract
Chronic care is an important area for cost-effective and efficient health service delivery. Matching demand and services for chronic care is not easy as patients may have different needs in different stages of the disease. More insight is needed into the complete patient journey to do justice to the services required in each stage of the disease, to the different experiences of patients in each part of the journey, and to outcomes in each stage. With patient journey we refer to the “journey” of the patient along the services received within a demand segment of chronic care. We developed a generic framework for describing patient journeys and provider networks, based on an extension of the well-known model of Donabedian, to relate demand, services, resources, behavior, and outcomes. We also developed a generic operational model for the detailed modeling of services and resources, allowing for insight into costs. The generic operational model can be tailored to the specific characteristics of patient groups. We applied this modeling approach to type 2 diabetes (T2D) patients. Diabetes care is a form of chronic care for patients suffering diabetes mellitus. We studied the performance of T2D networks, using a descriptive model template. To identify and describe demand we made use of the following demand segments within the diabetes type 2 population: patients targeted for prevention; patients with stage 1 diabetes treated by their GP with lifestyle advice; patients with diabetes stage 2 treated by their GP with lifestyle advice and oral medication; patients with stage 3 diabetes treated by their GP with lifestyle advice, oral medication, and insulin injections; patients with stage 4 diabetes with complications (treated by internal medicine specialists). We used a Markov model to describe the transitions between the different health states. The model enables the patient journey through the health care system for cohorts of newly diagnosed T2D patients to be described, and to make a projection of the resource requirements of the different demand segments over the years. We illustrate our approach with a case study on a T2D care network in The Netherlands and reflect on the role of demand segmentation to analyse the case study results, with the objective of improving the T2D service delivery.
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Affiliation(s)
- Sylvia G Elkhuizen
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Jan M H Vissers
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Mahdi Mahdavi
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, Netherlands.,National Institute for Health Research/Tehran University of Medical Sciences, Tehran, Iran.,Harvard T. H. Chan School of Public Health, The Bernard Lown Scholar for Cardiovascular Health, Department of Global Health and Population, Boston, MA, United States
| | - Joris J van de Klundert
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, Netherlands.,Prince Mohammad bin Salman School for Business and Entrepreneurship/King Abdullah Economic City, King Abdullah Economic City, Saudi Arabia
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Holen-Rabbersvik E, Thygesen E, Eikebrokk TR, Fensli RW, Slettebø Å. Barriers to exchanging healthcare information in inter-municipal healthcare services: a qualitative case study. BMC Med Inform Decis Mak 2018; 18:92. [PMID: 30404630 PMCID: PMC6223094 DOI: 10.1186/s12911-018-0701-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 10/26/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND In recent years, inter-municipal cooperation in healthcare services has been an important measure implemented to meet future demographic changes in western countries. This entails an increased focus on communication and information sharing across organisational borders. Technology enables efficient and effective solutions to enhance such cooperation. However, the systems in the healthcare sector tend not to communicate with one another. There is a lack of literature focusing on communication and information sharing in inter-municipal healthcare services. The aim of this article is to investigate both the characteristics of communication and information sharing, and the factors that serve as barriers to communication and information sharing for employees in inter-municipal healthcare services. METHODS In this study, a qualitative case study approach is used to investigate both characteristics of communication and information sharing, and factors enabling barriers to communication and information sharing for employees in newly established inter-municipal healthcare services. Data collection methods were individual interviews, focus group interviews, observation studies and a workshop. A total of 18 persons participated in the study. The interviews, observations and workshop were conducted over a period of ten months. RESULTS Communication and information sharing practices were found to be complex and characterised by multiple actors, information types and a combination of multiple actions. Findings indicate that 1. IT capability and usability 2. Differences 3. Privacy, confidentiality and security and 4. Awareness are all factors enabling barriers to communication and information sharing in inter-municipal healthcare services. Specifically, these barriers were related to lack of EHR usability, inadequate workflow processes, digital systems incompatibility, the understanding of needs in different systems and knowledge and practices regarding privacy and confidentiality. CONCLUSION By focusing on the context of inter-municipal cooperation when assessing communication and information sharing in healthcare services, this article contributes to close a gap in existing knowledge. The perspective of the employees provides useful insight, and findings can be relevant for future theory development and for managers and policymakers in inter-municipal services.
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Affiliation(s)
- Elisabeth Holen-Rabbersvik
- Department of Health and Nursing Science, Centre for eHealth, University of Agder, PO Box 509, 4898 Grimstad, Norway
| | - Elin Thygesen
- Department of Health and Nursing Science, Centre for eHealth, University of Agder, PO Box 509, 4898 Grimstad, Norway
| | - Tom Roar Eikebrokk
- Department of Information Systems, University of Agder, PO Box 422, 4604 Kristiansand, Norway
| | - Rune Werner Fensli
- Department of Information and Communication Technology, Centre for eHealth, University of Agder, PO Box 509, 4898 Grimstad, Norway
| | - Åshild Slettebø
- Department of Health and Nursing Science, Centre for care research, South University of Agder, PO Box 509, 4898 Grimstad, Norway
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Yousefi Nooraie R, Khan S, Gutberg J, Baker GR. A Network Analysis Perspective to Implementation: The Example of Health Links to Promote Coordinated Care. Eval Health Prof 2018; 42:395-421. [PMID: 29719988 DOI: 10.1177/0163278718772887] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Although implementation models broadly recognize the importance of social relationships, our knowledge about applying social network analysis (SNA) to formative, process, and outcome evaluations of health system interventions is limited. We explored applications of adopting an SNA lens to inform implementation planning, engagement and execution, and evaluation. We used Health Links, a province-wide program in Canada aiming to improve care coordination among multiple providers of high-needs patients, as an example of a health system intervention. At the planning phase, an SNA can depict the structure, network influencers, and composition of clusters at various levels. It can inform the engagement and execution by identifying potential targets (e.g., opinion leaders) and by revealing structural gaps and clusters. It can also be used to assess the outcomes of the intervention, such as its success in increasing network connectivity; changing the position of certain actors; and bridging across specialties, organizations, and sectors. We provided an overview of how an SNA lens can shed light on the complexity of implementation along the entire implementation pathway, by revealing the relational barriers and facilitators, the application of network-informed and network-altering interventions, and testing hypotheses on network consequences of the implementation.
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Affiliation(s)
- Reza Yousefi Nooraie
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Sobia Khan
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Jennifer Gutberg
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
| | - G Ross Baker
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
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Mahdavi M, Vissers J, Elkhuizen S, van Dijk M, Vanhala A, Karampli E, Faubel R, Forte P, Coroian E, van de Klundert J. The relationship between context, structure, and processes with outcomes of 6 regional diabetes networks in Europe. PLoS One 2018; 13:e0192599. [PMID: 29447220 PMCID: PMC5813938 DOI: 10.1371/journal.pone.0192599] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Accepted: 01/28/2018] [Indexed: 12/02/2022] Open
Abstract
Background While health service provisioning for the chronic condition Type 2 Diabetes (T2D) often involves a network of organisations and professionals, most evidence on the relationships between the structures and processes of service provisioning and the outcomes considers single organisations or solo practitioners. Extending Donabedian’s Structure-Process-Outcome (SPO) model, we investigate how differences in quality of life, effective coverage of diabetes, and service satisfaction are associated with differences in the structures, processes, and context of T2D services in six regions in Finland, Germany, Greece, Netherlands, Spain, and UK. Methods Data collection consisted of: a) systematic modelling of provider network’s structures and processes, and b) a cross-sectional survey of patient reported outcomes and other information. The survey resulted in data from 1459 T2D patients, during 2011–2012. Stepwise linear regression models were used to identify how independent cumulative proportion of variance in quality of life and service satisfaction are related to differences in context, structure and process. The selected context, structure and process variables are based on Donabedian’s SPO model, a service quality research instrument (SERVQUAL), and previous organization and professional level evidence. Additional analysis deepens the possible bidirectional relation between outcomes and processes. Results The regression models explain 44% of variance in service satisfaction, mostly by structure and process variables (such as human resource use and the SERVQUAL dimensions). The models explained 23% of variance in quality of life between the networks, much of which is related to contextual variables. Our results suggest that effectiveness of A1c control is negatively correlated with process variables such as total hours of care provided per year and cost of services per year. Conclusions While the selected structure and process variables explain much of the variance in service satisfaction, this is less the case for quality of life. Moreover, it appears that the effect of the clinical outcome A1c control on processes is stronger than the other way around, as poorer control seems to relate to more service use, and higher cost. The standardized operational models used in this research prove to form a basis for expanding the network level evidence base for effective T2D service provisioning.
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Affiliation(s)
- Mahdi Mahdavi
- National Institute of Health Research, Tehran University of Medical Sciences, Tehran, Iran
- Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Jan Vissers
- Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
- * E-mail:
| | - Sylvia Elkhuizen
- Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | | | | | | | - Raquel Faubel
- Joint Research Unit in ICT applied to Healthcare Process Re-engineering (eRDSS), Valencia, Spain
- University of Valencia, Valencia, Spain
| | - Paul Forte
- The Balance of Care Group, London, United Kingdom
| | - Elena Coroian
- Institute for Learning Innovation, Friedrich-Alexander-University Nuremberg-Erlangen, Nuremberg, Germany
| | - Joris van de Klundert
- Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
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Pucher KK, Candel MJ, Boot NM, de Vries NK. Predictors and mediators of sustainable collaboration and implementation in comprehensive school health promotion. HEALTH EDUCATION 2017. [DOI: 10.1108/he-12-2014-0101] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The Diagnosis of Sustainable Collaboration (DISC) model (Leurs et al., 2008) specifies five factors (i.e. project management, change management, context, external factors, and stakeholders’ support) which predict whether collaboration becomes strong and stable. The purpose of this paper is to study the dynamics of these factors in a study of multiple partnerships in comprehensive school health promotion (CSHP).
Design/methodology/approach
A Dutch two-year DISC-based intervention to support coordinators of five CSHP partnerships in the systematic development of intersectoral collaboration was studied in a pretest-posttest design. To uncover the determinants of sustainable collaboration and implementation of CSHP and to find possible mediators, the authors carried out multi-level path analyses of data on the DISC factors obtained from 90 respondents (response of approached respondents: 57 percent) at pretest and 69 respondents (52 percent) at posttest. Mediation mechanisms were assessed using joint significance tests.
Findings
The five DISC factors were important predictors of implementation of CSHP (explained variance: 26 percent) and sustainable collaboration (explained variance: 21 percent). For both outcomes, stakeholders’ support proved to be the most important factor. Regarding sustainable collaboration, mediation analysis showed that stakeholders’ support fully mediated the effects of change management, project management, external factors and context. This indicates that the extent of stakeholders’ support (e.g. appreciation of goals and high levels of commitment) determines whether collaboration becomes sustainable. The authors also found that the extent of stakeholders’ support in turn depends upon a well-functioning project management structure, the employment of change management principles (e.g. creation of a common vision and employment of appropriate change strategies), a favorable organizational context (e.g. positive experience with previous collaboration) and external context (e.g. positive attitudes of financing bodies and supporting health and educational policies). For the actual implementation of CSHP, partial mediation by the support factor was found. There was a direct positive effect of change management indicating that organizational knowledge is also necessary to implement CSHP, and a direct negative effect of project management, probably pointing to the negative effects of too much negotiation in the collaboration.
Research limitations/implications
A design lacking a control group, a small sample and a relatively early assessment after implementation support stopped limit the generalizability of the results.
Practical implications
Strategies targeting the DISC factors can enhance stakeholders’ support and thereby promote sustainable intersectoral collaboration and the implementation of CSHP.
Originality/value
The DISC model provides a fruitful conceptual framework for the study of predictors and processes in public health partnerships. The importance of stakeholders’ support and other factors in the model are demonstrated.
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Asselin J, Osunlana AM, Ogunleye AA, Sharma AM, Campbell-Scherer D. Challenges in interdisciplinary weight management in primary care: lessons learned from the 5As Team study. Clin Obes 2016; 6:124-32. [PMID: 26815638 PMCID: PMC5111761 DOI: 10.1111/cob.12133] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 09/27/2015] [Accepted: 11/26/2015] [Indexed: 12/28/2022]
Abstract
Increasingly, research is directed at advancing methods to address obesity management in primary care. In this paper we describe the role of interdisciplinary collaboration, or lack thereof, in patient weight management within 12 teams in a large primary care network in Alberta, Canada. Qualitative data for the present analysis were derived from the 5As Team (5AsT) trial, a mixed-method randomized control trial of a 6-month participatory, team-based educational intervention aimed at improving the quality and quantity of obesity management encounters in primary care practice. Participants (n = 29) included in this analysis are healthcare providers supporting chronic disease management in 12 family practice clinics randomized to the intervention arm of the 5AsT trial including mental healthcare workers (n = 7), registered dietitians (n = 7), registered nurses or nurse practitioners (n = 15). Participants were part of a 6-month intervention consisting of 12 biweekly learning sessions aimed at increasing provider knowledge and confidence in addressing patient weight management. Qualitative methods included interviews, structured field notes and logs. Four common themes of importance in the ability of healthcare providers to address weight with patients within an interdisciplinary care team emerged, (i) Availability; (ii) Referrals; (iii) Role perception and (iv) Messaging. However, we find that what was key to our participants was not that these issues be uniformly agreed upon by all team members, but rather that communication and clinic relationships support their continued negotiation. Our study shows that firm clinic relationships and deliberate communication strategies are the foundation of interdisciplinary care in weight management. Furthermore, there is a clear need for shared messaging concerning obesity and its treatment between members of interdisciplinary teams.
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Affiliation(s)
- J Asselin
- Department of Anthropology, University of Lethbridge, Lethbridge, Canada
| | - A M Osunlana
- Department of Family Medicine, University of Alberta, Clinical Research Unit, Edmonton, Canada
| | - A A Ogunleye
- Department of Family Medicine, University of Alberta, Clinical Research Unit, Edmonton, Canada
- Department of Medicine, Obesity Research & Management, University of Alberta, Edmonton, Canada
| | - A M Sharma
- Department of Medicine, Obesity Research & Management, University of Alberta, Edmonton, Canada
| | - D Campbell-Scherer
- Department of Family Medicine, University of Alberta, Clinical Research Unit, Edmonton, Canada
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Zou G, King R, Walley J, Yin J, Sun Q, Wei X. Barriers to hospital and tuberculosis programme collaboration in China: context matters. Glob Health Action 2015; 8:27067. [PMID: 26408404 PMCID: PMC4583609 DOI: 10.3402/gha.v8.27067] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Revised: 07/17/2015] [Accepted: 08/24/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND In many developing countries, programmes for 'diseases of social importance', such as tuberculosis (TB), have traditionally been organised as vertical services. In most of China, general hospitals are required to report and refer suspected TB cases to the TB programme for standardised diagnosis and treatment. General hospitals are the major contacts of health services for the TB patients. Despite the implementation of public-public/private mix, directly observed treatment, short-course, TB reporting and referral still remain a challenge. OBJECTIVE This study aims to identify barriers to the collaboration between the TB programme and general hospitals in China. DESIGN This is a qualitative study conducted in two purposefully selected counties in China: one in Zhejiang, a more affluent eastern province, and another in Guangxi, a poorer southwest province. Sixteen in-depth interviews were conducted and triangulated with document review and field notes. An open systems perspective, which views organisations as social systems, was adopted. RESULTS The most perceived problem appeared to be untimely reporting and referral associated with non-standardised prescriptions and hospitalisation by the general hospitals. These problems could be due to the financial incentives of the general hospitals, poor supervision from the TB programme to general hospitals, and lack of technical support from the TB programme to the general hospitals. However, contextual factors, such as different funding natures of different organisations, the prevalent medical and relationship cultures, and limited TB funding, could constrain the processes of collaboration between the TB programme and the general hospitals. CONCLUSIONS The challenges in the TB programme and general hospital collaboration are rooted in the context. Improving collaboration should reduce the potential mistrust of the two organisations by aligning their interests, improving training, and improving supervision of TB control in the hospitals. In particular, effective regulatory mechanisms are crucial to alleviate the negative impact of the contextual factors and ensure smooth collaboration.
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Affiliation(s)
- Guanyang Zou
- China Programme, COMDIS Health Services Delivery Research Consortium, University of Leeds, Shenzhen, China
- Institute for International Health and Development, Queen Margaret University, Edinburgh, UK
| | - Rebecca King
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, UK
| | - John Walley
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, UK
| | - Jia Yin
- Devision of Health System, Policy and Management, School of Public Health and Primary Care, Chinese University of Hong Kong, Hong Kong, China
| | - Qiang Sun
- Centre for Health Policy and Management, School of Public Health, Shandong University, Jinan, China
| | - Xiaolin Wei
- Devision of Health System, Policy and Management, School of Public Health and Primary Care, Chinese University of Hong Kong, Hong Kong, China;
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Pucher KK, Candel MJJM, Krumeich A, Boot NMWM, De Vries NK. Effectiveness of a systematic approach to promote intersectoral collaboration in comprehensive school health promotion-a multiple-case study using quantitative and qualitative data. BMC Public Health 2015; 15:613. [PMID: 26142899 PMCID: PMC4491197 DOI: 10.1186/s12889-015-1911-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 06/05/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We report on the longitudinal quantitative and qualitative data resulting from a two-year trajectory (2008-2011) based on the DIagnosis of Sustainable Collaboration (DISC) model. This trajectory aimed to support regional coordinators of comprehensive school health promotion (CSHP) in systematically developing change management and project management to establish intersectoral collaboration. METHODS Multilevel analyses of quantitative data on the determinants of collaborations according to the DISC model were done, with 90 respondents (response 57 %) at pretest and 69 respondents (52 %) at posttest. Nvivo analyses of the qualitative data collected during the trajectory included minutes of monthly/bimonthly personal/telephone interviews (N = 65) with regional coordinators, and documents they produced about their activities. RESULTS Quantitative data showed major improvements in change management and project management. There were also improvements in consensus development, commitment formation, formalization of the CSHP, and alignment of policies, although organizational problems within the collaboration increased. Content analyses of qualitative data identified five main management styles, including (1) facilitating active involvement of relevant parties; (2) informing collaborating parties; (3) controlling and (4) supporting their task accomplishment; and (5) coordinating the collaborative processes. CONCLUSIONS We have contributed to the fundamental understanding of the development of intersectoral collaboration by combining qualitative and quantitative data. Our results support a systematic approach to intersectoral collaboration using the DISC model. They also suggest five main management styles to improve intersectoral collaboration in the initial stage. The outcomes are useful for health professionals involved in similar ventures.
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Affiliation(s)
- Katharina K Pucher
- Department of Health Promotion, Maastricht University, Peter Debyeplein 1a, Box 616, 6200 MD, Maastricht, Netherlands.
| | - Math J J M Candel
- Department of Methodology and Statistics, Maastricht University, Peter Debyeplein 1a, 6200 MD, Maastricht, Netherlands.
| | - Anja Krumeich
- Department Department of Health, Ethics & Society, Maastricht University, Peter Debyeplein 1a, 6200 MD, Maastricht, Netherlands.
| | - Nicole M W M Boot
- Department of Education and Research, Nieuw Eyckholt 300, 6419 DJ , Heerlen, Netherlands.
| | - Nanne K De Vries
- Department of Health Promotion, Maastricht University, Peter Debyeplein 1a, Box 616, 6200 MD, Maastricht, Netherlands.
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Pucher K, Candel M, Boot N, van Raak A, de Vries NK. A multiple-case study of intersectoral collaboration in comprehensive school health promotion using the DIagnosis of Sustainable Collaboration (DISC) model. HEALTH EDUCATION 2015. [DOI: 10.1108/he-03-2014-0027] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
– Intersectoral collaboration is often a prerequisite for effective interventions in public health. The purpose of this paper is to assess the facilitating and hindering conditions regarding intersectoral collaboration between health authorities, public health services (PHSs), public services stakeholders (PPSs) and the education sector in comprehensive school health promotion (CSHP) in the Netherlands.
Design/methodology/approach
– CSHP collaborations in five Dutch regions were studied using a questionnaire based on the DIagnosis of Sustainable Collaboration (DISC) model, focusing on: change management; perceptions, intentions and actions of collaborating parties; project organization; and factors in the wider context. Univariate and multivariate analyses with bootstrapping were applied to 106 respondents (62 percent response).
Findings
– A similar pattern of facilitating and hindering conditions emerged for the five regions, showing positive perceptions, but fewer positive intentions and actions. An overall favorable internal and external context for collaboration was found, but limited by bureaucratic procedures and prioritizing stakeholders’ own organizational goals. Change management was rarely applied. Some differences between sectors emerged, with greatest support for collaboration found among the coordinating organizations (PHSs) and least support among the financing organization (municipalities).
Research limitations/implications
– The generalization of the findings is limited to the initial formation stage of collaboration, and may be affected by selection bias, small sample size and possible impact of interdepartmental collaboration within organizations.
Practical implications
– The authors recommend establishing stronger change management to facilitate translation of positive perceptions into intentions and actions, and coordination of divergent organizational structures and orientations among collaborating parties.
Originality/value
– The results show that it is valuable for collaborating parties to conduct DISC analyses to improve intersectoral collaboration in CSHP.
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Aantjes C, Quinlan T, Bunders J. Integration of community home based care programmes within national primary health care revitalisation strategies in Ethiopia, Malawi, South-Africa and Zambia: a comparative assessment. Global Health 2014; 10:85. [PMID: 25499098 PMCID: PMC4279695 DOI: 10.1186/s12992-014-0085-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Accepted: 11/25/2014] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND In 2008, the WHO facilitated the primary health care (PHC) revitalisation agenda. The purpose was to strengthen African health systems in order to address communicable and non-communicable diseases. Our aim was to assess the position of civil society-led community home based care programmes (CHBC), which serve the needs of patients with HIV, within this agenda. We examined how their roles and place in health systems evolved, and the prospects for these programmes in national policies and strategies to revitalise PHC, as new health care demands arise. METHODS The study was conducted in Ethiopia, Malawi, South Africa and Zambia and used an historical, comparative research design. We used purposive sampling in the selection of countries and case studies of CHBC programmes. Qualitative methods included semi-structured interviews, focus group discussions, service observation and community mapping exercises. Quantitative methods included questionnaire surveys. RESULTS The capacity of PHC services increased rapidly in the mid-to-late 2000s via CHBC programme facilitation of community mobilisation and participation in primary care services and the exceptional investments for HIV/AIDS. CHBC programmes diversified their services in response to the changing health and social care needs of patients on lifelong anti-retroviral therapy and there is a general trend to extend service delivery beyond HIV-infected patients. We observed similarities in the way the governments of South Africa, Malawi and Zambia are integrating CHBC programmes into PHC by making PHC facilities the focal point for management and state-paid community health workers responsible for the supervision of community-based activities. Contextual differences were found between Ethiopia, South Africa, Malawi and Zambia, whereby the policy direction of the latter two countries is to have in place structures and mechanisms that actively connect health and social welfare interventions from governmental and non-governmental actors. CONCLUSIONS Countries may differ in the means to integrate and co-ordinate government and civil society agencies but the net result is expanded PHC capacity. In a context of changing health care demands, CHBC programmes are a vital mechanism for the delivery of primary health and social welfare services.
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Affiliation(s)
- Carolien Aantjes
- Faculty of Earth and Life Sciences: Athena Institute, VU University Amsterdam, De Boelelaan 1085, 1081, HV, Amsterdam, The Netherlands. .,ETC. Foundation, Kastanjelaan 5, Leusden, The Netherlands.
| | - Tim Quinlan
- Faculty of Earth and Life Sciences: Athena Institute, VU University Amsterdam, De Boelelaan 1085, 1081, HV, Amsterdam, The Netherlands. .,Health Economics and HIV/AIDS Research Division, University of KwaZulu-Natal, Westville Campus, University Road, Durban, South-Africa.
| | - Joske Bunders
- Faculty of Earth and Life Sciences: Athena Institute, VU University Amsterdam, De Boelelaan 1085, 1081, HV, Amsterdam, The Netherlands.
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Cramer H, Dewulf G, Voordijk H. The barriers to nurturing and empowering long-term care experiments – Lessons learnt to advance future healthcare projects. INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 2014. [DOI: 10.1179/2047971913y.0000000064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Abstract
PURPOSE To examine the evolution of health care integration strategies and associated conceptualization and practice through a review and synthesis of over 25 years of international academic research and literature. METHODS A search of the health sciences literature was conducted using PubMed and EMBASE. A total of 114 articles were identified for inclusion and thematically analyzed using a strategy content model for systems-level integration. FINDINGS Six major, inter-related shifts in integration strategies were identified: (1) from a focus on horizontal integration to an emphasis on vertical integration; (2) from acute care and institution-centered models of integration to a broader focus on community-based health and social services; (3) from economic arguments for integration to an emphasis on improving quality of care and creating value; (4) from evaluations of integration using an organizational perspective to an emerging interest in patient-centered measures; (5) from a focus on modifying organizational and environmental structures to an emphasis on changing ways of working and influencing underlying cultural attitudes and norms; and (6) from integration for all patients within defined regions to a strategic focus on integrating care for specific populations. We propose that underlying many of these shifts is a growing recognition of the value of understanding health care delivery and integration as processes situated in Complex-Adaptive Systems (CAS). ORIGINALITY/VALUE This review builds a descriptive framework against which to assess, compare, and track integration strategies over time.
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Holen-Rabbersvik E, Eikebrokk TR, Fensli RW, Thygesen E, Slettebø Å. Important challenges for coordination and inter-municipal cooperation in health care services: a Delphi study. BMC Health Serv Res 2013; 13:451. [PMID: 24171839 PMCID: PMC4228434 DOI: 10.1186/1472-6963-13-451] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Accepted: 10/27/2013] [Indexed: 11/28/2022] Open
Abstract
Background Demographical changes have stimulated a coordination reform in the Norwegian health care sector, creating new working practices and extending coordination within and between primary and hospital care, increasing the need for inter-municipal cooperation (IMC). This study aimed to identify challenges to coordination and IMC in the Norwegian health care sector as a basis for further theorizing and managerial advice in this growing area of research and practice. Methods A Delphi study of consensus development was used. Experts in coordination and IMC in health care services were selected by the healthcare manager or the councillor in their respective municipalities. In the first round, an expert panel received open-ended questions addressing possible challenges, and their answers were categorized and consolidated as the basis for further validation in the second round. The expert panel members were then asked to point out important statements in the third round, before the most important statements ranked by a majority of the members were rated again in the fourth round, including the option to explain the ratings. The same procedure was used in round five, with the exception that the expert panel members could view the consolidated results of their previous rankings as the basis for a new and final rating. The statements reaching consensus in round five were abstracted and themed. Results Nineteen experts consented to participate. Nine experts (47%) completed all of the five rounds. Eight statements concerning coordination reached consensus, resulting in four themes covering these challenges: different culture, uneven balance of power, lack of the possibility to communicate electronically, and demanding tasks in relation to resources. Three statements regarding challenges to IMC reached consensus, resulting in following themes: coopetition, complex leadership, and resistance to change. Conclusions This study identified several important challenges for coordination and it supports previous research. IMC in health care services deals with challenges other than coordination, and these must be addressed specifically. Our study contributes to extended knowledge of theoretical and practical implications in the field of coordination and IMC in health care sector.
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Evans JM, Baker GR. Shared mental models of integrated care: aligning multiple stakeholder perspectives. J Health Organ Manag 2013; 26:713-36. [PMID: 23252323 DOI: 10.1108/14777261211276989] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Health service organizations and professionals are under increasing pressure to work together to deliver integrated patient care. A common understanding of integration strategies may facilitate the delivery of integrated care across inter-organizational and inter-professional boundaries. This paper aims to build a framework for exploring and potentially aligning multiple stakeholder perspectives of systems integration. DESIGN/METHODOLOGY/APPROACH The authors draw from the literature on shared mental models, strategic management and change, framing, stakeholder management, and systems theory to develop a new construct, Mental Models of Integrated Care (MMIC), which consists of three types of mental models, i.e. integration-task, system-role, and integration-belief. FINDINGS The MMIC construct encompasses many of the known barriers and enablers to integrating care while also providing a comprehensive, theory-based framework of psychological factors that may influence inter-organizational and inter-professional relations. While the existing literature on integration focuses on optimizing structures and processes, the MMIC construct emphasizes the convergence and divergence of stakeholders' knowledge and beliefs, and how these underlying cognitions influence interactions (or lack thereof) across the continuum of care. PRACTICAL IMPLICATIONS MMIC may help to: explain what differentiates effective from ineffective integration initiatives; determine system readiness to integrate; diagnose integration problems; and develop interventions for enhancing integrative processes and ultimately the delivery of integrated care. ORIGINALITY/VALUE Global interest and ongoing challenges in integrating care underline the need for research on the mental models that characterize the behaviors of actors within health systems; the proposed framework offers a starting point for applying a cognitive perspective to health systems integration.
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Affiliation(s)
- Jenna M Evans
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.
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Elissen AMJ, van Raak AJA, Paulus ATG. Can we make sense of multidisciplinary co-operation in primary care by considering routines and rules? HEALTH & SOCIAL CARE IN THE COMMUNITY 2011; 19:33-42. [PMID: 21143542 DOI: 10.1111/j.1365-2524.2010.00946.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Although it is widely acknowledged that the complex health problems of chronically ill and elderly persons require care provision across organisational and professional boundaries, achieving widespread multidisciplinary co-operation in primary care has proven problematic. We developed an explanation for this on the basis of the concepts of routines (patterns of behaviour) and rules, which form a relatively new yet promising perspective for studying co-operation in health-care. We used data about primary care providers situated in the Dutch region of Limburg, a region that, despite high numbers of chronically and elderly persons, has traditionally few healthcare centres and where multidisciplinary co-operation is limited. A qualitative study design was used, in which interviews and documents were the main data sources. Semi-structured interviews were conducted with providers from six primary care professions in the Dutch region of Limburg; relevant documents included co-operation agreements, annual reports and internal memos. To analyse the evidence, several data matrices were developed and all data were structured according to the main concepts under study, i.e. routines and rules. Although more research is needed, our study suggests that the emergence of more extensive multidisciplinary co-operation in primary care is hampered by the organisational rules and regulations prevailing in the sector. By emphasising individual care delivery rather than co-operation, these rules stimulate the perseverance of diversity between the routines by which providers perform their solo care delivery activities, rather than the creation of the amount of compatibility between those routines that is necessary for the current, rather limited shape of multidisciplinary co-operation to expand. Further research should attempt to validate this explanation by utilising a larger research population and systematically operationalising the rules existing in the legal and--more importantly--organisational environment of primary care.
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Affiliation(s)
- Arianne M J Elissen
- Department of Health Organization, Policy and Economics (HOPE), School of Public Health and Primary Care (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
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Bertezene S, Martin J. Mastering performance through quality and networking. TQM JOURNAL 2009. [DOI: 10.1108/17542730910965100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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van Raak A, Paulus A, Cuijpers R, te Velde C. Problems of integrated palliative care: A Dutch case study of routines and cooperation in the region of Arnhem. Health Place 2008; 14:768-78. [DOI: 10.1016/j.healthplace.2007.12.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2007] [Revised: 12/17/2007] [Accepted: 12/19/2007] [Indexed: 10/22/2022]
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The emergence of multidisciplinary teams for interagency service delivery in europe: is historical institutionalism wrong? HEALTH CARE ANALYSIS 2007; 16:342-54. [PMID: 17965939 DOI: 10.1007/s10728-007-0073-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2007] [Accepted: 09/26/2007] [Indexed: 10/22/2022]
Abstract
In Europe, a well-known problem is the coordination of interagency service delivery to independently living older persons, disabled persons or persons suffering from chronic illness. Coordination is necessary in order for the users to receive services at the appropriate time and place. Based on historical institutionalism, which focuses on the path dependency of the development of government policy and organizational and professional rules, it can be stated that coordination requires organizational models or other solutions that fit the characteristics of the context ('configuration') for which the solution is intended. The western European countries have different configurations. Remarkably, across these countries, we see the emergence of multidisciplinary teams as a solution to the problem of coordination. Consequently, if we take the above statement to mean that a solution should fit all the configuration's characteristics, we must reject the statement. However, when we assume that a solution should fit particular configurational characteristics, we must not. We take the second position and we argue that multidisciplinary teams have emerged because they fit one particular feature that is similar in the countries: professionalism and professional fragmentation.
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Eijkelberg IM, Spreeuwenberg C, Mur-Veeman IM, Wolffenbuttel BH. From shared care to disease management: key-influencing factors. Int J Integr Care 2007; 1:e17. [PMID: 16896415 PMCID: PMC1484400 DOI: 10.5334/ijic.22] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background In order to improve the quality of care of chronically ill patients the traditional boundaries between primary and secondary care are questioned. To demolish these boundaries so-called ‘shared care’ projects have been initiated in which different ways of substitution of care are applied. When these projects end, disease management may offer a solution to expand the achieved co-operation between primary and secondary care. Objective Answering the question: What key factors influence the development and implementation of shared care projects from a management perspective and how are they linked? Theory The theoretical framework is based on the concept of the learning organisation. Design Reference point is a multiple case study that finally becomes a single case study. Data are collected by means of triangulation. The studied cases concern two interrelated Dutch shared care projects for type 2 diabetic patients, that in the end proceed as one disease management project. Results In these cases the predominant key-influencing factors appear to be the project management, commitment and local context, respectively. The factor project management directly links the latter two, albeit managing both appear prerequisites to its success. In practice this implies managing the factors' interdependency by the application of change strategies and tactics in a committed and skilful way. Conclusion Project management, as the most important and active key factor, is advised to cope with the interrelationships of the influencing factors in a gradually more fundamental way by using strategies and tactics that enable learning processes. Then small-scale shared care projects may change into a disease management network at a large scale, which may yield the future blueprint to proceed.
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Affiliation(s)
- I M Eijkelberg
- Faculty of Health Sciences, Department of Health Organisation, Policy and Economics, University of Maastricht, PO Box 616, 6200 MD Maastricht, The Netherlands.
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Axelsson R, Axelsson SB. Integration and collaboration in public health—a conceptual framework. Int J Health Plann Manage 2006; 21:75-88. [PMID: 16604850 DOI: 10.1002/hpm.826] [Citation(s) in RCA: 235] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
With the increasing differentiation of organisations involved in the pursuit of public health, there is also a growing need for inter-organisational integration. Starting from the concepts of differentiation and integration, this article is attempting a theoretical reconstruction based on published research on inter-organisational integration in public health and related welfare services. Different forms of integration are defined and related to each other in a conceptual framework, which is in itself an integration of different theoretical perspectives. According to this framework, integration in the field of public health requires inter-organisational collaboration across different sectors of the society. Such intersectoral collaboration can be organised mainly in the form of multidisciplinary teams across the boundaries of different organisations and sectors. Such an organisation is fragile and volatile, however, which means that it needs a lot of management support in order to survive.
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Affiliation(s)
- Runo Axelsson
- Nordic School of Public Health, P.O. Box 12133, SE-402 42 Göteborg, Sweden.
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Abstract
OBJECTIVE To review the challenge of providing integrated mental health services from a policy and health management perspective. CONCLUSIONS The provision of integrated mental health services involving specialist mental health services, general practitioners, psychiatric disability and rehabilitation services and public community health services is a major challenge in the Australian health care context and is increasingly an expectation of the community. Government, Divisions of General Practice and public community health policy and many Government, State and local initiatives have attempted to address this challenge. However, much remains to be done, including culture change within services and professions and the development of technology to support integrated service provision.
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Affiliation(s)
- Tom Callaly
- Community and Mental Health, Barwon Health, Geelong, Vic., Australia.
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Fleury MJ. Quebec mental health services networks: models and implementation. Int J Integr Care 2005; 5:e07. [PMID: 16773157 PMCID: PMC1395508 DOI: 10.5334/ijic.127] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2005] [Revised: 05/04/2005] [Accepted: 05/12/2005] [Indexed: 11/20/2022] Open
Abstract
PURPOSE In the transformation of health care systems, the introduction of integrated service networks is considered to be one of the main solutions for enhancing efficiency. In the last few years, a wealth of literature has emerged on the topic of services integration. However, the question of how integrated service networks should be modelled to suit different implementation contexts has barely been touched. To fill that gap, this article presents four models for the organization of mental health integrated networks. DATA SOURCES The proposed models are drawn from three recently published studies on mental health integrated services in the province of Quebec (Canada) with the author as principal investigator. DESCRIPTION Following an explanation of the concept of integrated service network and a description of the Quebec context for mental health networks, the models, applicable in all settings: rural, urban or semi-urban, and metropolitan, and summarized in four figures, are presented. DISCUSSION AND CONCLUSION To apply the models successfully, the necessity of rallying all the actors of a system, from the strategic, tactical and operational levels, according to the type of integration involved: functional/administrative, clinical and physician-system is highlighted. The importance of formalizing activities among organizations and actors in a network and reinforcing the governing mechanisms at the local level is also underlined. Finally, a number of integration strategies and key conditions of success to operationalize integrated service networks are suggested.
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Affiliation(s)
- Marie-Josée Fleury
- Department of Psychiatry, McGill University, Douglas Hospital Research Center, 6875 LaSalle Blvd., Verdun (Québec), Canada H4H 1R3.
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van Raak A, Paulus A, Mur-Veeman I. Why do health and social care providers co-operate? Health Policy 2005; 74:13-23. [PMID: 16098408 DOI: 10.1016/j.healthpol.2004.12.006] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2003] [Accepted: 12/07/2004] [Indexed: 11/29/2022]
Abstract
Within Europe, although there are numerous examples of poor co-ordination in the delivery of integrated care, many providers do co-operate. We wanted to know why providers are moved to co-operate. In terms of systematic research, this is a new field; researchers have only begun to theorise about the rationales for co-operation. Practically, the issue of achieving co-operation attracts much attention from policymakers. Understanding the reasons for co-operation is a prerequisite for developing effective policy in support of integrated care. Our aim is to explore the comparative validity of different theoretical perspectives on the reasons for co-operation, to indicate directions for further study and for policy making. We used data from three successive studies to perform pattern matching with six established theoretical perspectives: transaction costs economics, strategic choice theory, resource dependence theory, learning theory, stakeholder theory and institutional theory. Insights from the studies were compared for validating purposes (triangulation). The first study concerned the evaluation of the Dutch 'National Home Health Care Programme' according to the case study methodology. The second and third studies were surveys among project directors: questionnaires were based on the concepts derived from the first study. Researchers should combine normative institutional theory, resource dependence theory and stakeholder theory into one perspective, in order to study relationship formation in health and social care. The concept of institutions (rules) is the linchpin between the theories. Policy makers must map the institutions of stakeholders and enable integrated care policy to correspond with these institutions as much as possible.
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Affiliation(s)
- Arno van Raak
- Maastricht University, Faculty of Health Sciences, Department of Health Organisation, Policy and Economics (HOPE), 6200 MD Maastricht, The Netherlands.
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