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- Bångsbo, Angela, PhD, 1968-, et al.
(author)
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Preconditions to implementation of an integrated care process programme
- 2021
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In: Journal of Integrated Care. - : Emerald Group Publishing Limited. - 1476-9018.
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Journal article (peer-reviewed)abstract
- PurposeThe purpose of this study was to investigate the preconditions of a full-scale implementation of an integrated care process programme for frail older people from the staff's understanding, commitment and ability to change their work procedures with comparisons over time and between organisations.Design/methodology/approachA repeated cross-sectional study was conducted in a hospital, municipal health and social care setting.FindingsStaff commitment decreased to the importance of a permanent municipal contact from baseline compared to the 12-months follow-up (p = 0.02) and the six- and 12-months follow-up (p = 0.05), to the information transfer from emergency department from the six- to the 12-months follow-up (p = 0.04), to discharge planning at the hospital at six- and 12-months follow-up (p = 0.04) and towards discharge planning at home from baseline to the six-month follow-up (p = 0.04). Significant differences occurred between the organisations about information transfer from the emergency department (p = 0.01) and discharge planning at home (p = 0.03). The hospital staff were the most committed.Practical implicationsThe results can guide the implementation of complex interventions in organisations with high-employee turnover and heavy workload.Originality/valueThe study design, allowing the comparison of implementation results over time and between organisations in a later phase, gives this study a unique perspective.
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| 2. |
- Edgren, Lars, 1948, et al.
(author)
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Achieving integrated care through CAS thinking and a collaborative mindset
- 2015
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In: Journal of Integrated Care. - 1476-9018. ; 23:3, s. 108-119
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Journal article (peer-reviewed)abstract
- Purpose - The purpose of this paper is to contribute to knowledge by exploring and distilling how providers in health and social care who have adopted complex adaptive systems thinking (CAS thinking) and have a collaborative mindset are in a better position to achieve integrated care than those who adopt reductionist approaches. Design/methodology/approach - This paper is a research review and a conceptual analysis of key aspects drawn from the literature on CAS thinking and collaborative mindset applied to integrated care. By choosing this approach the authors intend to promote understanding and efforts made to put it into action. The intended audience comprises managers responsible for addressing the problem of fragmentation and the research community challenged by the task of supporting those managers. Findings - Specialization of knowledge and skill has increased the risk of fragmentation. It is possible to reduce that risk and hence to foster integrated care when providers with different specializations stimulated by a collaborative mindset develop an understanding of how they connect with others in a CAS. The essence of CAS thinking applied to integrated care is the readiness to connect. This readiness is facilitated by adopting a collaborative mindset. Originality/value - Literature on CAS thinking and collaborative mindset have evolved independently of one another. The study points at the importance of connecting the two concepts to produce effective action. © Emerald Group Publishing Limited 2015.
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| 4. |
- Grooten, Liset, et al.
(author)
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A scaling-up strategy supporting the expansion of integrated care : a study protocol
- 2019
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In: Journal of Integrated Care. - : Emerald Group Publishing Limited. - 1476-9018. ; 27:3, s. 215-231
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Journal article (peer-reviewed)abstract
- PurposeTo ensure that more people will benefit from integrated care initiatives, scaling-up of successful initiatives is the way forward. However, new challenges present themselves as knowledge on how to achieve successful large-scale implementation is scarce. The EU-funded project SCIROCCO uses a step-based scaling-up strategy to explore what to scale-up, and how to scale-up integrated care initiatives by matching the complementary strengths and weaknesses of five European regions involved in integrated care. The purpose of this paper is to describe a multi-method evaluation protocol designed to understand what factors influence the implementation of the SCIROCCO strategy to support the scaling-up of integrated care.Design/methodology/approachThe first part of the protocol focuses on the assessment of the implementation fidelity of the SCIROCCO step-based strategy. The objective is to gain insight in whether the step-based strategy is implemented as it was designed to explore what works and does not work when implementing the scaling-up strategy. The second part concerns a realist evaluation to examine what it is about the SCIROCCO’s strategy that works for whom, why, how and in which circumstances when scaling-up integrated care.FindingsThe intended study will provide valuable information on the implementation of the scaling-up strategy which will help to explain for what specific reasons the implementation succeeds and will facilitate further improvement of project outcomes.Originality/valueThe expected insights could be useful to guide the development, implementation and evaluation of future scaling-up strategies to advance the change towards more sustainable health and care systems.
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| 5. |
- Hemphälä, Jens, 1973-, et al.
(author)
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Uncovering misalignments in the health- and elderly care system
- 2023
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In: Journal of Integrated Care. - : Emerald. - 1476-9018. ; 31:5, s. 117-128
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Journal article (peer-reviewed)abstract
- Purpose: The increasing size of the elderly population is emerging as a primary catalyst for the escalation of healthcare expenditure, and a sense of urgency is manifest. However, the complexity of the health- and elderly care systems provides challenges in improving system efficiency. Hence, the system-level understanding of the main obstacles to integration care needs further exploration. In order to better integrate health- and elderly care, the study needs to identify the actual misalignments underpinning the issue. This study provides the theoretical foundations for resource misalignments and provides empirical examples of these. Design/methodology/approach: Semi-structured interviews with multiple stakeholders on various hierarchical levels were carried out to create a more complete view of the system and resources deployed in health- and elderly care. The application of user-centered design methods and co-creation with employees have also been crucial to the outcomes of the study. Findings: Results show that health- and elderly care is a large-scale complex system. The overlapping and mutually reinforcing misalignments are: (1) regulation and policy differences, (2) stakeholder quantity and variation, (3) external control of health- and elderly care, (3) decreasing collaboration and (4) communication channels and IT development. Originality/value: This qualitative study builds on institutional theory and resource integration theory and contributes with empirical descriptions of misalignments in the health- and elderly care system. These descriptions will serve as points of departure for systems design to improve the efficiency and effectiveness of health- and elderly care.
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| 6. |
- Kjellberg, Inger, 1959, et al.
(author)
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Pursuing collaborative advantage in Swedish care for older people: stakeholders' views on trust
- 2020
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In: Journal of Integrated Care. - 1476-9018. ; 28:3, s. 231-241
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Journal article (peer-reviewed)abstract
- Purpose The purpose of this paper is to explore stakeholder views on the policy of integrated health and social care for older people with complex needs in Sweden and the issue of trust in implementing the policy. Design/methodology/approach The study used a qualitative interview design and interviews with nine strategically selected stakeholders. A thematic analysis focused on trust, as defined in the theory of collaborative advantage, was used. Findings This study of health and social care exposed a lack of trust on political, strategic and inter-professional levels. Two opposing lines of argument were identified in the interviews. One advocated a single government authority for health and social care. The other was in accordance with recently implemented national policies, which entailed more collaboration between local government authorities, obliging them to make joint local agreements. The Swedish experience is discussed in an international context, examining the need for collaboration in integrated care services for older people. Research limitations/implications Although the findings are important for the current adjustment in health and social care for older people, the number of interviewees are limited. Future studies will include more regions and longitudinal studies. Originality/value Sweden is currently undergoing an extensive adjustment in line with recent national government policy which involves more primary health care and a corresponding reduction in the number of hospital beds. The restructuring of the care system for older people with complex needs is a paradox, as it simultaneously increases the need for centralisation while also increasing coordination and collaboration on a local basis.
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| 7. |
- Szücs, Stefan, 1964, et al.
(author)
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Achieving sustainable governance of horizontal integration of care services: progress and democratic accountability of strategic coordination bodies for older people
- 2022
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In: Journal of Integrated Care. - 1476-9018. ; 30:5, s. 69-82
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Journal article (peer-reviewed)abstract
- Purpose The purpose is to analyse the relationship between democratic accountability and how sustainable governance is achieved by horizontally integrating care services for older people through collaboration in a coordination body of key leaders from across the health and social care system. Design/methodology/approach The data and measures come from two surveys with coordination body members in Sweden (politicians, administrators, professionals) from a sample of 73 bodies in 2015 (n = 549) and the same/corresponding 59 bodies in 2019 (n = 389). Findings The governance of integrating care scale and the accountability scales repeatedly show consistency among individual members. Systematic progress is found among large coordination bodies: the greater the average perception of governance of horizontally integrating care in 2015, the greater it was in 2019 – and regardless of the period, the stronger the internal administrative or political monitoring and reviewing of the coordination body, the greater its governance (while the relationship to the external monitoring and reviewing is weak). However, the growing importance of external accountability is indirect, shown by stronger correlations between the internal political and external monitoring and reviewing, regardless of size. Research limitations/implications The scales are based on self-reported perceptions that cannot be objectively verified, but they can be linked to changes in outcomes and user experiences in the later stages of the research. Originality/value Repeatedly verified scales of internal and external accountability for analysing and evaluating governance of integrating care services horizontally, which is useful for improving strategic coordination of integrated care.
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| 8. |
- Åhgren, Bengt
(author)
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Creating Integrated Care : Evaluation and Management of Local Care in Sweden
- 2007
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In: Journal of Integrated Care. - 1476-9018. ; 15:6, s. 14-21
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Journal article (peer-reviewed)abstract
- It seems impossible to create a comprehensive evaluation model which fully takes into account the multi-dimensional context of integrated health and social care. Clinical integration, as a prerequisite for efficient outcomes of integration, must nonetheless get special attention. For more extensive evaluations, a quality chain matrix, including co-operating acts by different providers, has proven to be useful. Examples of evaluated services in Sweden are given, and the management benefits of the use of evaluation data are highlighted.
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