Improvement attributes in healthcare: implications for integrated care

Patrick John Harnett (National Integrated Care Programme, Older Persons, Social Care Division, Health Service Executive, Dublin, Ireland)

International Journal of Health Care Quality Assurance

ISSN: 0952-6862

Publication date: 16 April 2018



Healthcare quality improvement is a key concern for policy makers, regulators, carers and service users. Despite a contemporary consensus among policy makers that integrated care represents a means to substantially improve service outcomes, progress has been slow. Difficulties achieving sustained improvement at scale imply that methods employed are not sufficient and that healthcare improvement attributes may be different when compared to prior reference domains. The purpose of this paper is to examine and synthesise key improvement attributes relevant to a complex healthcare change process, specifically integrated care.


This study is based on an integrative literature review on systemic improvement in healthcare.


A central theme emerging from the literature review indicates that implementing systemic change needs to address the relationship between vision, methods and participant social dynamics.

Practical implications

Accommodating personal and professional network dynamics is required for systemic improvement, especially among high autonomy individuals. This reinforces the need to recognise the change process as taking place in a complex adaptive system where personal/professional purpose/meaning is central to the process.


Shared personal/professional narratives are insufficiently recognised as a powerful change force, under-represented in linear and rational empirical improvement approaches.



Harnett, P. (2018), "Improvement attributes in healthcare: implications for integrated care", International Journal of Health Care Quality Assurance, Vol. 31 No. 3, pp. 214-227.

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