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Article
Publication date: 22 January 2020

Axel Kaehne

197

Abstract

Details

Journal of Integrated Care, vol. 28 no. 1
Type: Research Article
ISSN: 1476-9018

Article
Publication date: 25 June 2020

Axel Kaehne

The purpose of this paper is to critically reflect on the practice, rhetoric and reality of integrating care. Echoing Le Grand's framework of motivation, agency and…

Abstract

Purpose

The purpose of this paper is to critically reflect on the practice, rhetoric and reality of integrating care. Echoing Le Grand's framework of motivation, agency and policy, it is argued that the stories the authors tell themselves why the authors embark on integration programmes differ from the reasons why managers commit to these programmes. This split between policy rhetoric and reality has implications for the way the authors investigate integration.

Design/methodology/approach

Examining current integration policy, practice and research, the paper adopts the critical framework articulated by Le Grand about the underlying assumptions of health care policy and practice.

Findings

It is argued that patient perspectives are speciously placed at the centre of integration policy but mask the existing organizational and managerial rationalities of integration. Making the patient the measure of all things integration would turn this agenda back on its feet.

Originality/value

The paper discusses the underlying assumptions of integration policy, practice and research. Increasing the awareness about the gap between what the authors do, why the authors do it and the stories the authors tell themselves about it injects a much needed amount of criticality into research and practice.

Details

Journal of Integrated Care, vol. 28 no. 3
Type: Research Article
ISSN: 1476-9018

Keywords

Content available
Article
Publication date: 16 October 2017

Robin Miller, Jon Glasby and Axel Kaehne

359

Abstract

Details

Journal of Integrated Care, vol. 25 no. 4
Type: Research Article
ISSN: 1476-9018

Article
Publication date: 22 July 2019

Axel Kaehne

Big Data is likely to have significant implications for the way in which services are planned, organised or delivered as well as the way in which we evaluate them. The…

Abstract

Purpose

Big Data is likely to have significant implications for the way in which services are planned, organised or delivered as well as the way in which we evaluate them. The increase in data availability creates particular challenges for evaluators in the field of integrated care and the purpose of this paper is to set out how we may usefully reframe these challenges in the longer term.

Design/methodology/approach

Using the characteristics of Big Data as defined in the literature, the paper develops a narrative around the data and research design challenges and how they influence evaluation studies in the field of care integration.

Findings

Big Data will have significant implications for how we conduct integrated care evaluations. In particular, dynamic modelling and study designs capable of accommodating new epistemic foundations for the phenomena of social organisations, such as emergence and feedback loops, are likely to be most helpful. Big Data also generates opportunities for exploratory data analysis approaches, as opposed to static model development and testing. Evaluators may find research designs useful that champion realist approaches or single-n designs.

Originality/value

This paper reflects on the emerging literature and changing practice of data generation and data use in health care. It draws on organisational theory and outlines implications of Big Data for evaluating care integration initiatives.

Details

Journal of Integrated Care, vol. 27 no. 3
Type: Research Article
ISSN: 1476-9018

Keywords

Article
Publication date: 16 October 2017

Axel Kaehne

Integration is policy, practice as well as object of systematic investigation. What we do not know is whether or not integration can be understood as a science. In his…

Abstract

Purpose

Integration is policy, practice as well as object of systematic investigation. What we do not know is whether or not integration can be understood as a science. In his book The Structure of Scientific Revolutions, Thomas Kuhn formulated a notion of (natural) sciences based on the emergence of commitments amongst a community of scientists to a set of logics, model and exemplars. He called this a paradigm. The purpose of this paper is to assess the scientific nature of integration by perceiving it as a paradigm in Kuhn’s sense.

Design/methodology/approach

The paper proceeds by conceptual reflection through matching existing components, theories and exemplifications of integration to Kuhn’s model of a scientific paradigm. Integration is understood broadly, either vertical or horizontal, and located within the practical domains of policy formulation, policy implementation and evaluation research. The nature, scope and depth of group commitments amongst students and practitioners of integration receive particular attention in line with Kuhn’s social interactionist approach.

Findings

Employing Kuhn’s notion of paradigm in the context of integration highlights the fundamental tension between integration efforts and integration outcomes. Whilst integration defines itself in contradistinction to professional boundaries and fragmentation, the paper argues that it fails to develop a strong theoretical and empirical foundation for a robust and stable group commitment. The reason is that the key motivational force that may create a stable group commitment amongst those engaged in integration, the patient perspective, remains outside the integration paradigm. This leaves integration as a practice and policy model underdeveloped, mainly paradigmatically illustrated by singular exemplars and rooted in aspirational policy vocabulary, while clustered around a near dogmatic belief that working together between services must lead to improved quality of care. To become a scientific paradigm the group commitment in integration would have to coalesce around a clear ontology (symbolic generalisations), epistemology (models of knowledge) and manifestations in practice (exemplars).

Research limitations/implications

At present both the ontology and epistemological foundations of integration practice and research are insufficiently clear. This hampers the development of integration practice as well as a better understanding of how to evaluate integration outcomes. Future studies should focus on the depth, nature and subject of group commitments to assess whether integration is a viable candidate for scientific paradigm or an assorted construct of policy aspirations.

Originality/value

The paper questions the rigour and trajectory of integration practice, policy and research. It identifies a tension at the centre of the field between group commitments to scientific exemplars (case studies) and symbolic generalisations, encapsulated in the desire to improve patient care. The notion of a scientific paradigm thus helps to re-frame the discussion about research and practice in integration.

Details

Journal of Integrated Care, vol. 25 no. 4
Type: Research Article
ISSN: 1476-9018

Keywords

Article
Publication date: 12 January 2018

Axel Kaehne, Andrea Beacham and Julie Feather

The purpose of this paper is to outline the current thinking on co-production in health and social care, examine the challenges in implementing genuine co-production and…

Abstract

Purpose

The purpose of this paper is to outline the current thinking on co-production in health and social care, examine the challenges in implementing genuine co-production and argue for a pragmatic version of co-production that may assist programme managers in deciding which type of co-production is most suitable for which programme.

Design/methodology/approach

A discussion paper based on the professional and academic knowledge and insights of the authors. A focus group interview schedule was used to guide discussions between authors.

Findings

The authors argue for a pragmatic approach to co-production within integrated care programmes. The authors set out the basic parameters of such an approach containing procedural rather than substantive standards for co-production activities leaving sufficient room for specific manifestations of the practice in particular contexts.

Practical implications

The authors put forward a pragmatic model of co-production that defines the essential elements of a process for ensuring services are designed to meet with the needs of patients yet allowing the process itself to be adapted to different circumstances.

Originality/value

The paper summarises the discussion on co-production in relation to integration programmes. It formulates a pragmatic model of co-production that may assist programme managers in establishing good practice co-production frameworks when designing or implementing integrated health and social care services.

Details

Journal of Integrated Care, vol. 26 no. 1
Type: Research Article
ISSN: 1476-9018

Keywords

Article
Publication date: 18 April 2017

Axel Kaehne, Derek Birrell, Robin Miller and Alison Petch

The purpose of this paper is to outline relevant policies on the integration of health and social care (HSC) in the four home nations: Scotland, Wales, Northern Ireland…

1413

Abstract

Purpose

The purpose of this paper is to outline relevant policies on the integration of health and social care (HSC) in the four home nations: Scotland, Wales, Northern Ireland and England and offer a comparison of emphasis and approaches and draw out general insights on the implementation of integrated care policy.

Design/methodology/approach

The paper is written as a piece of critical reflection by drawing on the authors’ knowledge and expertise and wider evidence where available.

Findings

Since 2010, HSC integration has started to diverge significantly in the four constituent countries of the UK. Although England and Wales have undergone considerable re-organisation of the NHS, Scotland and Northern Ireland have largely been marked by organisational continuity. However, beyond organisational differences, policy approaches, policy emphases and implementation strategies have also started to show considerable dissimilarity across the UK. An important contributory factor may be different ideological perspectives on the role of competition and pilots, partnership, patient choice and organisational incentives to bring about change in the field.

Research limitations/implications

The paper identifies a serious lack of comparative research in integration policy, despite the considerable opportunities for quasi-experimental studies. This lack of empirical research impedes shared learning across the home nations.

Originality/value

The paper presents a descriptive comparison of current integration policy between HSC providers in the four home nations. It reveals considerable opportunities for further research and comparative modelling of integration approaches.

Details

Journal of Integrated Care, vol. 25 no. 2
Type: Research Article
ISSN: 1476-9018

Keywords

Article
Publication date: 10 April 2018

Axel Kaehne

Differences in professional values, organisational interests and access to resources are key issues to be addressed when integrating services. They are widely seen by…

Abstract

Purpose

Differences in professional values, organisational interests and access to resources are key issues to be addressed when integrating services. They are widely seen by service planners and commissioners to be matters of governance. However, they also inform critical debates in political science. In essence they revolve around the question of distribution, or (how to decide) who gets what. The purpose of this paper is to re-frame the subject of inter-organisational governance in integration by conceptualising it through the lens of three prominent politico-theoretical approaches: the liberal, the authoritarian and the radical-utopian.

Design/methodology/approach

A discussion paper that proceeds by utilising political science terms of reference and applying it to a public management problem.

Findings

All three theories provide particular insights into the way in which service planners and commissioners may think about the inescapable plurality of values and interests in integration programmes. Where the liberal perspective places particular emphasis on the purpose and utility of organisational autonomy and self-direction, the authoritarian model highlights the need to produce results within tight timescales. It also accords with the manner in which integration policy is normally implemented, top down. The radical-utopian model is built on the least realistic assumptions but offers researchers a useful framework to assess the rationale and effectiveness of value-based policy in integration programmes wherever robust inter-organisational structures fail to materialise.

Originality/value

Whilst there has been significant research on how to conceptualise integration programmes, scholars have usually championed a public management approach. The potential insights of political thought have not been explored until now. The paper demonstrates that the wider conceptual framework of political theory has significant purchase in the field of integration studies and can help us understand the benefits and limitations of an interdisciplinary approach.

Details

Journal of Integrated Care, vol. 26 no. 2
Type: Research Article
ISSN: 1476-9018

Keywords

Article
Publication date: 28 January 2021

Axel Kaehne

Abstract

Details

Journal of Integrated Care, vol. 29 no. 1
Type: Research Article
ISSN: 1476-9018

Content available
Article
Publication date: 12 April 2022

Axel Kaehne

Abstract

Details

Journal of Integrated Care, vol. 30 no. 2
Type: Research Article
ISSN: 1476-9018

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