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New organization theory posits that coordination mechanisms work by generating three integrating conditions: accountability (clarity about task responsibilities), predictability (clarity about which, when, and how tasks will be accomplished), and common understanding (shared perspectives about tasks). We apply this new theory to health care to improve understanding of how accountable care organizations (ACOs) are attempting to reduce the fragmentation that characterizes the US health care system. Drawing on four organizational case studies, we find that ACOs rely on a wide variety of coordination mechanisms that have been designed to leverage existing organizational capabilities, accommodate local contingencies. and, in some instances, interact strategically. We conclude that producing integrating conditions across the care continuum requires suites of interacting coordination mechanisms. Our findings provide a conceptual foundation for future research and improvements.

The authors aim to present findings from their research on the implementation of Unified Assessment (UA) policy and the work of care coordinators who oversee the delivery of support to older people with complex needs.

A mixed methods approach included staff interviews (n=95) and focus groups (n=3).

The care coordinator role is controversial and the lack of common terminology across health and social care obscures its importance. It is seen as a social care responsibility. Limited ownership amongst healthcare professionals leads to tensions in practice. The challenges of breaking down silo thinking embedded in established professional practices are highlighted as are infrastructural and capacity deficits. Disparities between policy intentions and practice means that UA is failing to meet core objectives relating to the delivery of seamless support.

Further research is needed to develop and evaluate evidence‐informed interventions that test solutions to the problems faced in practice and support the delivery of more effective arrangements.

Practice development may be supported by: guidelines that are more prescriptive and include a formal role definition; joint training to promote shared understanding of key concepts; investment in administrative and IT infrastructures; and more coordinated direction at strategic level.

Over a decade has elapsed since the publication of UA Policy Guidance; however, there is limited published evidence on the effectiveness of UA policy and its translation into practice.

This paper aims to generate a better understanding of how challenges and opportunities for sustainable change during digitalization relate to the organizing work of change agents mandated to facilitate technology adoption from within local work organizations.

This study examines the work of welfare technology coordinators, health-care professionals who are mandated to facilitate the use of technologies in home-based services in a Norwegian city. Data comprise ethnographic observations of meetings and work practices, interviews and documents collected over one year. A practice-based approach was applied to analyze how the welfare technology coordinators go about integrating technologies with the work practices, and the forms of negotiations this work implies in their work community.

The analysis identified four sets of practices in the coordinators’ work: exploring and integrating new technologies into work practices, legitimizing aims and values, formalizing routines and responsibilities and critically considering existing and envisioned service practices. Through these practices, emerging problems and disconnections in the service organization were attended to in a continuous manner.

The study contributes to the literature by examining the work of internal change agents mandated to facilitate multiple and simultaneous technology adoption and demonstrates the importance of recognizing the continuous efforts and negotiations of these agents as significant to sustainable organizing.

The aim of this study was to evaluate the efficacy with which care plans capture and make use of data on the spiritual and religious concerns of mental health service users in a UK Health and Social Care Trust.

A questionnaire was given to service users (n=71) and the findings compared with the information held on their behalf by the relevant Health and Social Care Trust at three key points in the care planning process.

The study found that the importance that many service users accorded to spirituality and religion was not reflected in the electronic records, that some information was wrong or wrongly nuanced when compared with the patient's self-description and that service users themselves were often mistaken regarding the type and quality of information held on record.

The implications of these findings are discussed in relation to the process of information gathering, to the training and support of Care Coordinators and to the monitoring and revision of Care Plans. The discrepancy between the information supplied by service users and that recorded by the Trust suggests that, despite government guidance, spiritual and religious concerns are not being given consideration in the construction of care plans. Possible reasons for this oversight are discussed.

Although there have been studies of the delivery of “spiritual care” in general acute care, there have been no similar studies in relation to mental health service users and their needs. The comparison of information from the service users themselves with the information recorded by the Trust provides a measure of the extent to which service user's own perspectives are being incorporated into their care plans.

As the notion of “integrated care” has received ever greater policy traction, so the idea that a named individual should take responsibility for coordinating the various elements of care for service users has also gained ground. The purpose of this paper is to look at the proposal to hand this role to GPs, examine the policy expectations and explore some of the implementation dilemmas.

Review of policy documents and relevant literature.

That the role of “care coordinator” has rarely succeeded in the past and that there are specific difficulties in expecting GPs to take on the task.

Review of existing literature linked to emergent policy – no original research.

This is a new application of an enduring policy concept. Currently the literature is thin.

The purpose of this paper is to explore the integration of school and leisure activities and to inform professional practice by exploring the opportunities and challenges that arise when school-day teachers and leisure-care personnel set out to build a collaborative network.

This paper presents a multiple case study of five Reykjavik elementary schools that participated in a project called “The Day of the Child.” Data were gathered using semi-structured interviews and focus groups with school leaders, leisure-time center coordinators, teachers, and leisure-care personnel, as well as using field notes and documentary analysis.

The participants in the study reported that increased integration supported the well-being of children by offering leisure activities within the school day. Emphasis on leisure reinforced children’s informal and social learning. Challenges identified were organizational barriers, such as professional boundaries between leisure and school, unclear roles of leisure-care personnel and lack of active collaboration. Drawing on the findings, the author explores possibilities for enhanced professional practice within schools.

Leisure and informal learning are marginalized in the educational discourse due to the global push in education toward outcomes-based education and standardized testing. This study underlines the need for leisure pedagogy in elementary schools.

This paper provides an understanding of the importance of informal learning within the formal school culture. The findings reflect the experiences and insights of those working with children and focuses on a much neglected part of education, informal learning.

The purpose of this paper is to explore how community aged care workers evaluate job quality using a job quality framework.

The study uses a qualitative approach. Data were collected using semi-structured interviews and focus groups from a large aged care organisation.

Perceptions of job quality are influenced by individual motivations, match between life-stage and work flexibility, as well as broader community views of the value of this type of work. Intrinsic factors (e.g. autonomy, job content) moderate the impact of extrinsic factors such as pay and job security.

The sample is relatively small and the study is based on data from one aged care organisation which may not reflect employment conditions in other organisations.

Attraction and retention of community care workers can be improved by addressing factors associated with remuneration (including employment contracts and hours of work) and career structures. Skill and experience-based career structures would help build organisational capacity as well as making these jobs more attractive.

The demand for community care will continue to increase. Attracting, retaining and managing this workforce will be critical to meeting society’s expectations regarding the future care needs of older people.

This research explores an under-researched workforce group in a critical area of aged care management. It highlights two key areas with the potential to improve employee perceptions of job quality and therefore address issues related to attraction, retention, job satisfaction and ultimately organisational performance.

This study aims to examine how health-care managers in acute care and post-acute care facilities support and plan to improve transitional care for cardiac patients and their family caregivers, to better manage care in the home.

A qualitative descriptive approach, guided by appreciative inquiry was used in this study. A purposive sample of 16 participants were engaged in the study. Participants completed a demographic questionnaire, the caregiver policy lens questionnaire and participated in one of four focus group interviews. The semi-structured focus group interviews were audio-recorded and analyzed using thematic analysis.

Using Donabedian’s framework, six major themes contributed to how health-care managers can improve transitional care: structure included supporting personnel and continuing education; process included enacting approaches of care, coordinating care among the health-care team and calling to work upstream; and outcomes included needing to clarify expectations of home care services and witnessing the impact of the caregiver role.

These findings demonstrate the importance of Donabedian’s core dimensions of structure and processes in influencing caregiver outcomes. These results emphasize the central role of the manager in influencing system change to improve transitional care.

Attention deficit hyperactivity disorder (ADHD) is the most commonly studied and diagnosed psychiatric disorder in children. There is a need to engage service development, commissioning and service managers to address primary care involvement and define service models that will enable effective management of people with ADHD. The purpose of this project is to define recommendations through consensus that can be implemented to improve ADHD management in the UK.

A set of 40 consensus statements has been developed by a multidisciplinary group of ADHD professionals in the UK. These statements cover ten topics, ranging from commissioning of ADHD services to optimisation of the care pathway. The aim of the project was to define a set of standards that could be tested across a wider clinical population.

A total of 122 respondents scored each statement on a questionnaire and levels of agreement were summated and analysed. Of 40 statements, only four scored less than 90 per cent agreement, with all statements achieving greater than 74.9 per cent agreement.

Recommendations support the wider integration of ADHD services and the closer involvement of commissioners within the new GP consortia to ensure that the potentially negative societal and personal impacts of ADHD are managed effectively and with appropriate use of resources.

Effective integrated healthcare systems require capable, trained workforces with leadership, shared governance and co-ordination. The purpose of this paper is to characterise roles and responsibilities in relation to integrated care from the perspective of massive open online course (MOOC) participants.

MOOC discussion board posts were analysed using framework analysis consisting of transcription, familiarisation, coding, developing an analytical framework and application of the framework.

Boundaries and key issues surrounding roles and responsibilities were highlighted and participants suggested a number of enablers which could enhance integrated care in addition to barriers to consider and overcome.

Enablers included introduction of shared communication and IT systems to support continuity of care. Awareness and understanding of dementia was seen as crucial to promote person-centred care and care planning. The roles of education and experience were highlighted. Barriers preventing effective roles and suitable responsibility include funding, role conflicts, time constraints and time-consuming paperwork.