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Integrated health care delivery (IHCD), as a major issue of managed care, was considered the panacea to rising health care costs. In theory it would simultaneously provide high-quality and continuous care. However, owing to the backlash of managed care at the turn of the century many health care providers today refrain from using further integrative activities. Based on transaction cost economics, this chapter investigates why IHCD is deemed appropriate in certain circumstances and why it failed in the past. It explores the new understanding of IHCD, which focuses on actual integration through virtual integration instead of aggregation of health care entities. Current success factors of virtually integrated hybrid structures, which have been evaluated in a long-term case study conducted in the San Francisco Bay Area from July 2001 to September 2002, will elucidate the further development of IHCD and the implications for other industrialized countries, such as Germany.

This paper aims to report on research undertaken in an National Health Service (NHS) emergency department in the north of England, UK, to identify which patients, with which clinical conditions are returning to the emergency department with an unscheduled return visit (URV) within seven days. This paper analyses the data in relation to the newly introduced Integrated Care Boards (ICBs). The continued upward increase in demand for emergency care services requires a new type of “upstreamist”, health system leader from the emergency department, who can report on URV data to influence the development of integrated care services to reduce further demand on the emergency department.

Patients were identified through the emergency department symphony data base and included patients with at least one return visit to emergency department (ED) within seven days. A sample of 1,000 index visits between 1 January 2019–31 October 2019 was chosen by simple random sampling technique through Excel. Out of 1,000, only 761 entries had complete data in all variables. A statistical analysis was undertaken using Poisson regression using NCSS statistical software. A review of the literature on integrated health care and its relationship with health systems leadership was undertaken to conceptualise a new type of “upstreamist” system leadership to advance the integration of health care.

Out of all 83 variables regressed with statistical analysis, only 12 variables were statistically significant on multi-variable regression. The most statistically important factor were patients presenting with gynaecological disorders, whose relative rate ratio (RR) for early-URV was 43% holding the other variables constant. Eye problems were also statistically highly significant (RR = 41%) however, clinically both accounted for just 1% and 2% of the URV, respectively. The URV data combined with “upstreamist” system leadership from the ED is required as a critical mechanism to identify gaps and inform a rationale for integrated care models to lessen further demand on emergency services in the ED.

At a time of significant pressure for emergency departments, there needs to be a move towards more collaborative health system leadership with support from statistical analyses of the URV rate, which will continue to provide critical information to influence the development of integrated health and care services. This study identifies areas for further research, particularly for mixed methods studies to ascertain why patients with specific complaints return to the emergency department and if alternative pathways could be developed. The success of the Esther model in Sweden gives hope that patient-centred service development could create meaningful integrated health and care services.

This research was a large-scale quantitative study drawing upon data from one hospital in the UK to identify risk factors for URV. This quality metric can generate important data to inform the development of integrated health and care services. Further research is required to review URV data for the whole of the NHS and with the new Integrated Health and Care Boards, there is a new impetus to push for this metric to provide robust data to prioritise the need to develop integrated services where there are gaps.

To the best of the authors’ knowledge, this is the first large-scale study of its kind to generate whole hospital data on risk factors for URVs to the emergency department. The URV is an important global quality metric and will continue to generate important data on those patients with specific complaints who return back to the emergency department. This is a critical time for the NHS and at the same time an important opportunity to develop “Esther” patient-centred approaches in the design of integrated health and care services.

The aim of this paper is to report the process, findings and implications of a three‐year evaluation of integrated health centres (IHCs) established in three secondary schools in Cornwall by the School‐Based Integrated Health Centres (SBIHC) partnership.

When the partners had completed the capital works, an evaluation strategy was designed for 2009‐2012 to identify the extent to which each of the IHCs was meeting the aims set for the IHCs, and each IHC and school was contributing to the aims of the SBIHC project. Formative and summative evaluation used annual case studies to apply data progressively regarding: the use, users and operations of each IHC; students’ perceptions of the user‐friendliness of the IHCs; indicators of the general health and well‐being of students and their sexual and mental health; students’ exposure to crime, substance abuse and poverty; and students’ academic achievement, attendances and exclusions. This process culminated in this paper which reports and discusses findings, suggests implications for practice, theory and research and proposes future directions for the partnership.

All three schools engaged students closely in the design and decoration of their IHCs. Student ownership was extended into the selection of Coordinators and into centre management and governance. Budehaven Community School appointed a National Health Service (NHS)‐trained Coordinator for their IHC, The Haven, a mental health worker funded for one year by the NHS. After 2009‐2010, his responsibilities were shared by the NHS‐trained Receptionist and the Manager, an Assistant Headteacher. During Year 3, Budehaven added a “co‐location” building, Kevren. About 37 professionals are now located in or visit The Haven and Kevren. Student footfall doubled to about 4,000 in the second year and increased by another 25 per cent in the third year. The wide range of general, mental and sexual health services were highly valued by the students. The Crayon, the IHC in Hayle Community School, achieved a similar footfall over three years. It started with a Receptionist and the Pupil Welfare Officer. The Manager, a Deputy Headteacher, and the Headteacher moving most student support services into the IHC at the end of Year 1. From then on the Crayon had three full‐time professionals. By the end of Year 3, the Crayon had reached the limits of its facilities. A solely positive association was found between IHC usage and measured improvements to mental health and academic progress. The IHC in Penair School, Bywva, developed a wide range of general, sexual and mental health services, attracted a similarly strong footfall, and also reached capacity in Year 3. Penair refined their IHC's line management by an Assistant Headteacher and coordination by a Lead.

This paper offers a new conceptual model of the SBIHC model of health care centred on the reciprocity and integrity of relationships between students and professionals.

Government imperatives that drive integrated care are challenging corporate executive leadership. Conspicuous by its absence in both government's imperatives and the literature, is any reference to corporate executive leadership in transitioning a hierarchically oriented health system to a laterally integrated health system referred to, in this paper, as an integrated health system. This lack of reference to executive leadership involvement conveys either significant consequences or opportunities for corporate healthcare executives. The purpose of this qualitative, multi-case study is to explore corporate executive leadership in transitioning a hierarchically oriented health system to an integrated health system.

Between December 2017 and February 2018, a qualitative methodology and multi-case study design facilitated one hour telephone interviews with 11 presidents and four senior vice presidents. Critical case sampling was used to select the study sample from a target population of 246 corporate healthcare executives representing Ontario's major acute healthcare organizations/systems.

Corporate healthcare executives possess the requisite skills and knowledge to transition a hierarchically oriented to a laterally integrated the health system but are constrained by an undefined partnership role with government and fear of government changes.

This paper provides corporate executive leaders with a systematic leadership approach to organizational readiness, in transitioning to an integrated health system. Features and outcomes of the approach are illustrated.

Design, implementation, and evaluation are all important for integrated care. However, they miss one critical factor: education. The authors define “integrated care education” as meaningful learning that purposefully supports collaboration and the development of adaptive expertise in integrated care. The ECHO (Extensions for Community Health Outcomes) model is a novel digital health solution that uses technology-enabled learning (TEL) to facilitate, support, and model integrated care education. Using ECHO Concussion as a case study, the authors describe the effects of technology-enabled integrated care education on the micro-, meso-, and macro-dimensions of integrated care.

This case study was constructed using data extracted from ECHO Concussion from video-archived sessions, participant observation, and internal program evaluation memos. The research team met regularly to discuss the development of relevant themes to the dimensions of integrated care.

On the micro-level, clinical integration occurs through case-based learning and the development of adaptive expertise. On the meso-level, professional integration is achieved through the development of the “specialist generalist,” professional networks and empathy. Finally, on the macro-level, ECHO Concussion and the ECHO model achieve vertical and horizontal system integration in the delivery of integrated care. Vertical integration is achieved through ECHO by educating and connecting providers across sectors from primary to quaternary levels of care. Horizontal integration is achieved through the establishment of lateral peer-based networks across sectors as a result of participation in ECHO sessions with a focus on population-level health.

This case study examines the role of education in the delivery of integrated care through one program, ECHO Concussion. Using the three dimensions of integrated care on the micro-, meso-, and macro-levels, this case study is the first explicit operationalization of ECHO as a means of delivering integrated care education and supporting integrated care delivery.

The purpose of this paper is to explore community professionals’: opinions concerning social worker’s roles and statutory functions; understanding of collaborative and cooperative work; experiences of professional support; opinions on the aspects of anti-oppressive practices in social work; views on social work identity within multi-disciplinary team structures; exploring perceptions regarding the challenges of cultural; and contextual drivers of social work practice.

Design: thematic analysis of free-text data from a survey. Setting and participants: social workers, occupational therapists and nurses working within an integrated Health and Social Care NHS Trust. Main outcome measures: free-text coded and categorised by theme. Overarching themes are identified incorporating comment categories. Methods: 41 respondents (of n=600 survey respondents) provided free-text comments. Data were coded using a multistage approach: coding of comments into general categories (e.g. resources, budgets); coding of subcategories within main categories (e.g. s75 agreement, staffing levels); cross-sectional analysis to identify themes cutting across categories; and mapping of categories/subcategories to corresponding comparable research for comparison.

Most free-text respondents (51 per cent) were from social workers, with 32 per cent from occupational therapists and 17 per cent from nurses. These respondents provided comments that the authors developed into four overarching themes: first, culture – cultural biases and clashes of culture within an integrated care organisation which result in a negative experience for professionals and confusion for service users and/or carers. A lack of shared socialisation and the development of a shared culture. Second, austerity: the impact of economic austerity. Third, organisation: conceptual confusion in respect of defining/organising/structuring integrated care within a health organisation. Fourth, political: the political drivers of integration.

This study presents specific areas of concern for social workers and for integrated social care and health as a whole, revealing a number of themes present across the integration journey. While the majority of comments were negative, analysis reveals concerns shared by significant numbers of respondents: conceptual confusion in respect of organising integrated care within a health organisation, a lack of shared socialisation and the development of a shared culture within the integrated organisation, and the impact of economic austerity on integration.

After briefly describing self‐managed integrated community teams, the authors explore potential and actual methods of evaluating their structures, processes and outcomes. Primary health care staff in three comparable sites were studied using non‐participant observation, interviews, focus groups and questionnaires. After describing the fieldwork, the authors examine integrated team structures, which are characterised by a large number of barriers that integrated teams face. Processes surrounding different working practices are explored next. Ways of unifying health care professional practice in integrated teams are suggested using evidence from both the literature and fieldwork. Outcomes that emerged after one year of the new teams’ lives are discussed in detail. The difficulty in establishing acceptable outcomes, especially the validity and reliability of outcome measures, is considered. Throughout, the positive and negative aspects of integrated teams emerging from the fieldwork are compared and contrasted with issues in the literature. Finally, recommendations are made to help strengthen integrated teams in the UK.

This report aims to examine the capacity for research to support integrated care developments. The focus is on health service research agencies in English universities. It is designed to promote an understanding of alternative approaches as national research programmes offer new opportunities for larger and more rigorous studies.

The approach draws on three analyses of different data from relevant programmes of the National Institute for Health Research (NIHR) over a 30 month period. The data are derived from commissioning briefs, monitoring reports and annual reviews. Relevant international comparisons indicate possible responses to deficits.

The review points to a process of normalisation, through which integrated care has become an important standard dimension of health services research in England. While the commissioning of studies related to integrated care is shown to demonstrate a sustained and enhanced profile, the capacity of higher education providers appears to be changing. The growing emphasis on health services research corresponds with increased research leadership from clinical and public health academics, which raises questions regarding future multi‐disciplinary and social sciences contributions and projects on lateral forms of integrated care.

The findings are only derived from a single source from the NIHR portfolio, and a period in which there were significant and structural changes in the NHS and administration of relevant NIHR programmes.

The review is the first of its kind in employing aggregate NIHR programme data. It offers an original typology of higher education research agencies and novel insights into comparable developments elsewhere.

The aim of this paper is to highlight the significance of integrated governance in bringing about community participation, improved service delivery, accountability of public systems and human resource rationalisation. It discusses the strategies of innovative institutional structures in translating such integration in the areas of public health and nutrition for poor communities.

The paper draws on experience of initiating integrated governance through innovations in health and nutrition programming in the resource‐poor state of Chhattisgarh, India, at different levels of governance structures – hamlets, villages, clusters, blocks, districts and at the state. The study uses mixed methods – i.e. document analysis, interviews, discussions and quantitative data from facilities surveys – to present a case study analyzing the process and outcome of integration.

The data indicate that integrated governance initiatives improved convergence between health and nutrition departments of the state at all levels. Also, innovative structures are important to implement the idea of integration, especially in contexts that do not have historical experience of such partnerships. Integration also contributed towards improved participation of communities in self‐governance, community monitoring of government programs, and therefore, better services.

As governments across the world, especially in developing countries, struggle towards achieving better governance, integration can serve as a desirable process to address this. Integration can affect the decentralisation of power, inclusion, efficiency, accountability and improved service quality in government programs. The institutional structures detailed in this paper can provide models for replication in other similar contexts for translating and sustaining the idea of integrated governance.

This paper is one of the few to investigate innovative public institutions of a particularly vulnerable and poor region in India, and is unique in that it uses the lenses of governance and community mobilisation to explore this important, and under‐researched, topic.

Policy makers, practitioners and researchers have increasingly emphasised the need for both vertical and horizontal ‘integration’ and ‘integrated care’. This is not new; since the inception of the NHS wide‐ranging policies and programmes have sought to co‐ordinate services better. Current UK policy, however, tends to overlook this historical record and, in so doing, ignores potential learning from the past. We seek to help rectify this approach by reviewing historical (published and grey) literature over the past one hundred years, considering both the drivers for and the impediments to varied UK policy developments in integrating health and allied services. We aim to shed light on how the policy of integrated care has developed in the UK and draw out lessons for modern‐day policy makers.