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Article
Publication date: 19 July 2011

Michael Leibert

Healthcare services in the USA have been described as being fragmented and uncoordinated. Integrated delivery systems are frequently promoted as being instrumental in…

2140

Abstract

Purpose

Healthcare services in the USA have been described as being fragmented and uncoordinated. Integrated delivery systems are frequently promoted as being instrumental in efforts to improve the coordination of care and, thus, enhancing the quality of clinical care and patient services while ensuring optimum cost‐efficiencies. This study seeks to analyze and compare the performance of hospitals participating in highly integrated systems with non‐integrated hospitals based on outcome measures involving hospital performance.

Design/methodology/approach

The study compares the performance of 50 flagship hospitals participating in the most highly integrated delivery systems in the USA with a representative sample of non‐system hospitals utilizing one‐way analysis of variance. The comparative analysis was based on three key performance measures; clinical quality of medical care, patient satisfaction, and cost‐efficiency considerations.

Findings

The results of the review demonstrate that there is a statistically significant positive difference between the clinical quality performance of the highly integrated hospitals compared with the quality performance of non‐highly integrated facilities. No difference was identified between the two sample groups of hospitals for the performance measures related to patient satisfaction or cost‐efficiencies.

Originality/value

The study is an attempt to evaluate the implications and effectiveness of integration within the health care delivery system. It suggests that integrated delivery systems may provide the organization structure appropriate to help support and enhance the quality of clinical care for patients.

Book part
Publication date: 11 August 2014

Jenna M. Evans, Ross G. Baker, Whitney Berta and Barnsley Jan

To examine the evolution of health care integration strategies and associated conceptualization and practice through a review and synthesis of over 25 years of…

Abstract

Purpose

To examine the evolution of health care integration strategies and associated conceptualization and practice through a review and synthesis of over 25 years of international academic research and literature.

Methods

A search of the health sciences literature was conducted using PubMed and EMBASE. A total of 114 articles were identified for inclusion and thematically analyzed using a strategy content model for systems-level integration.

Findings

Six major, inter-related shifts in integration strategies were identified: (1) from a focus on horizontal integration to an emphasis on vertical integration; (2) from acute care and institution-centered models of integration to a broader focus on community-based health and social services; (3) from economic arguments for integration to an emphasis on improving quality of care and creating value; (4) from evaluations of integration using an organizational perspective to an emerging interest in patient-centered measures; (5) from a focus on modifying organizational and environmental structures to an emphasis on changing ways of working and influencing underlying cultural attitudes and norms; and (6) from integration for all patients within defined regions to a strategic focus on integrating care for specific populations. We propose that underlying many of these shifts is a growing recognition of the value of understanding health care delivery and integration as processes situated in Complex-Adaptive Systems (CAS).

Originality/value

This review builds a descriptive framework against which to assess, compare, and track integration strategies over time.

Details

Annual Review of Health Care Management: Revisiting The Evolution of Health Systems Organization
Type: Book
ISBN: 978-1-78350-715-3

Keywords

Book part
Publication date: 10 November 2005

Katharina Janus and Volker Amelung

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…

Abstract

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.

Details

International Health Care Management
Type: Book
ISBN: 978-0-76231-228-3

Article
Publication date: 1 September 2022

Bashir Tijani, Xiaohua Jin and Robert Osei-Kyei

Due to the frenetic and dynamic working conditions ascribed to architecture, engineering and construction (AEC) project organizations, enormous research has addressed the…

Abstract

Purpose

Due to the frenetic and dynamic working conditions ascribed to architecture, engineering and construction (AEC) project organizations, enormous research has addressed the poor mental health propensity of project management practitioners (PMPs). However, research has not considered the distant factors related to organizational design causing poor mental health. Therefore, this study addresses the problem by integrating institutional theory, agency theory and resource-based theory (RBT) to explore the relationship between organizational design elements: project governance, knowledge management, integrated project delivery, project management skills and mental health management indicators. Examples of mental health management indicators include social relationships, work-life balance and project leadership.

Design/methodology/approach

Purposive sampling method was adopted to collect survey data from 90 PMPs in 60 AEC firms in Australia. Structural equation modelling (SEM) was utilized to test the relationship between the variables.

Findings

The research found that project governance, knowledge management and integrated project delivery are positively correlated to mental health management indicators. However, the research finding suggests that project management skills have a negative impact on mental health management indicators.

Originality/value

The findings offer guidelines to AEC firms on achieving positive mental health management outcomes through concentration on project governance, knowledge management and integrated project delivery. It further calls for a reconsideration of existing project management skills causing poor mental health management outcomes.

Details

Engineering, Construction and Architectural Management, vol. ahead-of-print no. ahead-of-print
Type: Research Article
ISSN: 0969-9988

Keywords

Article
Publication date: 26 October 2012

Jenna M. Evans and G. Ross Baker

Health service organizations and professionals are under increasing pressure to work together to deliver integrated patient care. A common understanding of integration…

2236

Abstract

Purpose

Health service organizations and professionals are under increasing pressure to work together to deliver integrated patient care. A common understanding of integration strategies may facilitate the delivery of integrated care across inter‐organizational and inter‐professional boundaries. This paper aims to build a framework for exploring and potentially aligning multiple stakeholder perspectives of systems integration.

Design/methodology/approach

The authors draw from the literature on shared mental models, strategic management and change, framing, stakeholder management, and systems theory to develop a new construct, Mental Models of Integrated Care (MMIC), which consists of three types of mental models, i.e. integration‐task, system‐role, and integration‐belief.

Findings

The MMIC construct encompasses many of the known barriers and enablers to integrating care while also providing a comprehensive, theory‐based framework of psychological factors that may influence inter‐organizational and inter‐professional relations. While the existing literature on integration focuses on optimizing structures and processes, the MMIC construct emphasizes the convergence and divergence of stakeholders' knowledge and beliefs, and how these underlying cognitions influence interactions (or lack thereof) across the continuum of care.

Practical implications

MMIC may help to: explain what differentiates effective from ineffective integration initiatives; determine system readiness to integrate; diagnose integration problems; and develop interventions for enhancing integrative processes and ultimately the delivery of integrated care.

Originality/value

Global interest and ongoing challenges in integrating care underline the need for research on the mental models that characterize the behaviors of actors within health systems; the proposed framework offers a starting point for applying a cognitive perspective to health systems integration.

Details

Journal of Health Organization and Management, vol. 26 no. 6
Type: Research Article
ISSN: 1477-7266

Keywords

Book part
Publication date: 25 July 2012

Peter Lazes, Liana Katz, Maria Figueroa and Arun Karpur

Purpose – This chapter explores the use of adaptive and disruptive change strategies to create an integrated health care delivery system that is both economically…

Abstract

Purpose – This chapter explores the use of adaptive and disruptive change strategies to create an integrated health care delivery system that is both economically sustainable and patient-centered.

Design/methodology – This case study of Montefiore Medical Center is based on a year of research that included focus-group interviews; individual interviews with executives, frontline staff, and union leaders; site visits; analysis of internal data; and a literature review.

Findings – Montefiore Medical Center is using both adaptive and disruptive strategies to develop an integrated delivery system driven by capitated payments from health insurance companies, a focus on primary care and chronic disease management programs, and community outreach. The growth of these delivery system components in conjunction with Montefiore's Care Management Corporation (to help manage the health plan contracts) has contributed to an affordable cost of care, improved clinical outcomes, and proactive patient and community engagement.

Originality and value – There is a paucity of case studies describing how safety-net hospitals – and health systems in general – can integrate the services they provide to create a positive, seamless, and economical patient experience. The story of Montefiore Medical Center offers an overview of how health care infrastructure and payment methods can be transformed to align financial and clinical incentives and to better serve a patient population that largely depends on government health insurance.

Details

Organizing for Sustainable Health Care
Type: Book
ISBN: 978-1-78190-033-8

Keywords

Article
Publication date: 30 April 2021

Livia Martin

Government imperatives that drive integrated care are challenging corporate executive leadership. Conspicuous by its absence in both government's imperatives and the…

Abstract

Purpose

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.

Design/methodology/approach

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.

Findings

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.

Originality/value

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.

Details

Journal of Integrated Care, vol. 30 no. 1
Type: Research Article
ISSN: 1476-9018

Keywords

Article
Publication date: 1 August 2008

Gina Bravo, Michel Raîche, Marie‐France Dubois and Réjean Hébert

Interest has grown in integrated care models as means of responding better to the needs of frail older adults. In order to provide appropriate input for health policy…

Abstract

Interest has grown in integrated care models as means of responding better to the needs of frail older adults. In order to provide appropriate input for health policy reforms, the effects of integrated care must be assessed with sound methodologies. Based on three experiments conducted in the province of Quebec, Canada, this article provides practical advice on key issues involved in evaluating integrated care models.

Details

Journal of Integrated Care, vol. 16 no. 4
Type: Research Article
ISSN: 1476-9018

Keywords

Article
Publication date: 6 May 2014

Christopher Durugbo, Ashutosh Tiwari and Jeffrey R. Alcock

The purpose of this paper is to explore the management of information flow for delivery reliability. It analyses how the integration strategies of traceability…

2010

Abstract

Purpose

The purpose of this paper is to explore the management of information flow for delivery reliability. It analyses how the integration strategies of traceability, transaction costs and vertical integration that shape integrated information flow are managed during delivery processes of firms. While delivery reliability contributes to firm competitiveness, information flow is central to firms interaction internally and externally to facilitate delivery.

Design/methodology/approach

The paper applies an exploratory multiple-case study involving 21 delivery team members in three industrial technology-based firms. Informed by a multidisciplinary framework from literature, the study captures “what” and “how” existing firms manage information flow during delivery. Individual cases from the company were compared analysed to determine themes that drive delivery-related integrated information flow management.

Findings

The paper finds that case firms prioritised understanding interaction logics, maintaining process timeliness, review-oriented streamlining and communication-oriented coordination. The study also finds that for delivery reliability in technology-based firms, the interplay of vertical integration, market relations and long term, voluntary relations, especially through the use of small, dedicated and highly skilled team, is required to effectively manage delivery-related integrated information flow.

Originality/value

The major contribution of this paper is an exposition on practices for facilitating information flow integration. It also offers insights that suggest integrated information flow for delivery reliability could be enhanced through the use of customer-focused communication channels, context-driven documentations, multiple and alternate communication channels as well as intuitive and user-friendly documentation strategies.

Details

Industrial Management & Data Systems, vol. 114 no. 4
Type: Research Article
ISSN: 0263-5577

Keywords

Article
Publication date: 1 May 1996

Sandra P. Price, Anne Morris and J. Eric Davies

This paper presents an overview of past and present research projects associated with electronic document delivery. The paper briefly outlines the Follet Report and…

Abstract

This paper presents an overview of past and present research projects associated with electronic document delivery. The paper briefly outlines the Follet Report and introduces the UK's Electronics Libraries Programme, including the recently funded Focused Investigation of Document Delivery (FIDDO) project at Loughborough University. Four research areas have been identified as follows: resource sharing projects; network communication projects; electronic scanning projects and electronic document delivery systems. Conclusions highlight the major impact that technological developments are currently having on this area, the need for librarians to reassess their role in the information chain, and the need for delivery systems capable of handling different formats and a wider coverage of material to satisfy requests.

Details

The Electronic Library, vol. 14 no. 5
Type: Research Article
ISSN: 0264-0473

1 – 10 of over 52000