Search results

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

Technological developments are having an impact on the construction sector and are creating a paradigm shift in project delivery methods. Traditional project delivery systems are inadequate in current project development processes. A more integrated project delivery system and the establishment of contractual and financial structures are needed. The purpose of this study is to incorporate integrated project delivery and real estate certificate concepts and propose a model for real estate development.

As a methodology, both integrated project delivery and real estate certificate concepts are reviewed individually, and a case to real estate certificate in Turkey is examined.

A real estate certificate is a new method for financing the development process. The system covers the financial dimension of the integrated project delivery system. When these two concepts are combined, they provide an alternative to the real estate development process.

This study is a preliminary study and lays the foundation for future studies.

In theory, both concepts have many advantages, in practice, it is essential to create the necessary legal basis for these advantages to be valid. As this process requires significant planning and contract management, the proposed model must be properly designed at the start of the project.

This study proposes a new model for real estate development by combining integrated project delivery and real estate certificate concepts.

To investigate the effects of payor–provider integration on the operational performance of health service provision. The research explores whether integration governs agency problems and tilts the incentives of diverse actors toward more systematic outcomes.

A two stage multimethod case study of occupational health services. A qualitative stage aimed to understand the reasons, mechanisms, and outcomes of payor–provider integration. A quantitative stage evaluated the performance of the integrated hospital against fee-for-service partner hospitals with a sample of 2,726 patients.

Payor–provider integration mitigates agency problems on multiple levels of the service system by complementing formal governance mechanisms with informal mechanisms. Compared to partner hospitals, the integrated hospital yielded 9% lower the total costs of occupational injuries achieved primarily by emphasizing conservative care and faster recovery.

Focuses on occupational health services in Finland. Provides initial evidence of the effects of payor–provider integration on the operational performance.

Vertical integration may provide systematic outcomes but requires mindful implementation of multiple mechanisms. Rigorous change management initiative is advised.

For patients, the research shows payor–provider integration of health services can be implemented in a manner that it reduces care costs while not compromising care quality and customer satisfaction.

This study provides a rare longitudinal analysis of payor–provider integration in health-care operations management. The study adds to the knowledge of operational performance improvement of health services.

The purpose of this paper is to develop a case definition of integrated health and social services initiatives that serve older adults, and will provide characteristics to aid in the identification of such initiatives. The case definition is intended to ease the identification of integrated health and social care initiatives.

A limited search was undertaken of both scientific and gray literature that documented and/or examined integrated health and social services initiatives. In addition, literature on well-documented and generally accepted integrated healthcare and social services models that reflect collaborations from healthcare and social services organizations that support older adults was also used to develop the case definition.

The case definition is as follows: healthcare organizations from across the continuum of care working together with social services organizations, so that services are complementary and coordinated in a seamless and unified system, with care continuity for the patient/client in order to achieve desired health outcomes within a holistic perspective; the initiatives comprise at least one healthcare organization and one social care organization; and these initiatives possess 18 characteristics, grouped under 9 themes: patient care approach; program goals; measurement; service and care quality; accountability and responsibility; information sharing; culture; leadership; and staff and professional interaction.

A limitation of this study is that the characteristics are based on a limited literature search. The quality of some of the literature both gray and published was not definitive: information on how they undertook the literature search was not provided; exclusion and inclusion criteria were not included; and there was insufficient detail on the design of the studies included. Furthermore, the literature reviews are based on integrated initiatives that target both seniors and non-senior’s based services. The cross-section of initiatives studied is also different in scale and type, and these differences were not explored.

The case definition is a useful tool in aiding to further the understanding of integrated health and social care initiatives. The number of definitions that exist for integrated health and social care initiatives can make it confusing to clearly understand this field and topic. The characteristics identified can assist in providing greater clarity and understanding on health and social care integration.

This study provides greater coherence in the literature on health and social care integration. It aids in better framing the phenomenon of healthcare and social services integration, thereby enhancing understanding. Finally, the study provides a very useful and concrete list of identifying characteristics, to aid in identifying integrated health and social care initiatives that serve older adults.