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Article
Publication date: 2 August 2013

Ryan Woolrych and Judith Sixsmith

Policy has identified the need for integrated dementia services for older people. However, the role of the formal carer within an integrated framework of service delivery

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686

Abstract

Purpose

Policy has identified the need for integrated dementia services for older people. However, the role of the formal carer within an integrated framework of service delivery has not been well articulated in practice. The aim of this paper is to understand the experiences of formal carers working with the context of an integrated dementia service by exploring findings from a research‐based evaluation.

Design/methodology/approach

The evaluation captured the experiences of formal carers working within the service via observations, semi‐structured interviews and focus groups.

Findings

Working with an integrated service brings about individual, social and organisational challenges to the role of the formal carer, in terms of: delivering flexibility and responsiveness, providing continuity of care, ensuring cross‐organisational working and acquiring skills, knowledge and expertise.

Originality/value

To facilitate the successful delivery of integrated care, the emerging role of the formal carer needs to be more clearly articulated and supported within a service context.

Details

Journal of Integrated Care, vol. 21 no. 4
Type: Research Article
ISSN: 1476-9018

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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

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Article
Publication date: 26 April 2011

Partha Priya Datta and Rajkumar Roy

As enterprises focus on offering integrated product/service bundles, performance‐based contracts become ever so important in ensuring effective delivery. Performance‐based…

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6491

Abstract

Purpose

As enterprises focus on offering integrated product/service bundles, performance‐based contracts become ever so important in ensuring effective delivery. Performance‐based contracts fall under the result‐oriented category of industrial product service systems (PSSs). The paper aims to present a conceptual framework for operations strategy in performance‐based industrial PSSs that will help manufacturing companies configure their operations to support effective delivery of integrated product/service offering.

Design/methodology/approach

This paper first develops a conceptual framework for operations strategy in performance‐based contracts by identifying the key elements after a detailed systematic review of literature. A major shift in support and maintenance logistics for complex engineering systems over the past few years has been observed in the defence and aerospace industries. Availability contracting, a special type of performance‐based contracts, is replacing traditional service procurement practices. Two exploratory case studies involving defence availability contracts are conducted for making inferences regarding the operations strategy.

Findings

The important findings of this research are a set of elements of operations strategy guiding the development of a conceptual framework, a set of operating principles and processes supporting effective delivery of performance‐based service contracts.

Originality/value

The true value of this research is to open up the novel area of result‐oriented industrial PSSs operations strategy by capturing the key characteristics of operations using both literature and empirical evidence.

Details

International Journal of Operations & Production Management, vol. 31 no. 5
Type: Research Article
ISSN: 0144-3577

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Article
Publication date: 26 June 2019

Siu Mee Cheng and Cristina Catallo

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…

Abstract

Purpose

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.

Design/methodology/approach

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.

Findings

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.

Research limitations/implications

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.

Practical implications

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.

Originality/value

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.

Details

Journal of Integrated Care, vol. 27 no. 4
Type: Research Article
ISSN: 1476-9018

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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

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Article
Publication date: 16 June 2014

Janice Caine

The purpose of this paper is to reflect upon the method of using a participatory action research (PAR) approach and offer some insight into the processes of integrated

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4636

Abstract

Purpose

The purpose of this paper is to reflect upon the method of using a participatory action research (PAR) approach and offer some insight into the processes of integrated working with service users and carers. The Public Bodies (Joint Working) (Scotland) Bill, 2013 (The Scottish Government, 2013) is focused on integrated and partnership working within the systems of health and social care. The author begins with a person-centred approach and explore the value of placing service user engagement for successful integrated practice. Through these reflections on PAR, the author offers some new lessons about what integration means to practitioners at the front line of service delivery.

Design/methodology/approach

This paper offers insights from a practitioner-research project which the author conducted within the author ' s own practice. It is a reflection on the process of using PAR with five people with dementia and their carers in a research project on the use of music to increase wellbeing for both the person with dementia and their carer. PAR helps to gain service user views but supports service users and providers to work in an integrated way.

Findings

This paper offers insights from a practitioner-research project which the author conducted within the author ' s own practice. It is a reflection on the process of using PAR with five people with dementia and their carers in a research project on the use of music to increase wellbeing for both the person with dementia and their carer. PAR helps to gain service user views but supports service users and providers to work in an integrated way.

Originality/value

A person-centred approach to service user participation in the research process has valuable insights for the integration of service users in the design and delivery of health and social care. The insights offered here highlight the complex processes which make-up effective engagement with service users and carers. It offers concrete details on the challenges which practitioners may face when they work to integrate service users and carers into the planning process. It also highlights the benefits of shared problem-solving and control. Practitioners already play an invaluable role in providing integrated care. This paper serves a reminder of much of what we already know and do. It also asks us to reconsider the focus of integration as a person-centred process.

Details

Journal of Integrated Care, vol. 22 no. 3
Type: Research Article
ISSN: 1476-9018

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Article
Publication date: 14 June 2013

Reynold Macpherson

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…

Abstract

Purpose

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.

Design/methodology/approach

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.

Findings

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.

Originality/value

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.

Details

International Journal of Educational Management, vol. 27 no. 5
Type: Research Article
ISSN: 0951-354X

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Article
Publication date: 17 August 2015

Janet Kelly

The purpose of this paper is to explore some of the critical areas of work in any long-term strategy to develop integrated occupational therapy services across health and…

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191

Abstract

Purpose

The purpose of this paper is to explore some of the critical areas of work in any long-term strategy to develop integrated occupational therapy services across health and social care for adults who are frail and elderly and living in their local communities. It explores the success that has been experienced in Aneurin Bevan University Health Board over the past eight years or more and proposes “keeping the faith” as a helpful personal strategy in avoiding disillusionment and disengagement in the process when setbacks occur along the way.

Design/methodology/approach

The paper is a combination of personal reflection and experience, with reference to the literature and what has been written about others’ professional experiences at bringing services and professional groups together.

Findings

Developing integrated occupational therapy services is not easy. However there are several critical factors, which once understood for their role in the overall process, add weight to the “right thing to do” argument. These “critical factors” provide a continued focus for the work when the challenges inherent in developing integrated services are in danger of outweighing the successes and the pressure is strong to revert to the default position of single agency service delivery.

Originality/value

This paper makes an effort to pursue integrated occupational services to serve as an example of wider attempts to pursue collaboration and integration, highlighting the need for remaining doggedly determined on the final objective – better services for people.

Diben

Mae’r erthygl hon yn archwilio rhai o’r meysydd gwaith hanfodol mewn unrhyw strategaeth hirdymor i ddatblygu gwasanaethau therapi galwedigaethol integredig ar draws iechyd a gofal cymdeithasol. Mae’n nodi ‘cadw’r ffydd’ fel strategaeth bersonol ddefnyddiol yn osgoi dadrithio a datgysylltu yn y broses pan fydd rhwystrau yn digwydd ar hyd y ffordd. Mae’r papur yn dadlau bod yr hyn yr ydym yn ei wneud a’r buddion i ddefnyddwyr y gwasanaeth pan fyddwn yn gwneud pethau’n iawn gymaint yn well, fel na ddylai cyflenwi unrhyw beth arall fod yn opsiwn. Mae’n cynnig mai integreiddio yw’r peth iawn i’w wneud hyd yn oed pan na ellir meintioli a mesur canlyniadau’n hawdd, oherwydd cymhlethdod y broses dros gyfnodau hir. Er bod y ffocws ar wasanaethau therapi galwedigaethol, diben ychwanegol y papur yw dangos sut y mae gwasanaethau ac asiantaethau eraill yn debygol o wynebu’r un brwydrau ac yn gallu dysgu o’r profiad hwn.

Cynllun/methodoleg/dull

Mae’r papur yn gyfuniad o adlewyrchu a phrofiad personol, wedi ei gyfuno â chymariaethau o’r llenyddiaeth a phrofiadau proffesiynol pobl eraill yn dod â gwasanaethau a grwpiau proffesiynol gyda’i gilydd. Mae’n ystyried y gofyniad i ailddylunio’r gweithlu fel ffactor allweddol a phwysigrwydd cadw’r person/claf/defnyddiwr y gwasanaeth yn ganolog i’r holl ystyriaethau yn ymwneud ag ymarfer, proses a pholisi.

Canfyddiadau

Gellir priodoli’r llwyddiant yn datblygu gwasanaethau therapi galwedigaethol integredig yn ardal Bwrdd Iechyd Prifysgol Aneurin Bevan dros yr 8 mlynedd neu fwy (ac sy’n dal yn waith sy’n mynd rhagddo) i sawl ffactor sydd, unwaith y cânt eu deall am eu rôl yn y broses gyffredinol, yn ychwanegu pwysau at y ddadl ‘y peth iawn i’w wneud’. Mae’r ‘aml’ ffactorau hyn yn rhoi ffocws parhaus i’r gwaith pan fydd yr heriau mewn perygl o wrthbwyso’r llwyddiannau ac mae’r pwysau yn gryf i ddychwelyd i sefyllfa ddiofyn o gyflenwi gwasanaeth gan un asiantaeth.

Gwreiddioldeb/gwerth

Mae’r papur hwn yn gwneud ymdrech i fynd ar drywydd gwasanaethau galwedigaethol integredig i wasanaethu fel enghraifft o ymdrechion ehangach i fynd ar drywydd cydweithredu ac integreiddio, gan dynnu sylw at yr angen am weddill ei benderfynu doggedly ar yr amcan terfynol – gwell gwasanaethau i bobl.

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Article
Publication date: 1 June 2010

Martin Connor and George Kissen

This article describes the strategy for delivering integrated care in Trafford on a whole‐systems basis. It describes an approach to integrating services across primary…

Abstract

This article describes the strategy for delivering integrated care in Trafford on a whole‐systems basis. It describes an approach to integrating services across primary care, community health services, social services and acute care. It covers the (clinically led) process of developing the strategic framework, the principles developed and used, and the specific programme to be carried out in 2010/11.

Details

Journal of Integrated Care, vol. 18 no. 3
Type: Research Article
ISSN: 1476-9018

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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…

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2069

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

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