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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.

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.

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).

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

The rising of chronic illness and the continuous aging of the global population requires a re-organization of health care systems based on relations and exchange of information to address patient needs in the community. The re-organization of health care systems involves interconnected changes and the development of integrated health care information systems and novel eHealth services. In Crete, the Foundation for Research and Technology-Hellas has developed HYGEIAnet, a Regional Health Information Network (RHIN) to contribute to the re-organization of health care systems and information sharing. We present HYGEIAnet, some of the most critical and novel eHealth services developed and deployed, discuss the impact of an RHIN on health care processes, and explore innovative models and services for health delivery and the coordination of care. We then critically discuss lessons learned regarding the effective management of change to overcome organizational and cultural issues in such large-scale initiatives. The paper concludes with policy and practice recommendations for managing change processes in health care organizations.

Systems of care and evidence-based practice possess distinct histories. Though each developed out of attempts to improve services to youth with emotional and behavioral disorders, they did so from perspectives so different as to appear diametrically opposed. Service systems exist at multiple levels, including the practice, program, and system levels (Rosenblatt, 1988, 2005; Rosenblatt & Woodbridge, 2003). Research on health and mental health service systems similarly varies, often by level of the service system, with the research methods, independent and dependent variables, populations of interest, and ultimately the consumers of the research product interacting differentially in the creation and understanding of what constitutes a knowledge base for service delivery. Systems of care and, with limited exceptions, evidence-based practices exist at different levels of the service delivery structure, require and derive from different research approaches, and speak to overlapping but historically different audiences.

The service industry is a major component of the economy. Raw material, components, assemblies, and finished products are shipped between suppliers, manufacturers, distributors, and retailers. Accordingly, timely receipt of shipped goods is crucial in maintaining the efficiency and effectiveness of such service processes. A service provider offers an incentive to the customer by specifying a competitive target time for delivery of goods. Further, if the delivery time is deviant from the target value, the provider offers to reimburse the customer for an amount that is proportional to the value of the goods and the degree of deviation from the target value. The service provider may set the price to be charged as a function of product value. This price is in addition to the operational costs of logistics that are not considered in the formulated model. For protection against deviation from target due dates, the service provider agrees to reimburse the customer. The reimbursement could be based on an asymmetric loss function influenced by the degree of deviation from the target due date as well as product value. The penalties could be different for early and late deliveries since the customer may experience different impact and consequences accordingly. The chapter develops a model to determine the amount (price) that the provider should add to the cost estimate of the delivery contract for protection against delivery deviations. Such a cost estimate will include the operational costs (fixed and variable) of the shipment, to which an amount is added to cover the expected payout to customers when the delivery time deviates from the target value. The optimal price should be such that the expected revenue will at least exceed the expected payout.

This chapter seeks to optimize HR shared services performance by highlighting the potential for service fragmentation that can arise out of in the so-called Ulrich (structure or service delivery) model.

The evidence used in this chapter principally comes from the author’s own work, especially research for the UK’s Chartered Institute of Personnel and Development (CIPD), and draws upon academic literature where possible.

This chapter argues that HR directors should guard against three sets of fragmentation risks. Firstly, HR shared services should be properly connected to the rest of HR to offer customers an integrated service to avoid the structure’s division of labor inducing incoherence. Second, to guard against this risk, HR directors should exercise care in outsourcing/offshoring beyond individual, discrete services because contractually or spatially separating services risks exacerbating this tendency to fragmentation. Outsourcing/offshoring may focus too much on cost savings and insufficiently on quality. So, third, HR should argue for the distinctiveness of its activities and fight commoditization that is also implied in the creation of cross-functional shared service centers.

The arguments in this chapter could be better supported by academic research. In-depth case studies of management decision making and shared services operation would help support or challenge the chapter’s conclusion, as could quantitative evidence on the benefits/disbenefits of outsourcing/offshoring/cross-functional shared services centers.

We have highlighted a number of reported problems with HR shared services operation, besides the three principal risks noted above, but we have suggested possible solutions that could be adopted by practitioners.

HR managers may find this chapter helpful in designing new HR structures or in assessing the effectiveness of shared services that goes beyond the typical key performance indicator measures.

Chronic illnesses require long term, ongoing medical care as well as the provision of a variety of social support services. These diverse systems of care need to be integrated. However, under managed care, health care systems adhere to a disease model where emphasis is placed upon cure rather than care. While managed care can increase system coordination, the logic of cost containment favors acute services over the long term supportive services needed by chronic care clients. In this paper I describe efforts in one community which has received funding to integrate services for individuals with chronic mental illness as well as a planning grant to integrate multiple chronic care systems (HIV, mental health, and substance abuse) for minority clients. I describe various models of system integration and how diverse systems can be coordinated. In the conclusion I examine the barriers to system integration and argue that sociologists need to play a stronger role in understanding systems of care.

The major objective of this research is to examine and characterize service delivery systems for persons with mental illness in a resource scarce environment, i.e. a rural area characterized by persistent poverty and disadvantaged poulations. Although a number of studies have investigated the integration of mental health, general health, and social services, few have focused on systems of care in rural areas. To characterize service delivery systems, this exploratory study uses a case study approach that includes network analysis, quantitative analysis, and a system assessment. The findings suggest that scarcity of resources in these rural environments is an overriding factor in the development of an integrated service delivery system for persons with a mental illness. With no psychiatrists, long waits for commitment, and few emergency accomodations, these rural environments afford service providers little opportunity for proactive or strategic planning. In fact, we view the development of integrated (e.g. client referral and technical information exchange) service networks in rural communities, especially areas of extreme resource scarcity, as problematic. The resource exchange networks that exist are best characterized as informal, moderately centralized, and of limited density. This translates into a system of care that is provider-driven and crisis-oriented.