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The purpose of this paper is to highlight the challenges regarding learning in stakeholder relations in profit and nonprofit organizations.

Conclusions and models presented in the paper have been designed based on the systems perspective, critical thinking and critical review of previous contributions.

Organizational learning has been examined in profit and nonprofit organizations, and factors which stimulate this process have been identified. More precisely, factors contributing to organizational learning in board of directors have been critically examined, accreditation as a factor contributing to organizational learning in higher education institutions (HEIs) has been suggested, learning dynamics in university–industry collaborations and inter-professional learning have been examined, as well as organizational learning as a bottom-up approach supported by transformational leaderships.

Conclusions and models provided in the paper need further empirical testing and validation.

Useful implications for practitioners in profit and nonprofit sector have been suggested based on the critical analysis of previous contributions regarding stimulation of organizational learning in stakeholder relations.

Contributions from previous authors have been systemically and critically reviewed, adapted models have been provided and suggestions for practitioners in this regard have been offered.

Maintaining user-focused integrated team working in complex care is one of the demands made of UK health and social care (H&SC) organisations who need employees that are resilient, resilience being the ability to persevere and thrive in the face of exposure to adverse situations (Rogerson and Ermes, 2008, p. 1). Grant and Kinman (2012) write that resilience is a complex and multi-dimensional construct that is underexplored in social care team work. The purpose of this paper is to capture the views of managers in H&SC to explore the making of resilient teams, identify factors that influence team performance and inform organisational workforce development strategy.

A general inductive approach (Silverman, 2011) was applied. Five focus groups were facilitated (n=40) each with eight participants all of whom were leaders and managers of teams in H&SC, working in the integrated care context in the UK.

Findings indicate that further investment in strategies and resources to sustain and educate employees who work in teams and further research into how organisational systems can facilitate this learning positively may contribute to resilient teams and performance improvement. The authors note specifically that H&SC organisations make a distinction between the two most prevalent team types and structures of multi-disciplinary and inter-professional and plan more targeted workforce development for individual and team learning for resiliency within these team structures. In doing so organisations may gain further advantages such as improved team performance in problematic care situations.

Data captured are self-reported perceptions of H&SC managers. Participant responses in the focus group situation may have been those expected rather than those actually modelled in the realities of team work practice (Tanggaard, 2008). Further, in the sample all participants were engaged in a higher education programme and it is possible participants may have been more engaged with their practice and thinking more critically about the research questions than those not currently undertaking postgraduate study (Ng et al., 2014). Nor were the researchers able to observe the participants in team work practice over time or during critical care delivery incidents.

The preliminary link made here between multi-disciplinary and inter-professional team type, and their different stress points and subsequent workforce intervention, contributes to the theory of resilient teams. This provides organisations with a foundation for the focus of workplace learning and training around resilience. H&SC practitioner views presented offer a greater understanding of team work processes, together with a target for planning workforce development strategy to sustain resilience in team working.

This preliminary research found that participants in H&SC valued the team as a very important vehicle for building and sustaining resilience when dealing with complex H&SC situations. The capitalisation on the distinction in team type and individual working practices between those of interprofessional and multidisciplinary teams and the model of team learning, may have important consequences for building resilience in H&SC teams. These findings may be significant for workforce educators seeking to develop and build effective practice tools to sustain team working.

In healthcare, organizational boundaries are often viewed as barriers to change. The purpose of this paper is to show how middle managers create inter-organizational change by doing boundary work: the dual act of redrawing boundaries and coordinating work in new ways.

Theoretically, the paper draws on the concept of boundary work from Science and Technology Studies. Empirically, the paper is based on an ethnographic investigation of middle managers that participate in a Dutch reform program across health, social care, and housing.

The findings show how middle managers create a sense of urgency for inter-organizational change by emphasizing “fragmented” service provision due to professional, sectoral, financial, and geographical boundaries. Rather than eradicating these boundaries, middle managers change the status quo gradually by redrawing composite boundaries. They use boundary objects and a boundary-transcending vocabulary emphasizing the need for societal gains that go beyond production targets of individual organizations. As a result, work is coordinated in new ways in neighborhood teams and professional expertise is being reconfigured.

Since boundary workers create incremental change, it is necessary to follow their work for a longer period to assess whether boundary work contributes to paradigm change.

Organizations should pay attention to conditions for boundary work, such as legitimacy of boundary workers and the availability of boundary spaces that function as communities of practice.

By shifting the focus from boundaries to boundary work, this paper gives valuable insights into “how” boundaries are redrawn and embodied in objects and language.

Over the past decade, there has been growing international interest in shaping local organisational cultures in primary healthcare. However, the contextual relevance of extant culture assessment instruments to the primary care context has been questioned. The aim of this paper is to derive a new contextually appropriate understanding of the key dimensions of primary care medical practice organisational culture and their inter-relationship through a synthesis of published qualitative research.

A systematic search of six electronic databases followed by a synthesis using techniques of meta-ethnography involving translation and re-interpretation.

A total of 16 papers were included in the meta-ethnography from the UK, the USA, Canada, Australia and New Zealand that fell into two related groups: those focused on practice organisational characteristics and narratives of practice individuality; and those focused on sub-practice variation across professional, managerial and administrative lines. It was found that primary care organisational culture was characterised by four key dimensions, i.e. responsiveness, team hierarchy, care philosophy and communication. These dimensions are multi-level and inter-professional in nature, spanning both practice and sub-practice levels.

The research contributes to organisational culture theory development. The four new cultural dimensions provide a synthesized conceptual framework for researchers to evaluate and understand primary care cultural and sub-cultural levels.

The synthesised cultural dimensions present a framework for practitioners to understand and change organisational culture in primary care teams.

The research uses an innovative research methodology to synthesise the existing qualitative research and is one of the first to develop systematically a qualitative conceptual framing of primary care organisational culture.

Integrating health, social and informal care and seeking for new effective collaborations is a major topic in many countries, and requires innovation and improvement in current practices. Conceptual quality management models can facilitate practice improvement. However, a generic quality management model for integrated care was lacking. The purpose of this paper is to describe the results of multiple studies that resulted in a validated generic quality management model for integrated care. The Development Model for Integrated Care (DMIC) is the basis for a digital tool for self-evaluation and is being used in multiple ways in a large number of integrated care settings.

A literature review, a Delphi study and concept mapping study were executed to identify the essential ingredients of integrated care. A next step was an expert study on the development process of integrated care over time. Lastly, a survey study in 84 integrated care networks was performed to empirically validate the model. Based on the model, a digital self-assessment tool was created to apply the model in practice.

The studies showed that integrated care is a complex and multi-component concept but generic elements can be assessed. The literature and expert study resulted in a set of 89 elements of integrated care. The elements were grouped in nine clusters; “quality care”, “performance management”, “inter-professional teamwork”, “delivery system”, “roles and tasks”, “patient-centredness”, “commitment”, “transparent entrepreneurship” and “result-focused learning”. Four developmental phases named “the initiative and design phase”, “the experimental and execution phase”, “the expansion and monitoring phase” and “the consolidation and transformation phase” were found. The findings showed that the model is applicable for multiple integrated care settings.

The DMIC has the potential to serve as a research framework for integrated care, and the use as an evaluation tool on multiple levels. Further research is suggested about more explicitly involving the perspectives of clients, research on the involvement of multiple stakeholders and their professional backgrounds and the use of the model in other countries.

The DMIC is the basis of a digital web-based assessment tool, which is being used in the Netherlands in multiple integrated care settings. Applying the tool helps in assessing the current state of integrated care practice and defining suggestions for further improvement and development. It is also being used to benchmark multiple settings and is adopted in guidelines or care standards for integrated care.

A generic conceptual and validated model that can be supportive for integrated care practices, policy and research was lacking. The results of the summarized studies in this paper present such a conceptual model for integrated care and gives suggestions for further use in an international audience. Results in a Canadian study showed that the model can also be used in other settings and countries. This contributes to the opportunities for use of the model in integrated care practice, policy and research also in other countries.

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.

The potential of inter‐professional education and training in primary care is increasingly being recognised, especially in light of UK policy developments relating to clinical governance and primary care groups and trusts. Action to Support Practices Implementing Research Evidence (ASPIRE) was set up in North‐west England in 1997 to assist primary care teams in finding, appraising and applying evidence. Outlines some of the lessons learned and questions raised about the feasibility of such inter‐professional initiatives. It was necessary to gear the programme to meet the various expectations and needs of different professionals. Target setting by teams and the provision of protected time within a structured framework appeared to yield direct and indirect benefits to participants. However, there is a need for much more rigorous evaluation of multidisciplinary programmes with regard to their ability to overcome traditional hierarchies and barriers, their effectiveness in improving practice and their longer‐term costs and benefits.

The purpose of this paper is to consider how postgraduate education can contribute to the effective integration of health and social care through supporting public service managers to develop the skills required for collaborative working.

Review of documentation from ten years of delivery of a part-time postgraduate programme for health and social care managers, critical reflection on the findings in light of relevant literature.

The health and social care managers participating in this postgraduate programme report working across complex, shifting and hidden boundaries. Effective education for integration should: ground learning in experience; develop a shared language; be inter-professional and co-produced; and support skill development.

This paper addresses a gap in the literature relating to the educational and development needs of health and social care managers leading collaborative working.

Current government policy places great emphasis on increased collaboration between disciplines and professions within health care, as in public services across the board. To date, analyses of doctor‐manager relations have tended to focus on equipping doctors with management skills, once they have reached consultant level. In contrast, this paper evaluates a new management development initiative, designed to involve doctors and managers at an earlier career stage, and on an inter‐disciplinary basis. Interview and questionnaire responses indicate that specialist registrars and young managers share common values; however, they also acknowledge a high degree of mutual ignorance. Evaluation suggests that inter‐disciplinary programmes can provide a starting‐point for closer collaboration in practice; in conclusion, some options for sustaining this in the long term are identified.

The purpose of this paper is to propose a theoretical framework for researching gender equality implications of Clinical Microsystems, a new public management‐based model for multi‐professional collaboration and improvement of health care delivery.

The paper draws on literature from gender in organizations, new public management, multi‐professional collaboration and organizational control to critically analyze the Clinical Microsystem model.

While on the surface an egalitarian and consensus‐based model, it nevertheless risks reinforcing a gendered hierarchical order. The explicit emphasis on social competencies, on being collaborative and amenable to change risks, paradoxically, disfavoring women. A major reason is that control becomes more opaque, which favors those already in power.

The paper calls for researchers as well as practitioners to incorporate concerns of equality in the work place when introducing new work practices in health care. For research, the authors propose a useful theoretical framework for empirical research. For practice, the paper calls for more transparent conditions for multi‐professional collaboration, such as formalized merit and advancement systems, precisely formulated performance expectations and selection of team members based strictly on formal merits.

A gender analysis of a seemingly anti‐hierarchical management model is an original contribution, adding to the literature on Clinical Microsystem in particular but also to critical studies on new public management. Moreover, the paper makes a valuable practical contribution in suggesting ways of avoiding the reproduction of gender inequalities otherwise implied in the model.