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The scaling up of promising, innovative integration projects presents challenges to social and health care systems. Evidence that a new service provides (cost) effective care in a (pilot) locality can often leave us some way from understanding how the innovation worked and what was crucial about the context to achieve the goals evidenced when applied to other localities. Even unpacking the “black box” of the innovation can still leave gaps in understanding with regard to scaling it up. Theory-led approaches are increasingly proposed as a means of helping to address this knowledge gap in understanding implementation. Our particular interest here is exploring the potential use of theory to help with understanding scaling up integration models across sites. The theory under consideration is Normalisation Process Theory (NPT).

The article draws on a natural experiment providing a range of data from two sites working to scale up a well-thought-of, innovative integrated, primary care-based dementia service to other primary care sites. This provided an opportunity to use NPT as a means of framing understanding to explore what the theory adds to considering issues contributing to the success or failure of such a scaling up project.

NPT offers a framework to potentially develop greater consistency in understanding the roll out of models of integrated care. The knowledge gained here and through further application of NPT could be applied to inform evaluation and planning of scaling-up programmes in the future.

The research was limited in the data collected from the case study; nevertheless, in the context of an exploration of the use of the theory, the observations provided a practical context in which to begin to examine the usefulness of NPT prior to embarking on its use in more expensive, larger-scale studies.

NPT provides a promising framework to better understand the detail of integrated service models from the point of view of what may contribute to their successful scaling up.

NPT potentially provides a helpful framework to understand and manage efforts to have new integrated service models more widely adopted in practice and to help ensure that models which are effective in the small scale develop effectively when scaled up.

This paper examines the use of NPT as a theory to guide understanding of scaling up promising innovative integration service models.

The article seeks to explain whether and how value-based healthcare principles lead to hybridization. The public management literature has been increasingly interested in hybrid forms of governance and hybrid performance management, but empirical studies are still rare. Further, the article studies the design of performance management and accounting systems as healthcare organizations reorganize their care processes applying value-based healthcare principles.

This article first connects the theoretical discussions on value-based healthcare and performance management for hybrids. The conceptual understanding of performance management in hybrid healthcare uses a case study of a Finnish healthcare organization with documentary data and transcribed interviews with healthcare professionals from both the strategic and operative levels of healthcare.

The article illustrates and analyses how new policy-level objectives and principles of value-based healthcare led to hybridity in healthcare, manifest in mixed ownership of a particular care path and new forms of social and financial control. Further, the article provides empirical evidence of how increased hybridity necessitated new organizational modes and roles, new managerial tools for performance management and created a need to develop the capability to account and measure entire integrated care processes. Important enabling factors for the integration of care and hybrid performance management were commitment created in dialogue, voluntary-based trust and technology to generate factual shared information.

The study is informative for stakeholders, funders and managers of healthcare organizations, namely new knowledge for the discussion of hybrid governance in healthcare, including a critical account of the applicability and impact of a hybrid service model in healthcare management. Moreover, the article illustrates what needs to be reconsidered in performance management and accounting practices when reorganizing care processes according to the principles of value-based healthcare.

The article extends the analysis of performance management in hybrids and sheds new light on hybridization in healthcare. It also provides much-needed empirical evidence on the processes and practices of accounting and performance management after implementing a value-based healthcare strategy.

The purpose of this paper is to report on the origins, development and early impacts of a Health Care Home (HCH) model of care being rolled out around New Zealand (NZ).

This paper draws on a literature review on HCHs and related developments in primary health care, background discussions with key players, and a review of significant HCH implementation documents.

The HCH model of care is emerging from the sector itself and is being tailored to local needs and to meet the needs of local practices. A key focus in NZ seems to be on business efficiency and ensuring sustainability of general practice – with the assumption that freeing up general practitioner time for complex patients will mean better care for those populations. HCH models of care differ around the world and NZ needs its own evidence to show the model’s effectiveness in achieving its goals.

It is still early days for the HCH model of care in NZ and the findings in this paper are based on limited evidence. Further evidence is needed to identify the model’s full impact over the next few years.

This paper is one of the first to explore the HCH model of care in NZ.

This chapter integrates organization design and sustainability concepts to describe an accelerated transformational change at the Fairview Medical Group (United States).

A case study of the transformation at Fairview Medical Group’s primary care clinics was developed from interviews and first-person accounts of the change. Objective data regarding outcomes was used to evaluate the effectiveness of the redesign process.

The Fairview Medical Group developed an innovation and change capability to transform 35 primary care clinics in six months. All of the clinics were certified by the state of Minnesota as complying with their healthcare standards. Clinical outcomes, costs, and employee and physician engagement also increased. All of the improved measures are sustained.

Healthcare reform in the United States struggles because the organization design challenges are great and the change difficulties even greater. Fairview’s experience provides important evidence and lessons that can help advance our understanding of effective healthcare and create more sustainable healthcare systems. This chapter provides healthcare system administrators evidence and alternatives in the pursuit of implementation.

The purpose of this paper is to identify and describe the international and New Zealand (NZ) evidence for models of integrated ambulatory care and describe key implementation issues and lessons learnt.

A scoping review was conducted for published and grey literature on integrated care. Publications from 2000 to February 2019 that described integrated ambulatory care were included.

A total of 34 articles were included. Internationally and in NZ, the most common models of integrated care found were: transfer, relocation and joint working. The international literature showed that transferring care from hospitals to community and other integrated models of care between the primary–specialist interface increased access and convenience for patients. However, there was insufficient evidence of clinical and economic outcomes. Very few NZ-based studies reported on effectiveness of models of care. Key implementation issues were: no viable and sustainable funding, lack of infrastructure, lack of confidence, trust and communication between providers, increased workload and time and knowledge and skills gap to perform new roles. The NZ literature highlighted the need for an appropriate location for services, committed leadership, development of a governance group representing different provider groups, strong communication mechanisms, new workforce skills and overall change management.

The review provides an overview of key components of integrated care models in ambulatory settings and identifies some common elements across the models of care. The findings can inform the design and implementation of integrated ambulatory care in health systems.

This study focuses on the adoption of wearable technologies in a context where care-providing organizations can offer, in collaboration with caregivers, better care. Drawing on dual-factor theory and from the caregiver perspective, this study identifies and examines factors of technology adoption in four developing countries.

This study was undertaken using a quantitative approach. A survey was distributed among 1,013 caregivers in four developing countries in Asia including Iran, Azerbaijan, Turkmenistan and Iraq and collected quantitative data for model validation and hypotheses analysis. Building on the technology adoption literature, we identified six constructs that impact the behavioral intention of caregivers to use wearable technologies in aged care-providing organizations.

Our dual-factor model was successfully validated, and all hypotheses were supported. However, different results were found in the selected countries within the cross-country analysis.

This study has significant implications for the study of emerging technologies in aged care service operations. It provides a theoretical framework that may be adapted for future research, enabling practitioners in aged care to better understand the crucial role of technology adoption in service operations. Less attention was paid to the adoption of wearable technologies in aged care, particularly in developing countries, where healthcare services in aged care impose heavy costs on care providers.

This paper proposes an organizational change process to prepare physicians and other health professionals for their new roles in patient-centered medical homes (PCMHs). It provides physician-centered tools, models, concepts, and the language to implement transformational patient-centered medical care.

To improve care delivery, quality, and patient engagement, a systems approach to care is required. This paper examines a systems approach to patient care where all inputs that influence patient interactions and participation are considered in the design of health care delivery and follow-up treatment plans. Applying systems thinking, organizational change models, and team-building, we have examined the continuum of this change process from ideation through the diffusion of new methods and behaviors.

PCMHs make compelling business sense. Studies have shown that the PCMH improves patient satisfaction, clinical outcomes and reduces underuse and overuse of medical services. Patient-centered care necessitates transitioning from an adversarial to a collaborative culture. It is a transformation process predicated on strong leadership able to align an organization toward a vision of patient-centered care, creating a collaborative culture committed to health-goal achievement.

This paper proposes that the PCMH is a rigorous team-building transformational organizational change, a radical departure from the current hierarchical, silo-oriented, medical practice model. It requires that participants within and across health care organizations learn new skills and behaviors to achieve the anticipated quality and efficiency improvements. It is an innovative health care organization model of the future whose success is premised on teams supplanting the individual as the building block and unit of health care performance.

Transitional care (TC) models emerged to ensure healthcare coordination and continuity, as at-risk patients transfer between different settings or different levels of care within the same setting. TC models have been developed in many countries as well as within different healthcare service delivery models and organizations. This paper aims to focus on a TC model developed in Italy called Operating Centre for Transition (OCT), in order to (1) explore its distinctive features by establishing a framework of analysis, (2) apply the framework to study two OCTs and (3) provide recommendations on how to use the framework to evaluate and develop new OCTs in the future.

The authors adopted a grounded theory method to develop and validate the framework of analysis. The authors employed several qualitative methods following four iterative and recursive steps: (1) desk analysis of relevant documents, (2) in-depth interviews to key informants, (3) three meetings of an expert working group and (4) application of the framework to two case studies.

The framework of analysis identifies three core dimensions that are always present in any OCT: the service model, the functions and the organizational features. Moreover, for every dimension several variables that capture and understand OCTs’ nature, role and development level are identified.

The results of the study highlight the key elements of the OCT model in Italy and show that the proposed framework can be useful both to analyse existing OCTs and to support health managers and policy makers to create new OCTs or develop those already active.

Current debates surrounding the NHS contract in England are suggesting that it is in need of change to support an integrated health and social care transformation agenda that meets the needs of an ageing chronically ill population. The purpose of this paper is to describe a three-phase project in England that sought to develop and validate a whole systems contracting model for integrated health and social care focusing on older people with long-term conditions, and based on joint outcomes.

A participative mixed-method approach for the development of the contracting model was used; this consisted of a literature review, a design phase drawing on consensus method through stakeholder discussions and an international validation phase.

The final contracting model consists of four overarching and interrelated core elements: outcomes; partnership, collaboration and leadership; financial: incentives and risk; and legal criteria. Each core element has a series of more detailed contracting criteria, followed by further specifications attached to each criteria.

While the policy environment appears to be conducive to change and encourages the adoption of new ways of thinking, there are difficulties with the implementation of new innovative models that challenge the status quo, and this is discussed.

The paper concludes with reflections on the way forward for local development and implementation.

There is currently much discussion for the need to realign contracting for integrated care that has a better fit for the transformation agenda, but until now, there have been no attempts to develop a whole systems approach that focusses on joint outcomes. This research bridges the gap but recognizes the challenges to implementation.

This study aims to explore how knowledge management (KM) influences the intellectual capital (IC) of organizations operating in health care and how IC and knowledge-sharing (KS) can contribute to the achievement of sustainable development in health systems. Notably, this study focuses on telemedicine, investigating how relational capital contributes to KS in the context of remote care services.

To comply with the paper’s aim, the authors use a qualitative research method based on a polar case study suitable for IC in health-care studies. More precisely, this study analyzes a nonprofit organization that, for over 15 years, has offered a free multispecialist teleconsultation service to answer medical questions from the most disadvantaged places in the world.

The findings show that the KM significantly contributes to the IC of organizations. Indeed, it improves the data management and transmission system, it increases performance flexibility in times of resource scarcity without compromising business objectives and it can attract new human resources even when not motivated by selfish goals (volunteer physicians).

This research contributes to studies on IC in health care by focusing on the contribution of telemedicine to the creation of IC. In particular, this work emphasizes the ability of telemedicine to develop and share knowledge in disadvantaged areas of the world. Moreover, in the current context, still strongly permeated by the health emergency generated by the pandemic and recently by the war in Eastern Europe, the importance of such assistance and diagnosis grows.

The conclusions the research findings lead may guide policymakers toward a policy supporting telemedicine. It would alleviate general health-care costs and completely revolutionize light health care’s role. Moreover, reducing socioeconomic distances, improving access to care and applying innovative technologies for sharing outcomes foster balanced socioeconomic development and knowledge dissemination.

This research has shown how telemedicine represents a new successful business model even in times of crisis. The organizational model makes it possible to offer cutting-edge specialized care, contain costs, easily reach disadvantaged areas of the planet, strengthen the skills and autonomy of the most backward countries through a process of KS and push the structures operating there to interact with those in advanced countries.