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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.

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.

Purpose – The aim is to introduce a sociological perspective on resource integration and value co-creation into service research using a service systems approach.

Methodology/approach – Conceptual and a case study of the service system a Telecom Equipment and Service Provider is embedded in is reported.

Findings – The service practice of the service system is framed by social structures of signification, legitimation, and domination. However, the practice is also independent of the structures since it is embedded in and shapes the structural realm.

Research implications and limitations – Drawing on structuration and practice theory, the chapter offers a new framework describing how social and service structures and practices can inform and reveal mechanisms of service system dynamics. Based on the framework, three propositions are developed focusing on the mechanisms of resource integration and value co-creation. The implications need to be generalized in future research by studying other empirical contexts.

Practical implications – The chapter provides some tentative guidelines on how organizations can design service systems that enable and support customers and other actors in their resource integration and value co-creation processes by paying attention to social structures and forces and not only resources as such.

Originality – The chapter explicates how social structures have implications for value co-creation and resource integration in service system. It makes systematic use of structuration and practice theory to understand the social dimensions of service systems. A distinction between intended and realized resource integration is made.

The Balanced Scorecard (BSC) emphasizes on the of information system to track a limited number of balanced metrics (measures and indicators) that are closely aligned with organization's goals. This study investigates how system integration in different forms is related to the success of using the BSC for performance measurement. The use of a BSC in performance evaluation is considered in five contexts: determining cost, measuring efficiency, ensuring quality and customer satisfaction measure, promoting continuous innovation and monitoring contract negotiation. The findings indicate that system integration defined in the study positively relates to the success of using the BSC in all five decision perspectives. The findings conclude that hospitals need a streamlined, information integration across the continuum of care to better assess the operation results, in both organizational and technical perspectives.

Integrated health care delivery (IHCD), as a major issue of managed care, was considered the panacea to rising health care costs. In theory it would simultaneously provide high-quality and continuous care. However, owing to the backlash of managed care at the turn of the century many health care providers today refrain from using further integrative activities. Based on transaction cost economics, this chapter investigates why IHCD is deemed appropriate in certain circumstances and why it failed in the past. It explores the new understanding of IHCD, which focuses on actual integration through virtual integration instead of aggregation of health care entities. Current success factors of virtually integrated hybrid structures, which have been evaluated in a long-term case study conducted in the San Francisco Bay Area from July 2001 to September 2002, will elucidate the further development of IHCD and the implications for other industrialized countries, such as Germany.

Purpose: The purpose of this study is to assess the main and interaction effects of activity-based costing (ABC), internal information systems integration (IISI), and external information systems integration (EISI) on manufacturing plant operational performance, controlling for plant characteristics.

Methodology/approach: The study uses survey data from a cross-section of 369 U.S. manufacturing plants. Data were analyzed using hierarchical regression model.

Findings and implications: The results indicate partial support for the main and two-way interaction effects on plant operational performance. The three-way interaction effects are significant and positive, suggesting that deploying all three resources (i.e., ABC, IISI, and EISI) leads to the higher plant operational performance.

Originality/value: The paper significantly extends prior research and contributes to the understanding of the main and interaction effects of ABC, IISI, and EISI on manufacturing plant operational performance. The paper would also be of interest to practitioners interested in keeping up with academic literature.

Many attempts to integrate technology in Swedish schools have been initiated over the past 30 years with varying success. Although the use of digital tools has increased along with a general technology development, schools have mainly been using IT in administrative support activities. In recent years, school system reforms and developments in the educational technology sector have both required and enabled schools to digitalize. In this chapter, we follow the implementation of two technologies in a benchmark school in order to understand how technology integration is achieved. We suggest four types of embeddedness resulting from different types of activities that are subject to technology integration, as well as the social and material conditions that guide convergence during the postimplementation phase.

Using a survey method, this study extends prior research by comparing the impact of IT integration on manufacturing financial performance under activity-based costing (ABC) and volume-based costing (VBC). The findings indicate that IT integration is significantly associated with financial performance for plants that have adopted ABC, while this relationship does not hold for plants that have adopted VBC. The findings suggest that the type of costing system can help explain contradictory findings in extant literature regarding the impact of information technology on organization's financial performance.