Purpose Fragmentation in health and social care services can result in poor access to services, lack of continuity and inadequate provision for needs. A focus on integration of services are thus suggested to prevent negative consequences of fragmentation for service recipients. There are, however, few studies that explore the competence needed for integration of services in municipal health and social care organizations. This study explores which types of competence stakeholders require and how collective competence can promote service integration. Methods This is a single-case study, and the data consist of focus group interviews and individual interviews with service recipients, family caregivers, professionals and managers. The data were analysed both inductively and deductively. Results The analysis resulted in four main themes: 1) Knowledge about individual life situations and organization and system, 2) investigation competence, 3) person-centred collaboration competence and 4) facilitating competence. The themes form the basis for a collective competence framework that can promote service integration. Conclusion As service integration involves a high degree of interlinked activities between professionals and organizational units, a collective approach to the concept of competence is presumably applicable. When service integration competence is approached as a collective attribute of a network within and between organizational units, the organization can facilitate this competence by encouraging an active exchange of knowledge between professionals. We also argue that service integration competence increases connectivity and interdependency between professionals and organizational units, and includes service recipients and family caregivers as legitimate extra-professional parts of the collaborative network.
By studying how primary care providers organize their services for people with concurrent substance abuse and mental health problems (dual diagnosis), this study aims to investigate formal and informal integration mechanisms. The study has an explorative approach based on interviews with people with dual diagnosis, managers, and front-line professionals in a Norwegian municipality of medium size. We found poor formal structures for internal coordination between services for mental health care and services for substance abuse, although they were organised in the same unit. Further, there were challenges in cooperation between this unit and the other healthcare units. Front-line professionals seemed to compensate for poor formal organisational structures with individual, informal coordination arrangements. Drawing on organisational theory, in particular the dilemmas of street-level bureaucrats and the role they play in policy implementation, this chapter discusses the importance and limitations of informal coordination measures for people with dual diagnosis.
The home nursing care is responsible for providing health care to patients with chronic and complex disorders in the municipality. This requires interprofessional collaboration between the nurses and general practitioners (GP`s). This article explores how the Coordination Reform has affected the collaboration between GP`s and nurses in the home nursing care, and what organisational factors are important for the collaboration. The results are based on a case study with focus group interviews including 20 nurses and in depth interviews with four GP`s. Analysis revealed that the Coordination reform has led to an asymmetry in the need for collaboration where the nurses have an increase in the need for collaboration. In addition, nurses wanted more meetings in patients` homes to discuss patients' health care needs. However, the funding system attached to the GP`s and their role as self-employed was an organisational barrier meeting nurses' needs.
Background: This study concerns the collaboration between a hospital and three municipalities when it comes to allocation of municipal rehabilitation services. In order to make the transitions from the hospital to the municipal health service fast and effective, the professionals has started using electronic messaging system This study examines how the electronic messaging systemaffected the collaboration between the hospital and the municipal health service. Methods: The researchers conducted group interviews with professionals at the hospital, at the municipal service offices and at the municipal rehabilitation clinic. There were totally 25 participants divided into 7 interviews. Lessons learned: Electronic medical record systems can improve the information exchange between the hospital and the municipalities, but in situations where one has to collaborate about the solution of wicked problems, it looks as though there still is a need for personal contact.
PurposeNew Public Management (NPM) has increased fragmentation in municipal health and social care organizations. In response, post-NPM reforms aim to enhance integration through service integration. Integration of municipal services is important for people with complex health and social challenges, such as concurrent substance abuse and mental health problems. This article explores the conditions for service integration in municipal health and social services by studying how public management values influence organizational and financial structures and professional practices.Design/methodology/approachThis is a case study with three Norwegian municipalities as case organizations. The study draws on observations of interprofessional and interagency meetings and in-depth interviews with professionals and managers. The empirical field is municipal services for people with concurrent substance abuse and mental health challenges. The data were analyzed both inductively and deductively.FindingsThe study reveals that opportunities to assess, allocate and deliver integrated services were limited due to organizational and financial structures as the most important aim was to meet the financial goals. The authors also find that economic and frugal values in NPM doctrines impede service integration. Municipalities with integrative values in organizational and financial structures and in professional approaches have greater opportunities to succeed in integrating services.Originality/valueApplying a public management value perspective, this study finds that the values on which organizational and financial structures and professional practices are based are decisive in enabling and constraining service integration.
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