Barriers to the Integration of Care in Inter-Organisational Settings: A Literature Review

Abstract

Introduction:In recent years, inter-organisational collaboration between healthcare organisations has become of increasingly vital importance in order to improve the integration of health service delivery. However, different barriers reported in academic literature seem to hinder the formation and development of such collaboration.Theory and methods:This systematic literature review of forty studies summarises and categorises the barriers to integrated care in inter-organisational settings as reported in previous studies. It analyses how these barriers operate.Results:Within these studies, twenty types of barriers have been identified and then categorised in six groups (barriers related to administration and regulation, barriers related to funding, barriers related to the inter-organisational domain, barriers related to the organisational domain, barriers related to service delivery, and barriers related to clinical practices). Not all of these barriers emerge passively, some are set up intentionally. They are not only context-specific, but are also often related and influence each other.Discussion and conclusion:The compilation of these results allows for a better understanding of the characteristics and reasons for the occurrence of barriers that impede collaboration aiming for the integration of care, not only for researchers but also for practitioners. It can help to explain and counteract the slow progress and limited efficiency and effectiveness of some of the inter-organisational collaboration in healthcare settings.

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“…Research indicates that trust and leadership are important conditions determining a network’s success [1617] and these cannot be simply enforced. A case study from Canada provides a telling example of how mandated collaboration can result in a failed network [34].…”

“…There is also evidence to suggest that taking away self-organization of care might threaten the stability of networks as shared values and an agreement on the importance of the shared mission is a factor determining HCNs’ success [1617]. …”

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“…This has important consequences for accountable care organizations who are required to publicly report patient and graft survival rates . Deficits in team integration lead to higher failure rates in service quality, timeliness, and efficiency . Additionally, opportunities to reinforce team goals and support deliberate practice‐based learning are lost .…”

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“…Vertical integration refers to the different levels within a hierarchical structure, while horizontal integration refers to the structures on the same level within the structure. The scheme has previously demonstrated its relevance in several studies and will serve as an analytical tool for the present study to highlight the structures of integration within a siloed structure for drug prevention aimed at youth (Figure ).…”