Collective Case Study on Integrated Health and Social Care Within a Canadian Context: Alberta, Ontario and Nova Scotia

Abstract

<p><strong>Introduction:</strong> Canada’s population is rapidly aging and is putting a strain on Canada’s fragmented welfare system. Integrated health and social care (IHSC) produces positive health and system outcomes. This phenomenon is not fully understood in a Canadian context. A multiple case study of IHSC in Alberta, Ontario and Nova Scotia was undertaken to answer the research questions: What are the factors that support successful services integration among different healthcare and social services organizations serving older adults within a Canadian context? The three cases studied were: geriatric assessment program collaboratory in Alberta; Healthy at Home day program in Ontario, and the Middleton Day Program in Nova Scotia.</p> <p><strong>Theory and Methodology:</strong> A collective case study strategy was undertaken and was anchored on a version of the Cheng & Catallo (2020) conceptual framework. This framework identified critical integration factors including leadership, team-based care, communications, information sharing, dedicated resources, inter-organizational culture, performance measurement, accountability agreements and structures, and shared vision and goals. Also, external influencing factors were identified including patient characteristics, geographic setting, government policies and priorities, funding models and governance authorities. Primary data was used and based on key informant interviews of representatives from organizations that comprised each case and focus groups. Within-case analysis and cross-case analysis was undertaken to determine common themes within each case and across the three cases. </p> <p><strong>Results and Discussion: </strong>The cross-case analysis revealed that the three cases shared common integration and external influence factors. Many of the integration factors noted in the conceptual framework were present, except for performance measurement and accountability structures and agreements. Role clarity and champions were two new factors that were identified. In addition, the three cases revealed that the external factors in the conceptual framework were present along with three new factors, close sense of community, communities with an aging population and integrating within the not-for-profit sector. </p> <p><strong>Conclusions and Implications:</strong> The collective case study revealed that context was important in influencing integration in the three cases. It showed that there are policymaking and practice opportunities for government and service administrators that can improve IHSC for older adults and research opportunities for researchers.</p>