Conceptual framework: factors enabling collaborative healthcare and social services integration

Abstract

PurposeA conceptual framework for collaboratively based integrated health and social care (IHSC) integration is proposed to aid in understanding how to accomplish IHSC.Design/methodology/approachThis model is based on extant literature of successfully IHSC initiatives.FindingsThe model aims to identify enabling integration factors that support collaborative integration efforts between healthcare and social services organizations. These factors include shared goals and vision, culture, leadership, team-based care, information sharing and communications, performance measurement and accountability agreements, and dedicated resources and financing. It also identifies factors that act as external influencers that can support or hinder integration efforts among collaborating organizations. These factors are geographic setting, funding models, governance structures, and public policies. These factors are intended to ensure that a realist lens is applied when trying to understand and explain IHSC.Originality/valueThis model is intended to provide a framework to support research, policy and implementation efforts.

Factors Impacting Primary Care Engagement in a New Approach to Integrating Care in Ontario, Canada

“…Some administrators in our study demonstrated the value they placed in primary care engagement through early primary care involvement in system co-design and by encouraging PCPs to lead or co-lead the OHT. Shared leadership has been identified as a core enabling factor for integrated healthcare according to two recent reviews [26,27]. It will be of interest to follow the OHTs over time to observe how PCP involvement will impact the success of the OHT.…”

“…Administrators struggled with how to adequately compensate PCPs in an equitable way with other OHT partners (e.g., PFAs) and generally seemed unaware of PCPs' concerns around professional autonomy. Adequate compensation has been highlighted in the implementation literature generally, as well as specifically to integrated care, as key to success [26][27][28]. Although the Ministry announced funding for approved teams, at the time of this study, during the formational stage, no funding was provided.…”

“…Further, our participants explained that compensation should be the same across the OHTs to avoid providing (dis)incentives for PCPs to join one OHT over another. Clear delineation of responsibilities and accountabilities have also been recommended, for example, through formal accountability agreements [26,27], which could alleviate PCPs' concerns around diminished professional autonomy. In contrast, there was agreement among PCPs and administrators about the importance of addressing local context, such as crosssectoral relationships and experiences with previous integrated care initiatives, when engaging with PCPs in OHT formation.…”

“…The factors in each of these three levels affect primary care engagement either by improving involvement and buyin or by decreasing engagement, leading to frustration, disenfranchisement, and ultimately, disengagement. While frameworks exist for enabling integrated care [27,29] that include primary care concepts [30], to the best of our knowledge, and after consulting an information specialist, they do not specifically address primary care engagement. Our findings (e.g., the interrelated levels of factors) could therefore inform future research aimed at developing primary care engagement frameworks and guide future implementation research on factors that may influence integrated care.…”

Health Care and Community-Based Organization Partnerships to Address Social Needs: Medicare Advantage Plan Representatives’ Perspectives

“…The Cheng and Catalo model of health care and social services integration helps explain how health care entities and community-based organizations can partner to address these social risk factors (Cheng & Catallo, 2019). Their model defines seven essential factors (Shared Visions & Goals, Leadership, Culture, Team-based Care, Dedicated Resources & Funding, Accountability Agreements, Performance Management, and Information Sharing & Communications) for collaboration between health care and social service organizations, as well as four external domains (Funding Models, Governance Systems, Public Policies, and Community/Geography) that influence these collaborations.…”