Decision-Making Dilemmas within Integrated Care Service Networks: A Systematic Literature Review

Abstract

Introduction:The diverse nature of people's care needs requires collaboration between different organisations and sectors. One way of achieving such collaboration is through integrated care service networks. Decision-making is considered an important aspect of network governance and key to achieve further integration of care services. As integrated care scholars only implicitly seem to touch upon the issue of decisionmaking, we aimed to identify multiple decision-making dilemmas.Theory and Methods: A systematic literature review was conducted of eighteen empirical studies in which decision-making dilemmas in integrated care service networks were inductively identified. To frame and understand these dilemmas, we partly drew on Provan and Kenis' governance models and their hypothesised decisionmaking dilemma for service networks.Results: Identified decision-making dilemmas included 1) autonomy versus interdependence, 2) diversity versus coherence, and 3) self-interest versus common goals. In line with Provan and Kenis' hypothesis, we highlight a cross-cutting dilemma of inclusiveness (all viewpoints are considered hence widely supported decisions) vs. efficiency (reaching timely decisions). Discussion and conclusion:We believe that network-and 'systemic' stakeholders both need to reflect upon and learn from decision-making dilemmas to work towards widely supported and adequate decisions. This is important for achieving aligned and holistic care services that many people desire.

Toward Iran's health system regionalization: a qualitative approach.

“…IHNs, as micro levels in regionalized health systems, have been promoted in health systems to overcome the fragmentation due to decentralization and promote population health and coordination capacity of regionalized networks (32)(33)(34). The fundamental principles behind regionalized systems of care at the operational level, as proposed by Walton and Mohr (2021), are standard selection, infrastructure design and development, data collection and surveillance, and performance veri cation (10).…”

From Integrated Care to Integrating Care: A Conceptual Framework of Behavioural Processes Underlying Effective Collaboration in Care

“…While all actors involved can contribute in their own unique ways, this is not to say that all actors are necessarily "equivalent." That is, (perceived) differences in power and status may exist, which may hinder joint working [33,82,83]. Dos Santos and Giovanella [84], for instance, described how political stakeholders offered health administrators little room to speak up, causing them to have little influence on the decisions about new health policies in Brazil.…”

“…The delivery of integrated care services can, at its very basis, be regarded as a joint decision-making process in which multiple actors with different backgrounds, interests, values, perspectives, and expertise try to make joint decisions regarding the delivery of integrated care services [cf. 31,32,33]. Such decision-making processes occur at different levels [4].…”