Making integration work

Blumenthal, David

doi:10.1111/1475-6773.13575

Cited by 5 publications

(3 citation statements)

References 11 publications

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“…This may be because many systems have consolidated ownership or common functions without truly integrating operations, making the "systemness" of health systems appear elusive (Kerrissey et al, 2017). Identifying health system features that enable integrated services in practice thus calls for consideration beyond structural and functional arrangements alone (Blumenthal, 2020). In particular, social features of integration-pertaining to the integration of norms and interpersonal relationships-have received little attention in health services, despite their prominence in organizational scholarship as central features of system integration and functioning (Singer et al, 2018;Valentijn et al, 2015).…”

Section: Introductionmentioning

confidence: 99%

Social Features of Integration in Health Systems and Their Relationship to Provider Experience, Care Quality and Clinical Integration

et al. 2021

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More is known about the structural features of health system integration than the social features—elements of normative integration (alignment of norms) and interpersonal integration (collaboration among professionals and with patients). We surveyed practice managers and 1,360 staff and physicians at 59 practice sites within 17 health systems (828 responses; 61%). Building on prior theory, we developed and established the psychometric properties of survey measures describing normative and interpersonal integration. Normative and interpersonal integration were both consistently related to better provider experience, perceived care quality, and clinical integration (e.g., a 1-point increase in a practice’s normative integration was associated with 0.53-point higher job satisfaction and 0.77-point higher perceived care quality in the practice, measured on 1 to 5 scales, p < .01). Variation in social features of integration may help explain why some health systems better integrate care, pointing to normative and interpersonal integration as potential resources for improvement.

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Section: Introductionmentioning

confidence: 99%

Social Features of Integration in Health Systems and Their Relationship to Provider Experience, Care Quality and Clinical Integration

et al. 2021

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“…We posit that the problems of walls and voids for feeling heard are particularly salient in the large bureaucratic organizational forms that characterize much of hospital care today. Bureaucracies are characterized by hierarchies of authority, specialized functions, and formalized processes, and these features remain common principles of contemporary organizations (Monteiro & Adler, 2022), especially in health care as ownership consolidation has increased, leading to the presence of large and complex organizations (Blumenthal, 2020). Feeling heard may require unique attention for bureaucratic settings because the hierarchy and formalized processes of bureaucracies can undermine even a well-intentioned listener.…”

Section: Discussionmentioning

confidence: 99%

Overcoming walls and voids: Responsive practices that enable frontline workers to feel heard

Kerrissey,

Satterstrom,

Pae

et al. 2024

Health Care Manage Rev

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Background There is increasing recognition that beyond frontline workers’ ability to speak up, their feeling heard is also vital, both for improving work processes and reducing burnout. However, little is known about the conditions under which frontline workers feel heard. Purpose This inductive qualitative study identifies barriers and facilitators to feeling heard among nurses in hospitals. Methodology We conducted in-depth semistructured interviews with registered nurses, nurse managers, and nurse practitioners across four hospitals (N = 24) in a U.S. health system between July 2021 and March 2022. We coded with the aim of developing new theory, generating initial codes by studying fragments of data (lines and segments), examining and refining codes across transcripts, and finally engaging in focused coding across all data collected. Findings Frontline nurses who spoke up confronted two types of challenges that prevented feeling heard: (a) walls, which describe organizational barriers that lead ideas to be rejected outright (e.g., empty solicitation), and (b) voids, which describe organizational gaps that lead ideas to be lost in the system (e.g., structural mazes). We identified categories of responsive practices that promoted feeling heard over walls (boundary framing, unscripting, priority enhancing) and voids (procedural transparency, identifying a navigator). These practices appeared more effective when conducted collectively over time. Conclusion Both walls and voids can prevent frontline workers from feeling heard, and these barriers may call for distinct managerial practices to address them. Future efforts to measure responsive practices and explore them in broader samples are needed. Practice Implications Encouraging responsive practices may help ensure that frontline health care workers feel heard.

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“…Ultimately, choices about integrating care reflect priorities and values of health care delivery organizations, 45,46 and the cost is one of several important variables. Payment reforms and innovations that align cost reductions with other patient benefits remain vital, but some aspects of integrated care may remain both costly and beneficial.…”

Section: Discussionmentioning

confidence: 99%

Higher Medicare Expenditures Are Associated With Better Integrated Care as Perceived by Patients

et al. 2021

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Making integration work

Cited by 5 publications

References 11 publications

Social Features of Integration in Health Systems and Their Relationship to Provider Experience, Care Quality and Clinical Integration

Social Features of Integration in Health Systems and Their Relationship to Provider Experience, Care Quality and Clinical Integration

Overcoming walls and voids: Responsive practices that enable frontline workers to feel heard

Higher Medicare Expenditures Are Associated With Better Integrated Care as Perceived by Patients

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