The meaning of integrated care: a systems approach

Edgren, Lars

doi:10.5334/ijic.293

Cited by 46 publications

(66 citation statements)

References 8 publications

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“…For this reason, a complex-adaptive system (CAS) perspective has been increasingly advocated for categorizing and analyzing information in a manner that provides a more complete picture of forces affecting change around dynamic systems such as integrated care [721–23]. The CAS presents as a new perspective to guide the design, development and evaluation of integrated care systems through understanding key focus areas to allocate resources so as to achieve best possible outcomes [4572223].…”

Section: Applying a Complex-adaptive System (Cas) Perspective To The mentioning

confidence: 99%

Implementation of Integrated Care in Singapore: A Complex Adaptive System Perspective

Nurjono¹,

Yoong²,

Yap³

et al. 2018

International Journal of Integrated Care

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Background:Integrated care that focuses on organising healthcare services around people and their communities rather than their diseases is promoted as the strategy to overcome the challenges associated with growing complexity in healthcare needs, demand for healthcare services and inadequate supply of services due to fragmentation in the provision of services. While conceptually appears to be simple, integrated care is made up of multicomponent delivery strategies targeting various levels of the healthcare system while engaging various stakeholders in their execution.Methods:We applied the complex adaptive system (CAS) perspective to two different initiatives that exemplify approaches towards integrating care in Singapore: the Regional Health System (RHS) model, implemented across healthcare institutions at the national level, and CARITAS Integrated Dementia Care implemented in the northern region of Singapore. We adopted an inductive approach in our analysis in which we studied the RHS and CARITAS Integrated Dementia Care according to the components of the CAS. We applied the typical characteristics of CAS: (i) diverse, interdependent and semi-autonomous actors (ii) self-organizing capacity and simple rules (iii) relationship with the bigger system, emergent behaviour and non-linearity in our analysis of key drivers behind the implementation of both the RHS and CARITAS integrated dementia care.Results:By considering the RHS and CARITAS as whole networks each comprising of interacting and adaptive components instead of separate entities within a bigger system, the CAS provided a new mind-set in surfacing issues associated to the implementation of these integrated care networks. In addition to important actors, systems, it informed understanding of relationships and dependencies between different parts of the network – revealing the lack of homogeneity, conformity and difficulties in designing any optimal system in advance given the many moving parts.Conclusions:Drawing on the two examples of integrated care networks, this paper highlights the significance of effective collaboration built on a common focus, responsiveness to emergent behaviours, simple rules, the ability to self-organize and adapt in response to unexpected situations in further development of integrated care in the Singapore context and beyond.

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Section: Applying a Complex-adaptive System (Cas) Perspective To The mentioning

confidence: 99%

Implementation of Integrated Care in Singapore: A Complex Adaptive System Perspective

Nurjono¹,

Yoong²,

Yap³

et al. 2018

International Journal of Integrated Care

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“…Since the many countries that have decided to pursue the integration route have historically been developed with a hospital at their core [3], moving to an integrated way of functioning represents a significant change endeavour. Notwithstanding the fact that healthcare policies of various natures fail to be implemented due to lack of managerial expertise [8], the implementation of integrative policies appears particularly complex given that it does not rely on a single provider organization [9]. Hence, as Goodwin et al [10] exposed in their systematic literature review on the management of networks—which are relevant to the broader objective of integrating services—it is imperative to learn more about the leadership and management required to implement integrated care.…”

Section: Introductionmentioning

confidence: 99%

Is the PRISMA-France glass half-full or half-empty? The emergence and management of polarized views regarding an integrative change process

Etheridge¹,

Couturier²,

Trouvé³

et al. 2009

Int J Integr Care

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Aim: The PRISMA-France pilot project is aimed at implementing an innovative case management type integration model in the 20th district of Paris. This paper apprehends the emergence of two polarized views regarding the progression of the model's spread in order to analyze the change management enacted during the process and its effects.Method: A qualitative analysis was conducted based on an institutional change model. Results:Our results suggest that, according to one view, the path followed to reach the study's current level of progress was efficient and necessary to lay the foundation of a new health and social services system while according to the other, change management shortcomings were responsible for the lack of progress. Discussion: While neither of these two views appears entirely justified, analyzing the factors underlying their differences pinpoints some of the challenges involved in managing the spread of an integrated service delivery network. Meticulous preparation for the change management role and communication of the time and effort required for a wholesale institutional change process may be significant factors for a successful integrative endeavor.

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“…This approach has undoubtly contributed to the development of knowledge in medicine and it still constitutes the core of evidence-based healthcare [1], but systematically disregards also the well established parts of the corpus doctrinae which do not involve particular opinions, but just well consensued knowledge, which obviously exist. The overall value of the restrictive experimental approach may decrease as the levels of complexity of the analysed phenomenon increases; particularly in highly complex situations as those occurring when organisations behave as a complex adaptive system [2]. …”

Section: Introductionmentioning

confidence: 99%

Integrating clinicians, knowledge and data: expert-based cooperative analysis in healthcare decision support

Gibert

García‐Alonso

Salvador‐Carulla

2010

Health Res Policy Sys

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BackgroundDecision support in health systems is a highly difficult task, due to the inherent complexity of the process and structures involved.MethodThis paper introduces a new hybrid methodology Expert-based Cooperative Analysis (EbCA), which incorporates explicit prior expert knowledge in data analysis methods, and elicits implicit or tacit expert knowledge (IK) to improve decision support in healthcare systems. EbCA has been applied to two different case studies, showing its usability and versatility: 1) Bench-marking of small mental health areas based on technical efficiency estimated by EbCA-Data Envelopment Analysis (EbCA-DEA), and 2) Case-mix of schizophrenia based on functional dependency using Clustering Based on Rules (ClBR). In both cases comparisons towards classical procedures using qualitative explicit prior knowledge were made. Bayesian predictive validity measures were used for comparison with expert panels results. Overall agreement was tested by Intraclass Correlation Coefficient in case "1" and kappa in both cases.ResultsEbCA is a new methodology composed by 6 steps:. 1) Data collection and data preparation; 2) acquisition of "Prior Expert Knowledge" (PEK) and design of the "Prior Knowledge Base" (PKB); 3) PKB-guided analysis; 4) support-interpretation tools to evaluate results and detect inconsistencies (here Implicit Knowledg -IK- might be elicited); 5) incorporation of elicited IK in PKB and repeat till a satisfactory solution; 6) post-processing results for decision support. EbCA has been useful for incorporating PEK in two different analysis methods (DEA and Clustering), applied respectively to assess technical efficiency of small mental health areas and for case-mix of schizophrenia based on functional dependency. Differences in results obtained with classical approaches were mainly related to the IK which could be elicited by using EbCA and had major implications for the decision making in both cases.DiscussionThis paper presents EbCA and shows the convenience of completing classical data analysis with PEK as a mean to extract relevant knowledge in complex health domains. One of the major benefits of EbCA is iterative elicitation of IK.. Both explicit and tacit or implicit expert knowledge are critical to guide the scientific analysis of very complex decisional problems as those found in health system research.

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The meaning of integrated care: a systems approach

Cited by 46 publications

References 8 publications

Implementation of Integrated Care in Singapore: A Complex Adaptive System Perspective

Implementation of Integrated Care in Singapore: A Complex Adaptive System Perspective

Is the PRISMA-France glass half-full or half-empty? The emergence and management of polarized views regarding an integrative change process

Integrating clinicians, knowledge and data: expert-based cooperative analysis in healthcare decision support

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