The Odyssey of Integration: Is Management its Achilles’ Heel?

Abstract

Introduction:The importance of management to the implementation of integrated care is recognised in evidence and practice. Despite this recognition, there is a lack of clarity about what 'good' management of integrated care looks like, if the competences are different to management for 'traditional' care, and how such competences can be acquired. Theory and methods: This exploratory study is based on qualitative interviews with participants with extensive experience of implementing integrated care in senior professional, research, administrative and/or policy roles. It conceptualises management as working at 'strategic' and 'operational' levels. Results: Management of integrated care was seen to require an ability to create networks across professions and organisations, to be comfortable with distributing responsibilities, and to thoroughly understand the wider system. Competences to support these new ways of working included an understanding of how to implement people-centredness, to have courage to challenge the status quo, and to demonstrate humility to learn from others. Structured development opportunities for managers were lacking, but seen as vital for the sustainability of change. Discussion and conclusion: Management for integrated care remains an underdeveloped concept and practice. A first formulation of the competences necessary was achieved, but more work is urgently required to understand how to better prepare and support managers to achieve necessary changes in practice and culture.

Towards an Integrated Care Organisation from a CEO Perspective

“…All of these promising results of the Etxean Ondo project enabled us to verify the effectiveness of the proposed paradigm, supporting the expansion and consolidation stages [6] between 2016 and 2021. The findings also support the development of an exploratory research study focused on understanding the transformation process of the organisation from a managerial perspective [12,27]. The rest of this paper reports on the findings of this process of expansion and consolidation which began in 2016.…”

“…The constructivist approach based on Grounded Theory has been accepted as an appropriate methodology for research into complex social realities [12,27,32,42,43], combining systematic inductive, deductive, and verification approaches to construct mid-range theoretical frameworks [43][44][45].…”

“…This allowed us to plan a second research phase in order to gain a deeper insight into the main concerns identified in phase one. Using in-depth interviews [12], the CEO and main researcher interviewed operational and strategic managers in key positions within the organisation. This phase aimed to identify key organisational drivers for PCC implementation [42,46].…”

“…an underdeveloped concept and practice. Specifically, the lack of conceptual clarity among managers regarding how to scale, transfer and sustain this process [12,31] effectively and confidently [21] towards the organisational integration of PCC [8,11,23,32,33] remains a significant barrier [12,[27][28][29][30][34][35][36]. More research is urgently required to understand how to support managers so that they can achieve changes in practice and culture.…”

Integrated Care and Community Services in Global Health

“…Similarly, "people-centered," "people-focused," "peopledriven," and "people-powered" have all been used in scientific and gray literature to capture the nuances of how involved people, that is, individuals, families, communities, and civil society, are in the design, delivery, and monitoring of health and care systems. In essence, they all call for the same thingan equal partnership between policy makers, professionals, and people to co-design systems and services according to the needs of the people who use them (WHO 2007(WHO , 2015aMarmot et al 2008;Horne et al 2013;Miller et al 2016).…”