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Showing papers in "International Journal of Integrated Care in 2010"


Journal ArticleDOI
TL;DR: Recommendations for integrated working include a need to invest in resources for the successful integration of teams; a need for the development of clear standards for monitoring the success and failure of integrated teams; and the need for further empirical evidence of the processes used by integrated teams.
Abstract: Introduction: This literature review was conducted to provide a background understanding of the literature around integrated health and social care prior to a research project evaluating two integrated health and social care teams in England, UK. Methods: A systematic literature search of relevant databases was employed to identify all articles relating to integrated health and social care teams produced in the last 10 years in the UK. Results: Sixteen articles were found and reviewed; all were reviewed by the first reviewer and half by the second reviewer. Discussion: Key themes identified were: drivers, barriers and benefits of integrated working; staff development; and meeting the needs of service users. Conclusion: Recommendations for integrated working include; a focus on the management of integrated teams; a need to invest in resources for the successful integration of teams; a need for the development of clear standards for monitoring the success and failure of integrated teams; and the need for further empirical evidence of the processes used by integrated teams. These findings will be valuable for practitioners who are establishing services or want to improve integrated care in their own practice.

104 citations


Journal ArticleDOI
TL;DR: The financial architecture and operative details of the integrated pilot Gesundes Kinzigtal Integrated Care are described, showing how a more effective trans-sector organisation of Germany's health care system and increased investments in well-designed preventive programmes will lead to a reduction inmorbidity and a comparative reduction in health care cost.
Abstract: Introduction : Integrated care solutions need supportive financial incentives In this paper we describe the financial architecture and operative details of the integrated pilot Gesundes Kinzigtal Description of integrated care case : Located in Southwest Germany, Gesundes Kinzigtal is one of the few population-based integrated care approaches in Germany, organising care across all health service sectors and indications The system serving around half of the population of the region is run by a regional health management company (Gesundes Kinzigtal GmbH) in coope­ration with the physicians' network in the region (MQNK), a German health care management company with a background in medical sociology and health economics (OptiMedis AG) and with two statutory health insurers (among them is the biggest health insurer in Southwest Germany: AOK Baden-Wurttemberg) Discussion and (preliminary) conclusion : The shared savings contract between Gesundes Kinzigtal GmbH and the two health insurers, providing financial incentives for managers and health care providers to realize a sub­stantial efficiency gain, could be an appropriate contractual base of Gesundes Kinzigtal's population health gain approach This approach is based on the assumption that a more effective trans-sector organisation of Germany's health care system and increased investments in well-designed preventive programmes will lead to a reduction in morbidity, and in particular to a reduced incidence and prevalence of chronic diseases This, in turn, is to lead to a comparative reduction in health care cost Although the comparative cost in the Kinzigtal region has been reduced from the onset of Gesundes Kinzigtal Integrated Care, only future research will have to demonstrate whether - and to what extent - cost reduction may be attributed to a real population health gain

90 citations


Journal ArticleDOI
TL;DR: The development and nature of coordination within a mental health and social care consortium and the impact on care processes and client outcomes are described and a model for organisations establishing structures for network coordination is presented.
Abstract: Background : Well-organised clinical cooperation between health and social services has been difficult to achieve in Sweden as in other countries. Purpose : This paper presents an empirical study of a mental health coordination network in one area in Stockholm. The aim was to describe the development and nature of coordination within a mental health and social care consortium and to assess the impact on care processes and client outcomes. Method : Data was gathered through interviews with coordina­tors from three rehabilitation units. The interviews focused on coordination activities aimed at supporting the clients’ needs and investigated how the coordinators acted according to the consortium's holistic approach. Data on The Camberwell Assess­ment of Need (CAN-S) showing clients’ satisfaction was used to assess on set of outcomes. Findings : The findings revealed different coordination activities and factors both helping and hindering the network coordination activities. One factor helping was the history of local and personal informal cooperation and shared responsibilities evident. Unclear roles and routines hindered cooperation Practical value : The contribution is an empirical example and a model for organisations establishing structures for network coordination. One l esson for current policy about integrated health care is to adapt and implement ”pair coordinators” where full structural integration is not possible. Another lesson, based on the idea of patient quality by coordinated care, is specific to adapt the work of the local psychiatric addictive team – an independent special team in the psychiatric outpatient care serving psychotic clients with complex addictive problems.

64 citations


Journal ArticleDOI
TL;DR: This paper highlights and discusses three challenges that seem to be insufficiently articulated when hospital and community nurses interact during discharge planning, how local practices circumvent formal structures, and how nurses have different understanding of what it means to be ‘ready to be discharged’.
Abstract: Introduction: Health care systems and nurses need to take into account the increasing number of people who need post-hospital nursing care in their homes. Nurses have taken a pivotal role in discharge planning for frail patients. Despite considerable effort and focus on how to undertake hospital discharge successfully, the problem of ensuring continuity of care remains. Challenges: In this paper, we highlight and discuss three challenges that seem to be insufficiently articulated when hospital and community nurses interact during discharge planning. These three challenges are: how local practices circumvent formal structures, how nurses' different perspectives influence their assessment of patients' need for post-hospital care, and how nurses have different understanding of what it means to be ‘ready to be discharged’. Discussion: We propose that nurses need to discuss these challenges and their implications for nursing care so as to be ready to face changing demands for health care in future.

59 citations



Journal ArticleDOI
TL;DR: Functioning and disability (D&F) are two related domains of a single health construct key to understand the relationship between the individual and the disease, where social support plays an effect modifier role.
Abstract: Functioning and disability (D&F) are two related domains of a single health construct key to understand the relationship between the individual and the disease, where social support plays an effect modifier role [2]. Therefore, D&F is regarded as a key domain in the recent models of diagnosis (i.e. person-centered medicine) [3] and intervention (i.e. Integrated Care as a complex adaptive system) [4] within the holistic paradigm.

50 citations


Journal ArticleDOI
TL;DR: Healing should be directed toward restoration of functioning and a consequent return of well-being and that might not be true to the patients experience or offer the best opportunities for intervention.
Abstract: A brief description of what is a person is followed by a brief description of what sickness is It is apparent that virtually every aspect of the person is altered to some degree by serious illness It is a circumstance of the ascendant theory of sickness (‘when a person is sick it is because of disease’), history, and a result of the development of science that the physical manifestations of sickness are so prominent Because persons are of a piece, whatever happens to one part happens to the all Because of this, if a determinant of the illness is personal, psychological, social, or spiritual there will necessarily be physical manifestations as well If these are given the most attention (as at present) that might not be true to the patients experience or offer the best opportunities for intervention Sickness makes itself known by interferences in functioning that prevent persons from pursuing their goals and purposes Healing should be directed toward restoration of functioning and a consequent return of well-being

48 citations


Journal ArticleDOI
TL;DR: In this article, the authors provide social scientists with an insight into dementia knowledge and for those with practice experience it provides illustrations of how the social sciences can help to make sense of this work.
Abstract: There is much knowledge about dementia from the social sciences and one way of organising it is to see it as part of professional learning. This book is such a text: it provides social scientists with an insight into dementia knowledge and for those with practice experience it provides illustrations of how the social sciences can help to make sense of this work. There is room for such a text in meeting student needs by providing an up-to-date overview of social science perspectives. Educationalists will find it reliable and multi-purpose, in being a ‘primer’ for those new to dementia or to social science. It will also be a potential resource for nurse, social work and other practice educators who are new to dementia programmes or wish to expand their teaching. In my experience, this is particularly helpful when trying to convey key messages about multi-professional or integrated care. Very quickly, professionals from many disparate disciplines realise that they do not have all the answers. This book will therefore be of interest to the student or researcher on their own, but also to classes and teams.

45 citations


Journal ArticleDOI
TL;DR: The challenges connected to the transformation and emergence of professional identity in transdisciplinary multi-agency network meetings and the use of Open Dialogue are explored.
Abstract: This is the journal's pdf version originally published in International Journal of Integrated Care: http://www.ijic.org/index.html

44 citations


Journal ArticleDOI
TL;DR: This review of the CPA experience suggests that there is the potential for better care integration for those patients with multiple or complex needs where a strategy of personalised care planning and pro-active care co-ordination is provided.
Abstract: Introduction : This policy paper considers what the long-term conditions policies in England and other countries could learn from the experience of the Care Programme Approach (CPA). The CPA was introduced in England in April 1991 as the statutory framework for people requiring support in the community for more severe and enduring mental health problems. The CPA approach is an example of a long-standing 'care co-ordination' model that seeks to develop individualised care plans and then attempt to integrate care for patients from a range of providers. Policy description : The CPA experience is highly relevant to both the English and international debates on the future of long-term conditions management where the agenda has focused on developing co-ordinated care planning and delivery between health and social care; to prioritise upstream interventions that promote health and wellbeing; and to provide for a more personalised service. Conclusion : This review of the CPA experience suggests that there is the potential for better care integration for those patients with multiple or complex needs where a strategy of personalised care planning and pro-active care co-ordination is provided. However, such models will not reach their full potential unless a number of preconditions are met including: clear eligibility criteria; standardised measures of service quality; a mix of governance and incentives to hold providers accountable for such quality; and genuine patient involvement in their own care plans. Implications : Investment and professional support to the role of the care co-ordinator is particularly crucial. Care co-ordinators require the requisite skills and competencies to act as a care professional to the patient as well as to have the power to exert authority among other care professionals to ensure multidisciplinary care plans are implemented successfully. Attention to inter-professional practice, culture, leadership and organisational development can also help crowd-in behaviours that promote integrated care.

42 citations


Journal ArticleDOI
TL;DR: Integrative care approaches to the evaluation of paediatric abdominal pain appear well accepted by families, yielding high levels of satisfaction, and enhance receptivity to treatment recommendations.
Abstract: Objectives : To assess patient and family satisfaction with evaluation received through a multidisciplinary paediatric Abdominal Pain Clinic (APC) staffed by a paediatric gastroenterologist and a paediatric psychologist as compared to a traditional gastroenterology clinic (GI) staffed by a paediatric gastroenterologist only Methods : Two hundred and ninety-eight families (145 APC, 153 GI) with a child or adolescent aged 8-17 years seen for initial evaluation of a chronic abdominal pain completed an anonymous survey to assess understanding of the treatment recommendations made, intent to follow through with various treatment recommendations, and the overall level of satisfaction with the evaluation service provided Family perceptions of strengths and challenges of the APC evaluation process also were explored Results : APC families reported being prescribed adjunctive mental health and other therapies at significantly higher rates than GI families, while the rates of medication were comparable APC families also reported significantly greater receptivity to beginning the treatments prescribed and higher levels of overall satisfaction with the evaluation process The contribution of integrated medical and psychological perspectives frequently was identified as a strength of the APC evaluation process Challenges identified for the APC evaluation were few and focused on issues related to paperwork and scheduling issues Conclusions : Integrative care approaches to the evaluation of paediatric abdominal pain appear well accepted by families, yielding high levels of satisfaction, and enhance receptivity to treatment recommendations Integrative care starting at the time of first evaluation may be particularly well-tailored to enhance outcomes, reduce health care utilization, and yield financial savings within this population

Journal ArticleDOI
TL;DR: The Trialogue experience – an exercise in communication between service users, families and friends and mental health workers on equal footing – is indicative of the capacity for surviving and gaining from serious discussions of adverse issues as well as the great possibilities of cooperative efforts and coordinated action.
Abstract: Communications and collaborations between mental health care users and user activists, family carers and friends, and mental health professionals and policy makers outside and beyond traditional clinical and pedagogic encounters are needed to strengthen a rights-based approach in the field of mental health and further civil society involvement. The Trialogue experience – an exercise in communication between service users, families and friends and mental health workers on equal footing – is indicative of our capacity for surviving and gaining from serious discussions of adverse issues as well as the great possibilities of cooperative efforts and coordinated action.

Journal ArticleDOI
TL;DR: An innovative bottom-up and pragmatic strategy used to implement a new integrated care model in France for community-dwelling elderly people with complex needs, which relied on establishing a collaborative dynamic among health and social stakeholders.
Abstract: Background Sustaining integrated care is difficult, in large part because of problems encountered securing the participation of health care and social service professionals and, in particular, general practitioners (GPs). Purpose To present an innovative bottom-up and pragmatic strategy used to implement a new integrated care model in France for community-dwelling elderly people with complex needs. Results In the first step, a diagnostic study was conducted with face-to-face interviews to gather data on current practices from a sample of health and social stakeholders working with elderly people. In the second step, an integrated care model called Coordination Personnes Agees (COPA) was designed by the same major stakeholders in order to define its detailed characteristics based on the local context. In the third step, the model was implemented in two phases: adoption and maintenance. This strategy was carried out by a continuous and flexible leadership throughout the process, initially with a mixed leadership (clinician and researcher) followed by a double one (clinician and managers of services) in the implementation phase. Conclusion The implementation of this bottom-up and pragmatic strategy relied on establishing a collaborative dynamic among health and social stakeholders. This enhanced their involvement throughout the implementation phase, particularly among the GPs, and allowed them to support the change practices and services arrangements.

Journal ArticleDOI
TL;DR: Using path dependency as an analytical framework helps to understand the reasons why institutional integration is critical to organizational and clinical integration, and the complex construction of institutional integration in France.
Abstract: Background : The literature on integration indicates the need for an enhanced theorization of institutional integration. This article proposes path dependence as an analytical framework to study the systems in which integration takes place. Purpose : PRISMA proposes a model for integrating health and social care services for older adults. This model was initially tested in Quebec. The PRISMA France study gave us an opportunity to analyze institutional integration in France. Methods : A qualitative approach was used. Analyses were based on semi-structured interviews with actors of all levels of decision-making, observations of advisory board meetings, and administrative documents. Results : Our analyses revealed the complexity and fragmentation of institutional integration. The path dependency theory, which analyzes the change capacity of institutions by taking into account their historic structures, allows analysis of this situation. The path dependency to the Bismarckian system and the incomplete reforms of gerontological policies generate the coexistence and juxtaposition of institutional systems. In such a context, no institution has sufficient ability to determine gerontology policy and build institutional integration by itself. Conclusion : Using path dependence as an analytical framework helps to understand the reasons why institutional integration is critical to organizational and clinical integration, and the complex construction of institutional integration in France.

Journal ArticleDOI
TL;DR: Dementia can indeed be taken as a model of a disease for which the customary fragmentation of support and care systems is particularly deleterious for persons with multiple needs and requiring skills belonging to multiple circles.
Abstract: As clearly expressed by the title, this book investigates care for dementia considering all aspects of these pathologies, whilst attempting to provide the reader with the very latest information, often stemming from recently published research. The reading of this book forges a direct link with integrated care insofar as these pathologies are not approached from an exclusively biological, psychological, environmental or social angle but include all of these dimensions at once. At the end of the book the reader will find a section dedicated to the societal aspect of dementia, this section is particularly important for a researcher in integrated care. Dementia can indeed be taken as a model of a disease for which the customary fragmentation of support and care systems is particularly deleterious for persons with multiple needs and requiring skills belonging to multiple circles.

Journal ArticleDOI
TL;DR: Patients sometimes report that doctors consider them a set of symptoms rather than a person, and skills in taking the patient perspective were among those performed most poorly in a sample of primary care physicians.
Abstract: Patients sometimes report that doctors consider them a set of symptoms rather than a person. A recent article by a patient in a major Norwegian newspaper had the title ‘I am not a knee cap’. The author had suffered a knee injury, but felt that he was treated by doctors merely as a knee cap rather than as a human being. This feeling is hardly unique. In a focus group study a few years ago patients with rheumatic diseases reported similar experiences and emphasized the importance of being seen as an individual rather than a disease entity [1]. Moreover, in an empirical test of the Four Habits communication skills training model Krupat et al. found that skills in taking the patient perspective were among those performed most poorly in a sample of primary care physicians [2].

Journal ArticleDOI
TL;DR: Non-communicable diseases or chronic conditions, such as cancer, diabetes and heart disease, are affecting the health and quality of life of an increasing number of patients around the world, placing an ever-increasing burden on health systems originally designed to address acute medical conditions.
Abstract: Non-communicable diseases or chronic conditions, such as cancer, diabetes and heart disease, are affecting the health and quality of life of an increasing number of patients around the world. The World Health Organization (WHO) estimated that in 2005 they caused an estimated 35 million deaths representing 60% of all deaths globally with 80% of deaths due to non-communicable diseases occurring in low and middle income countries [1]. This is placing an ever-increasing burden on health systems, originally designed to address acute medical conditions.

Journal ArticleDOI
TL;DR: The status of psychiatry around the world, as perceived during the first decade of this millennium reflects the great opportunities and challenges for understanding the human mind.
Abstract: The status of psychiatry around the world, as perceived during the first decade of this millennium reflects the great opportunities and challenges for understanding the human mind. We have learned much about neurotransmission, learning, memory, and brain development, and these basic insights have made possible the design of several classes of psychoactive drugs and psychosocial techniques for treatment [1].

Journal ArticleDOI
TL;DR: An evaluation of the 16 Integrated Care Pilots in England will produce a portfolio of evidence aimed at strengthening the evidence base for integrated care, and in particular identifying the context in which interventions are likely to be effective.
Abstract: Background : In response to concerns that the needs of the aging population for well-integrated care were increasing, the English National Health Service (NHS) appointed 16 Integrated Care Pilots following a national competition. The pilots have a range of aims including development of new organisational structures to support integration, changes in staff roles, reducing unscheduled emergency hospital admissions, reduced length of hospital stay, increasing patient satisfaction, and reducing cost. This paper describes the evaluation of the initiative which has been commissioned. Study design and data collection methods : A mixed methods approach has been adopted including interviews with staff and patients, non-participant observation of meetings, structured written feedback from sites, questionnaires to patients and staff, and analysis of routinely collected hospital utilisation data for patients/service users. The qualitative analysis aims to identify the approaches taken to integration by the sites, the benefits which result, the context in which benefits have resulted, and the mechanisms by which they occur. Methods of analysis : The quantitative analysis adopts a 'difference in differences' approach comparing health care utilisation before and after the intervention with risk-matched controls. The qualitative data analysis adopts a 'theory of change' approach in which we triangulate data from the quantitative analysis with qualitative data in order to describe causal effects (what happens when an independent variable changes) and causal mechanisms (what connects causes to their effects). An economic analysis will identify what incremental resources are required to make integration succeed and how they can be combined efficiently to produce better outcomes for patients. Conclusion : This evaluation will produce a portfolio of evidence aimed at strengthening the evidence base for integrated care, and in particular identifying the context in which interventions are likely to be effective. These data will support a series of evaluation judgements aimed at reducing uncertainties about the role of integrated care in improving the efficient and effective delivery of healthcare.

Journal ArticleDOI
TL;DR: Since then many research papers, case reviews, policy papers, special issues, editorials, book reviews, summaries of doctoral theses and congress proceedings have found their way to the columns of IJIC.
Abstract: 1 In pursuit of evidence based integrated care [1] was the title of the first editorial in the International Journal of Integrated Care (IJIC) that was published in November 2000, some 10 years ago. The inaugural issue was actually prepared in 1999 by a small group of enthusiastic scientists from Europe, USA and Canada who decided that integrated care was high on the political agenda but low on the scientific agenda. Between them, the idea for an open-access and electronically-based scientific journal was born. Since then many research papers, case reviews, policy papers, special issues, editorials, book reviews, summaries of doctoral theses and congress proceedings have found their way to the columns of IJIC.

Journal ArticleDOI
TL;DR: The chronic care model provided support for implementing rehabilitation programmes for four chronic conditions in Bispebjerg University Hospital, the City of Copenhagen, and GPs' offices.
Abstract: Introduction: Quality of care provided to people with chronic conditions does not often fulfil standards of care in Denmark and in other countries. Inadequate organisation of healthcare systems has been identified as one of the most important causes for observed performance inadequacies, and providing integrated healthcare has been identified as an important organisational challenge for healthcare systems. Three entities—Bispebjerg University Hospital, the City of Copenhagen, and the GPs in Copenhagen—collaborated on a quality improvement project focusing on integration and implementation of rehabilitation programmes in four conditions. Description of care practice: Four multidisciplinary rehabilitation intervention programmes, one for each chronic condition: chronic obstructive pulmonary disease, type 2 diabetes, chronic heart failure, and falls in elderly people were developed and implemented during the project period. The chronic care model was used as a framework for support of implementing and integration of the four rehabilitation programmes. Conclusion and discussion: The chronic care model provided support for implementing rehabilitation programmes for four chronic conditions in Bispebjerg University Hospital, the City of Copenhagen, and GPs' offices. New management practices were developed, known practices were improved to support integration, and known practices were used for implementation purposes. Several barriers to integrated care were identified.

Journal ArticleDOI
TL;DR: The study showed that the electronic discharge summary contributed to changes in health staff's work processes as well as increased legibility of summaries, and enabled municipal care staff to be better prepared for receiving patients, even though the information content mostly remained unaltered and was not always accurate.
Abstract: Introduction : Information and communication technologies (ICT) are seen as potentially powerful tools that may promote integration of care across organisational boundaries. Here we present findings from a study of a Norwegian project where an electronic interdisciplinary discharge summary was implemented to improve communication and information exchange between the municipal care service and the associated hospital. Objective : To investigate the implications of introduction and use of the electronic discharge summary for health staff, and relate it to the potential for promoting integration of care across the hospital-municipality boundary. Methods : We conducted semi-structured interviews with 49 health care providers. The material was analysed using a three-step process to identify the main themes and categories. Findings : The study showed that the electronic discharge summary contributed to changes in health staff's work processes as well as increased legibility of summaries, and enabled municipal care staff to be better prepared for receiving patients, even though the information content mostly remained unaltered and was not always accurate. Conclusion : Introduction of electronic discharge summaries did not result in a significant increase in integration of care. However, the project was a catalyst for the collaborating participants to address their interaction from new perspectives.

Journal ArticleDOI
TL;DR: At any level of care, nurses use the nursing process to structure care delivery as they assess clients, develop nursing diagnoses, plan and carry out interventions, and evaluate patient outcomes.
Abstract: Person-centered care is of utmost importance to the nursing profession. Nurses focus on the person across multiple settings, such as ambulatory, hospital, and home care, and also in community and public health settings. At any level of care, nurses use the nursing process to structure care delivery as they assess clients, develop nursing diagnoses, plan and carry out interventions, and evaluate patient outcomes. The nurse’s interventions are based on the nursing diagnoses and in support of the medical plan of care. The patient’s outcomes would be in response to the nurse’s interventions and the medical plan of care.

Journal ArticleDOI
TL;DR: The need for the doctor to come close enough to see and to hear and so to recognise the particular suffering individual underpins the commitment to person-centered medicine.
Abstract: In A Fortunate Man, his magnificent account of the work of a rural family doctor, published in 1967 [2], John Berger described the “individual and closely intimate recognition” which is necessary. He explains the need for the doctor to come close enough to see and to hear and so to recognise the particular suffering individual. It is this recognition that underpins the commitment to person-centered medicine. The practice of medicine depends on the ability to make a connection between the generalisations of biomedical science and the unique individual experience of illness and disease. In Doctor Zhivago, Boris Pasternak wrote [3]:

Journal ArticleDOI
TL;DR: The Programme on Global Standards was designed to provide a tool for quality improvement in medical education, which could be of direct assistance to institutions, organisations and national authorities responsible for education and training of medical doctors at all levels throughout the continuum of medical education.
Abstract: Since 1984 the WFME has conducted an “International Programme for the Reorientation of Medical Education” An important cornerstone in this process was the Edinburgh declaration of 1988 [1], adopted by the World Health Assembly in 1989 [2] In order to promote the programme and in keeping with its constitutional mandate, the WFME Executive Council in 1998 in a position paper launched its Programme on Global Standards [3] The purpose was to provide a tool for quality improvement in medical education, which could be of direct assistance to institutions, organisations and national authorities responsible for education and training of medical doctors at all levels throughout the continuum of medical education

Journal ArticleDOI
TL;DR: In this paper, the authors compared ten local mental health networks in diverse contexts (rural/urban and regionalized/non-regionalized) to clarify the governance processes that foster interorganizational collaboration and the conditions that support them.
Abstract: Objective : Modes of governance were compared in ten local mental health networks in diverse contexts (rural/urban and regionalized/non-regionalized) to clarify the governance processes that foster inter-organizational collaboration and the conditions that support them. Methods : Case studies of ten local mental health networks were developed using qualitative methods of document review, semi-structured interviews and focus groups that incorporated provincial policy, network and organizational levels of analysis. Results : Mental health networks adopted either a corporate structure , mutual adjustment or an alliance governance model. A corporate structure supported by regionalization offered the most direct means for local governance to attain inter-organizational collaboration. The likelihood that networks with an alliance model developed coordination processes depended on the presence of the following conditions: a moderate number of organizations, goal consensus and trust among the organizations, and network-level competencies. In the small and mid-sized urban networks where these conditions were met their alliance realized the inter-organizational collaboration sought. In the large urban and rural networks where these conditions were not met, externally brokered forms of network governance were required to support alliance based models. Discussion : In metropolitan and rural networks with such shared forms of network governance as an alliance or voluntary mutual adjustment , external mediation by a regional or provincial authority was an important lever to foster inter-organizational collaboration.

Journal ArticleDOI
TL;DR: ‘When GPs routinely pick up the telephone and talk to the consultant about a patient’s diagnosis or care options and actually work together to support the patient in the care they receive’.
Abstract: Last year I was undertaking an interview with a healthcare manager in England who was bemoaning the lack of care integration between primary care (general practice) and secondary care (hospitals) in the management of people with diabetes. When I asked her when she might know that the system had improved in the future she answered—‘when GPs routinely pick up the telephone and talk to the consultant about a patient’s diagnosis or care options ... and actually work together to support the patient in the care they receive’.

Journal ArticleDOI
TL;DR: The person-centered integrative diagnosis model is the key diagnostic project of the Psychiatry for the Person Institutional Program of the World Psychiatric Association (WPA General Assembly, 2005) which proposes the whole person in context, as the center and goal of clinical care and public health.
Abstract: The person-centered integrative diagnosis model (PID) is the key diagnostic project of the Psychiatry for the Person Institutional Program of the World Psychiatric Association (WPA General Assembly, 2005) which proposes the whole person in context, as the center and goal of clinical care and public health [9]. The PID is the operational articulation of the psychiatry for the person diagnostic principles with the goal of developing a model applicable into regular clinical care settings [10].

Journal ArticleDOI
TL;DR: Group discussions, as part of a consensus technique, appear to be a useful process to reconcile diverging perceptions of network performance among stakeholders.
Abstract: Background: Having a common vision among network stakeholders is an important ingredient to developing a performance evaluation process. Consensus methods may be a viable means to reconcile the perceptions of different stakeholders about the dimensions to include in a performance evaluation framework. Objectives: To determine whether individual organizations within traumatic brain injury (TBI) networks differ in perceptions about the importance of performance dimensions for the evaluation of TBI networks and to explore the extent to which group consensus sessions could reconcile these perceptions. Methods: We used TRIAGE, a consensus technique that combines an individual and a group data collection phase to explore the perceptions of network stakeholders and to reach a consensus within structured group discussions. Results: One hundred and thirty-nine professionals from 43 organizations within eight TBI networks participated in the individual data collection; 62 professionals from these same organisations contributed to the group data collection. The extent of consensus based on questionnaire results (e.g. individual data collection) was low, however, 100% agreement was obtained for each network during the consensus group sessions. The median importance scores and mean ranks attributed to the dimensions by individuals compared to groups did not differ greatly. Group discussions were found useful in understanding the reasons motivating the scoring, for resolving differences among participants, and for harmonizing their values. Conclusion: Group discussions, as part of a consensus technique, appear to be a useful process to reconcile diverging perceptions of network performance among stakeholders.

Journal ArticleDOI
TL;DR: Medicine for the person conceptually represents an attempt to bring to the foreground attention to the person as opposed to the inattention, disrespect and disregard of the person, an attitude that prevails in modern Medicine.
Abstract: Medicine for the person conceptually represents an attempt to bring to the foreground attention to the person (basically the person of the patient but also that of the physician) as opposed to the inattention, disrespect and disregard of the person, an attitude that prevails in modern Medicine [2–5] (but also in modern Society as such). This is a consequence of a variety of factors but, as refers to Medicine, fragmentation of care and hyperbolic dependence on technology seem to be major contributors [1].