IntroductionDespite over two decades of international experience and research on health systems integration, integrated care has not developed widely. We hypothesized that part of the problem may lie in how we conceptualize the integration process and the complex systems within which integrated care is enacted. This study aims to contribute to discourse regarding the relevance and utility of a complex-adaptive systems (CAS) perspective on integrated care.MethodsIn the Canadian province of Ontario, government mandated the development of fourteen Local Health Integration Networks in 2006. Against the backdrop of these efforts to integrate care, we collected focus group data from a diverse sample of healthcare professionals in the Greater Toronto Area using convenience and snowball sampling. A semi-structured interview guide was used to elicit participant views and experiences of health systems integration. We use a CAS framework to describe and analyze the data, and to assess the theoretical fit of a CAS perspective with the dominant themes in participant responses.ResultsOur findings indicate that integration is challenged by system complexity, weak ties and poor alignment among professionals and organizations, a lack of funding incentives to support collaborative work, and a bureaucratic environment based on a command and control approach to management. Using a CAS framework, we identified several characteristics of CAS in our data, including diverse, interdependent and semi-autonomous actors; embedded co-evolutionary systems; emergent behaviours and non-linearity; and self-organizing capacity.Discussion and conclusionOne possible explanation for the lack of systems change towards integration is that we have failed to treat the healthcare system as complex-adaptive. The data suggest that future integration initiatives must be anchored in a CAS perspective, and focus on building the system’s capacity to self-organize. We conclude that integrating care requires policies and management practices that promote system awareness, relationship-building and information-sharing, and that recognize change as an evolving learning process rather than a series of programmatic steps.

The benefits of community partnerships have been well established in the health service literature. However, measuring these benefits and associated outcomes is relatively new. This paper presents an innovative initiative in the application of a balanced scorecard framework for measuring and monitoring partnership activity at the community level, while adopting principles of evidence-based practice to the partnership process. In addition, it serves as an excellent example of how organizations can apply scorecard methodology to move away from relationship-based partnerships and into new collaborations of which they can select - using a formal skill and competency assessment for partnership success.

Mission, vision, and objectives statements are standard items created for most information technology units. Alignment of these with both the overall University mission and individual staff performance goals is often weak or lacking. Building upon the work of Kohrman and Trinkle [1], objectives for Indiana State University's Instructional and Research Technology Services (IRTS) were written as facilitating activities and built to be SMART (Specific, Measurable, Aggressive but attainable, Rewarding, and Time-bound). In addition, these activities were mapped to the University's mission as well as specific individual performance goals.In the spring of 2004 the staff of IRTS held a one day retreat to develop activities that included benchmarks and metrics to determine organizational and individual success. These facilitating activities were captured into a document which included who was doing the work, who was responsible for work completion and success, how the activity was to be measured, what types of data would be collected, the benchmarks for success, and a timeline for completion.Each quarter of the academic year, the unit reflected on the progress toward year-end benchmarks and made adjustments of resources to ensure timely completion of facilitating activities. As IRTS moves into its second full year, the initial process of developing facilitating activities has helped guide the direction and growth of the unit. It has also aided in quantification of the unit's work and staff accountability which is documented in the Office of Information Technology's 2005 Technology Profile.

Instructional and Research Technology Services (IRTS) is a new unit on the campus of Indiana State University (ISU) created to envision, explore, design, and evaluate new and emerging technologies to support teaching, research, and student learning. One of the most important tenants of this new group is to add value to ISU's information technology investments.Siegel (2003) commented, "IT matters to an organization when innovation matters".[1] Today most information technology services serve as a utility; people want them and expect them to work 100 percent of the time. It is hard to create an environment that supports innovation when stability has become the main focus.IRTS is designed to act as a catalyst; one that engages internal and external audiences in collaborative efforts where faculty are encouraged and supported to experiment and incorporate technology into their teaching and research activities. An additional goal of this group is to identify and acquire new funding sources for technology intensive teaching, learning, and research projects. This paper will describe this new unit's organizational structure, interaction with stakeholders, current projects, and an assessment of operational effectiveness.

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