Integrated care: a definition from the perspective of the four quality paradigms

Abstract

Purpose The purpose of this paper is to support the ongoing dialogue and shed light on the different views on integrated care. An overarching definition of integrated care is proposed combining the ways of thinking of the four quality paradigms the authors identify. The idea of epistemic fluency offers a way-out of ongoing discussions about “what integration is”. Design/methodology/approach Four paradigms of quality are presented and applied to healthcare. Epistemic fluency is proposed as the capacity to understand, switch between and combine different kinds of knowledge. The authors compare previously developed definitions of integrated care to the various combinations of paradigms. Findings All four paradigms of care quality are present in healthcare and in the most used definitions of integrated care. The Reflective Paradigm and the Emergence Paradigm receive least attention. Some definitions combine more than one paradigm. An overarching definition of integrated care is proposed. Research limitations/implications In this paper, only the most prominent definitions of integration have been considered. Practical implications Integration research and practice requires a widely accepted definition of integrated care, embracing all four paradigms of care quality. Our suggestion provides a common foundation that may prevent misunderstanding. Originality/value The use of quality management paradigms to frame the debate on defining integrated care is new and leads to new insights for teaching, research and practice.

Exploring the Quality Paradigms in Integrated Care: The Need for Emergence and Reflection

“…In a previous article, Van Kemenade and Van der Vlegel-Brouwer gave a comprehensive explanation of the four paradigms, namely the Empirical paradigm, the Reference paradigm, the Reflective paradigm and the Emergence paradigm. [ 32 ]. The four quality paradigms provide four lenses to look at the current situation in the field of research and development in integrated care and provide a common ground for discussion on what integrated care is.…”

“…Combining these paradigms led us to propose an overarching definition of integrated care: Integrated care is the process of help, care and service, managed and coordinated by interconnected highly competent professionals, who by their synergy -together with the patient and his family as partners- find solutions and create impact, continuously adapting to the context and circumstances [ 32 ] . This definition embraces the complex context, the person-centred vision of the integrated care field as well as the implication of the patient, the family and the community as co-producers of care, aiming to enhance the quality of life and improving health in populations.…”

“…This definition embraces the complex context, the person-centred vision of the integrated care field as well as the implication of the patient, the family and the community as co-producers of care, aiming to enhance the quality of life and improving health in populations. Understanding, combining, and switching between the four quality paradigms can be described as ‘epistemic fluency’ [ 32 42 ].…”

Health and Social Care Reform in Scotland – What Next?

“…Synthesis was undertaken by experts with different perspectives drawn from IFIC Scotland's multi-sector Reference Network https://integratedcarefoundation.org/ ific-scotland-3. Thus, it blends both the reference and reflective quality paradigms of integrated care research [17].…”

Bumpy road: implementing integrated psychiatric and somatic care in joint-specialty emergency departments: a mixed-method study using Normalization Process Theory

“…Pressman and Wildavsky’s legendary pioneering study of implementation from 1973, Implementation: How Great Expectations Are Dashed in Oakland , highlights implementation failure and points to the “complexity of joint actions” as the key implementation problem (Pressman and Wildavsky, 1973; Winter, 2013). Insights from implementation research lead to expectations of implementation of IC as a critical case because IC is defined in “joint actions” (Kodner and Spreeuwenberg, 2002; Shaw et al , 2011; Goodwin, 2013, 2016; Kaehne, 2018; Van Kemenade and van der Vlegel-Brouwer, 2019; Miller and Stein, 2020). In accordance with this expectation, multiple studies have documented barriers to IC (Minkman, 2012; Maruthappu et al , 2016; Overbeck et al , 2016; Auschra, 2018; Rodgers et al , 2018; Miller and Stein, 2020; Raus et al , 2020), and psychiatric/somatic IC seems to be extra challenging for implementation (Laursen et al , 2009; Knowles et al , 2013; Rodgers et al , 2018).…”