Organizational Context and Capabilities for Integrating Care: A Framework for Improvement

Abstract

Background:Interventions aimed at integrating care have become widespread in healthcare; however, there is significant variability in their success. Differences in organizational contexts and associated capabilities may be responsible for some of this variability.Purpose:This study develops and validates a conceptual framework of organizational capabilities for integrating care, identifies which of these capabilities may be most important, and explores the mechanisms by which they influence integrated care efforts.Methods:The Context and Capabilities for Integrating Care (CCIC) Framework was developed through a literature review, and revised and validated through interviews with leaders and care providers engaged in integrated care networks in Ontario, Canada. Interviews involved open-ended questions and graphic elicitation. Quantitative content analysis was used to summarize the data.Results:The CCIC Framework consists of eighteen organizational factors in three categories: Basic Structures, People and Values, and Key Processes. The three most important capabilities shaping the capacity of organizations to implement integrated care interventions include Leadership Approach, Clinician Engagement and Leadership, and Readiness for Change. The majority of hypothesized relationships among organizational capabilities involved Readiness for Change and Partnering, emphasizing the complexity, interrelatedness and importance of these two factors to integrated care efforts.Conclusions:Organizational leaders can use the framework to determine readiness to integrate care, develop targeted change management strategies, and select appropriate partners with overlapping or complementary profiles on key capabilities. Researchers may use the results to test and refine the proposed framework, with a focus on the hypothesized relationships among organizational capabilities and between organizational capabilities and performance outcomes.

Mapping for Conceptual Clarity: Exploring Implementation of Integrated Community-Based Primary Health Care from a Whole Systems Perspective

“…The connection here is a bit more obvious as inter-organizational linkages and partnerships create processes such as sharing administrative and clinical information, referral systems, and joint accountabilities that are important to cross-organizational coordination of care [16]. Similarly, at the provider level, community linkages between individual providers can enable coordination of patient care across health and social care boundaries [35].…”

“…The organization research team adopted the Organizational Context and Capabilities for Integrating Care (CCIC) Framework [16] to guide data collection and analysis. The CCIC Framework is a theoretically grounded model that captures key organizational factors that influence successful implementation of integrated models of care.…”

“…Each level of analysis is led by one of four research teams who have developed robust conceptualizations of pertinent issues relevant to their level of analysis and disciplinary approach. Three theoretical frameworks are brought to bear on this research question including: 1) Ham’s Ten Characteristics of the High-Performing Chronic Care System [15] (which captures key elements of the CCM) to capture patient/carer and provider level perspectives; 2) Organizational Context and Capabilities for Integrating Care (CCIC) framework [16] to capture organizational and provider level perspectives; and 3) the Health Policy Monitor (HPM) [17] survey methodology to capture system and policy level perspectives. See Wodchis et al [18] and Breton et al [19] in this issue for an overview of the research program and case study summaries.…”

Implementing Integrated Care – Lessons from the Odense Integrated Care Trial

“…Despite many efforts, implementation of the Odense project failed due to a combination of factors that are well known in implementation research and relatively well described in recent literature on dissemination of integrated care models across contexts [891011]. The most important being that the:…”

A Research Program on Implementing Integrated Care for Older Adults with Complex Health Needs (iCOACH): An International Collaboration

“…The organizational interviews make use of our Context and Capabilities for Integrating Care (CCIC) framework that includes seven factors related to basic structures, seven related to people and values, and four related to processes [39]. From these 18 different factors related to context and capabilities, interviewees selected up to six factors and discussed how these factors affected the implementation of the integrated care model and commented on why other factors were not as important.…”