Social Features of Integration in Health Systems and Their Relationship to Provider Experience, Care Quality and Clinical Integration

Abstract

More is known about the structural features of health system integration than the social features—elements of normative integration (alignment of norms) and interpersonal integration (collaboration among professionals and with patients). We surveyed practice managers and 1,360 staff and physicians at 59 practice sites within 17 health systems (828 responses; 61%). Building on prior theory, we developed and established the psychometric properties of survey measures describing normative and interpersonal integration. Normative and interpersonal integration were both consistently related to better provider experience, perceived care quality, and clinical integration (e.g., a 1-point increase in a practice’s normative integration was associated with 0.53-point higher job satisfaction and 0.77-point higher perceived care quality in the practice, measured on 1 to 5 scales, p < .01). Variation in social features of integration may help explain why some health systems better integrate care, pointing to normative and interpersonal integration as potential resources for improvement.

Centralization and democratization: Managing crisis communication in health care delivery

“…The undesired effects of such pathologies and paradoxes can be further amplified in health systems that leverage numerous information technologies to connect individuals across geographic and professional boundaries. Inability to manage such paradoxes and coordinate across these boundaries can harm patient safety, care quality, and caregiver experience (Kerrissey et al, 2022).…”

Disentangling the Role of Health Care Systems in Producing High-Quality Care

“…Because only limited scientific evidence exists regarding how these features of health systems impact quality, we are missing critical opportunities to improve quality. Moreover, it would likely be fruitful to similarly disentangle system effects on a variety of outcomes adjacent to quality, such as health care costs, patient experience, health care provider wellness, and health equity.…”

Socio-Organizational Dimensions: The Key to Advancing the Shared Care Record Agenda in Health and Social Care

“…For example, professional and organizational jurisdictions, interests, governance arrangements, concerns about losing control of the data, and, in some instances, competition between providers may result in a reluctance to share data. Awareness of some of these issues is increasing, with some work giving consideration to normative integration across professionals [7]. Silos may inadvertently be reinforced by existing organizational and technological structures, including existing infrastructures and legacy systems that are simply not designed for sharing data across settings that often vary significantly in relation to digital maturity.…”