The contribution of professions to the governance of integrated care: Towards a conceptual framework based on case studies from Denmark

Abstract

Objective Good governance of integrated care is key to better health care, but we know little about how professions can help make this happen. Our aim is to introduce a conceptual framework to analyse how professions contribute to the governance of integrated care, and to apply the framework to a secondary analysis of selected case studies from Denmark. Methods We developed a framework, which identified the what, how and why of the contribution professions make to the governance of integrated care. We included five qualitative Danish studies, using coordination as an indicator of integrated care. We adopted a thematic approach in our analysis, combining deductive and inductive elements. Results Health professions engage in highly diverse activities, which fall into closely connected clusters of more formal or more informal coordination. Professions apply many different adaptive mechanisms at different levels to fit coordination into local contexts. Professions are driven by interlocking rationales, where a common focus on patients connects organizational and professional concerns. Conclusions Our analytical framework emerges as a useful tool for analysis. The contribution of professions to the governance of integrated care needs greater attention in health policy implementation as it can promote more effective governance of integrated care.

Engaging health care professionals in quality improvement: A qualitative study exploring the synergies between projects of professionalisation and institutionalisation in quality improvement collaborative implementation in Denmark

“…17,20 Quality improvement collaborative implementation also represents a project of institutionalisation, that is how health care professions make sense of and embed the political and organisational framing of the QICs, including policymakers' and administrators' aim to improve health care through evidence-based objectives, measures, and change initiatives, and a bottom-up and data-driven methodology, into their professional practices. Our analytical lens was informed by neo-institutional profession research, particularly Scott, 17,19,21 whereby projects of institutionalisation capture the broader institutional role played by professions in defining, interpreting, and applying institutional elements. Scott identified three ways in which this role may be exercised.…”

“…Third, professions act as regulatory agents by participating in the establishment and implementation of legally sanctionable rules and regulations. 17 , 19 , 21 While the use of Scott’s framework is novel within QI research, it has been applied to account for projects of institutionalisation of professions within other areas of health care, for example, welfare governance in older people and integrated care. 10 In our analysis, we focused on the cultural-cognitive and normative aspects of the project of institutionalisation, as these were most relevant to our setting.…”