Towards a values framework for integrated health services: an international Delphi study

Abstract

Background: In order to organize person-centered health services for a growing number of people with multiple complex health and social care needs, a shift from fragmented to integrated health services delivery has to take place. For the organization of governance in integrated health services, it is important to better understand the underlying factors that drive collaboration, decision-making and behavior between individuals and organizations. Therefore, this article focuses on these underlying normative aspects of integrated health services. This study investigates the values that underpin integrated health services delivery as a concept, by examining the extent to which an initial literature based set of underlying values underpins integrated care and the relevance of these values on the different levels of integration. Methods: An international Delphi study with 33 experts from 13 different countries was carried out to examine the initial set of underlying values of integrated health services. In addition, the relevance of the values was assessed on the different levels of integration: personal level, professional level, management level and system level. Results: The study resulted in a refined set of 18 values of integrated health services developed in three Delphi study rounds. In addition, the results provided insight into the relevance of these values on the personal level (e.g. 'trustful'), professional level (e.g. 'collaborative'), management level (e.g. 'efficient') and system level (e.g. 'comprehensive') of integration. Some of the values score consistent across the different levels of integration while other values score inconsistent across these levels. Conclusions: The Delphi study resulted in an international normative basis for integrated health services delivery as a concept. The values can be used as ingredients for a values framework and provide a better understanding of the normative aspects of integrated health services delivery. Future research could focus on associated behaviors in practice, the relationship between normative integration and governance, and differences between the value priorities of stakeholder groups.

Developing Interpersonal Trust Between Service Users and Professionals in Integrated Services: Compensating for Latent Distrust, Vulnerabilities and Uncertainty Shaped by Organisational Context

“…Trust between stakeholders is described as important on all organisational levels in integrated services (including on a micro-level) [ 17 ] and for planning and facilitating good return-to-work processes [ 52 ]. This study corroborates these finding and provides insight into why interpersonal trust is perceived as particularly important on a micro-level and how interpersonal trust is sought to be nurtured in this specific context.…”

“…The development of trust between organisations has been thoroughly investigated [ 6 9 12 16 ]. However, it is recommended that more studies investigate trust-building between micro-level stakeholders in integrated service delivery [ 17 ]. Although distrust between professionals is a common problem in integrated services [ 18 ], there is little knowledge about how this might affect service users and how the problem of distrust can be resolved.…”

Goal-Oriented Care: A Catalyst for Person-Centred System Integration

“…Maybe most important is how GOC was able to activate normative integration, which was key when working between different organizations that had different cultures and driving visions. In the presented cases GOC helped create a framework to establish a shared vision amongst providers and organizations, identified as necessary to drive integrated care models [ 50 51 ]. As noted earlier, GOC, like person-centred care, requires a philosophical shift in how providers, managers, and patients think about the delivery of health care services.…”

Guidance for Health Care Leaders During the Recovery Stage of the COVID-19 Pandemic

“…To create the framework for this report, we assembled a team of 32 coauthors from 17 countries who were selected based on their relevant professional and/or academic expertise [29][30][31][32] in various aspects of health leadership, health care, public health, and related fields. These fields and professions included: leadership research, public health, patient advocacy, patient safety, aged and long-term care, mental health, Indigenous health, infectious diseases, epidemiology, nursing, physicians, regulated health professionals, the military, peacekeeping, academic health care centers, community hospitals, primary care, national health leadership organizations, and a national chief health officer.…”