Translating the Elements of Health Governance for Integrated Care from Theory to Practice: A Case Study Approach

Abstract

Introduction:Against a paucity of evidence, a model describing elements of health governance best suited to achieving integrated care internationally was developed. The aim of this study was to explore how health meso-level organisations used, or planned to use, the governance elements.Methods:A case study design was used to offer two contrasting contexts of health governance. Semi-structured interviews were conducted with participants who held senior governance roles. Data were thematically analysed to identify if the elements of health governance were being used, or intended to be in the future.Results:While all participants agreed that the ten elements were essential to developing future integrated care, most were not used. Three major themes were identified: (1) organisational versus system focus, (2) leadership and culture, and, (3) community (dis)engagement.Discussion:Several barriers and enablers to the use of the elements were identified and would require addressing in order to make evidence-based changes.Conclusion:Despite a clear international policy direction in support of integrated care this study identified a number of significant barriers to its implementation. The study reconfirmed that a focus on all ten elements of health governance is essential to achieve integrated care.

The Odyssey of Integration: Is Management its Achilles’ Heel?

“…Evaluations of individual programmes also reflect the importance of proactive management to successful implementation [e.g. [14][15][16][17]. Contributions of strategic managers that have been identified to date are bringing together stakeholders, mobilizing action within organisations by emotionally connecting individuals with their vision, securing internal and external resources for implementation including to support learning, fostering a culture of innovation, and prioritising involvement of communities within strategic developments [12,13,15,17,54].…”

“…[14][15][16][17]. Contributions of strategic managers that have been identified to date are bringing together stakeholders, mobilizing action within organisations by emotionally connecting individuals with their vision, securing internal and external resources for implementation including to support learning, fostering a culture of innovation, and prioritising involvement of communities within strategic developments [12,13,15,17,54]. Operational managers' contribution includes generating confidence within frontline staff of their ability to implement, communicating the overall vision in a version that is understandable by the frontline, quantifying tangible benefits for service recipients, and practical coordination of activities and resources [1,4,16].…”

“…In addition to specific management functions, many of the general enablers of integrated care fall wholly or largely under the remit of managers. These include shared patient records, pooling of budgets, team-based processes, co-location, partnership governance, opportunities for development, person-centric quality improvement, and introduction of new roles [4,10,[16][17][18][19]. Such enablers commonly require both strategic and operational management within specific management functions such as finance, human resources, information technology.…”

A best practice health governance framework for integrated care: an exploratory study

“…In complex health systems, this focus on implementation research provides a basis for 'context-specific and evidence informed decision-making' regarding translation of theory into practice (Peters et al, 2013). The research in this thesis has resulted in a number of international and national publications (Nicholson et al, 2012;Nicholson et al, 2013;Nicholson et al, 2014;Nicholson et al, 2018), peer reviewed presentations (see Appendix 4), invited presentations, collegial meetings and training forums. In addition to the publications and peer reviewed presentations, the following section describes how the research has been presented to inform health policy and turn demonstrated research evidence into practice.…”

“…Leadership was a key enabler identified in both the alliances in NZ (Gauld, 2017) and integrated care services (Charles et al, 2018;Nicholson et al, 2018). Health care systems are complex systems in which innovation is accompanied by a degree of variation (Kelley-Patterson, 2012).…”