What are the ‘success factors’ for effective integration? Lessons from international case studies

PURPOSE: To describe key success factors, derived from literature review and international case studies that enable effective integration between clinicians, teams and organizations. THEORY: Effective integration is dependent on consideration of diverse factors operating at macro, meso and micro levels of health care. DATA SOURCES: Literature review and four international case studies. METHODS: A maximum variation sample of four ICOs was selected from organizations and services nominated by international experts as ‘high performing’; ensuring a range of national policy contexts, organizational arrangements, and integrative approaches. Case studies in the USA, Holland and Scotland, drew on data from 10 to 15 semi-structured interviews with managers and clinicians and on document review. Interviews explored understanding of and objectives for ‘integration’, external influences and impact of internal characteristics (e.g. leadership, governance, IT) in facilitating/hindering integration. Clinical interviewees also described hypothetical patient journeys. Analysis focused on potential barriers and facilitators to integration. PRELIMINARY CONCLUSIONS: Findings suggest integration requires four tiers of ‘success factors’: 1) a supportive ‘operating environment’ with appropriate policy, regulation, law, and payment systems; 2) organisational culture, infrastructure and processes (which may cross organizational boundaries) to support integration and enable; 3) effective inter-professional teams operating within or between organizations with linked infrastructure; shared assessments; common standards; care co-ordination and shared care plans and 4) activated patients to participate in care planning. DISCUSSION: Those wishing to develop effective ICOs will need to ensure that each of these four tiers is addressed simultaneously across all levels (i.e. macro, meso and micro) of health care.