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Carlsson KS, Brommels M. Integrated Health and Social Services for People With Chronic Mental Health Problems: People Are More Important Than Processes. Insights From a Multiple Case Study in Swedish Psychiatry. Front Public Health 2022; 10:845201. [PMID: 35812519 PMCID: PMC9257072 DOI: 10.3389/fpubh.2022.845201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 05/26/2022] [Indexed: 11/23/2022] Open
Abstract
Three mental health organizations, one merged with, one formally cooperating with, and one without formal links to social services were analyzed through the experience of staff, patients and relatives in order to elucidate what approaches best promoted service coordination. Seventeen staff and eight patients or relatives, recruited from the three organizations, participated in semi-structured interviews, guided by pre-selected categories derived from previous research about coordination and care processes. Directed content analysis was used to identify and categorize meaning units. Both staff and patients raised the same concerns. Organized collaboration between psychiatric care and social services addressed only some of patients' challenges. More important was patient access to financial and social assistance. The organizational arrangements were not referred to, whereas case management was seen as crucial. In many instances relatives have to act as case managers. Service integration in mental health has to include, in addition to social services, other authorities like social insurance and employment agencies. A case manager knowledgeable about all welfare services is best positioned to promote that “extended integration”. Relatives often have to take this responsibility to support this fragile group of patients. This observed importance of case management is supported by previous research in mental health and primary care. The role of relatives should be acknowledged and supported by those services.
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Klinga C, Hasson H, Andreen Sachs M, Hansson J. Understanding the dynamics of sustainable change: A 20-year case study of integrated health and social care. BMC Health Serv Res 2018; 18:400. [PMID: 29866114 PMCID: PMC5987399 DOI: 10.1186/s12913-018-3061-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 03/26/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Change initiatives face many challenges, and only a few lead to long-term sustainability. One area in which the challenge of achieving long-term sustainability is particularly noticeable is integrated health and social care. Service integration is crucial for a wide range of patients including people with complex mental health and social care needs. However, previous research has focused on the initiation, resistance and implementation of change, while longitudinal studies remain sparse. The objective of this study was therefore to gain insight into the dynamics of sustainable changes in integrated health and social care through an analysis of local actions that were triggered by a national policy. METHODS A retrospective and qualitative case-study research design was used, and data from the model organisation's steering-committee minutes covering 1995-2015 were gathered and analysed. The analysis generated a narrative case description, which was mirrored to the key elements of the Dynamic Sustainability Framework (DSF). RESULTS The development of inter-sectoral cooperation was characterized by a participatory approach in which a shared structure was created to support cooperation and on-going quality improvement and learning based on the needs of the service user. A key management principle was cooperation, not only on all organisational levels, but also with service users, stakeholder associations and other partner organisations. It was shown that all these parts were interrelated and collectively contributed to the creation of a structure and a culture which supported the development of a dynamic sustainable health and social care. CONCLUSION This study provides valuable insights into the dynamics of organizational sustainability and understanding of key managerial actions taken to establish, develop and support integration of health and social care for people with complex mental health needs. The service user involvement and regular reviews of service users' needs were essential in order to tailor services to the needs. Another major finding was the importance of continuously adapting the content of the change to suit its context. Hence, continuous refinement of the change content was found to be more important than designing the change at the pre-implementation stage.
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Affiliation(s)
- Charlotte Klinga
- Department of Learning, Informatics, Management and Ethics (LIME), Medical Management Centre (MMC) | Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Henna Hasson
- Department of Learning, Informatics, Management and Ethics (LIME), Medical Management Centre (MMC) | Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Magna Andreen Sachs
- Department of Learning, Informatics, Management and Ethics (LIME), Medical Management Centre (MMC) | Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Johan Hansson
- Department of Learning, Informatics, Management and Ethics (LIME), Medical Management Centre (MMC) | Karolinska Institutet, 171 77 Stockholm, Sweden
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Abstract
Introduction: To meet the needs of vulnerable people, the integration of services across different sectors is important. This paper presents a preliminary review of service integration across sectors in Europe. Examples of service integration between social services, health, employment and/or education were studied. A further aim of the study was to improve conceptual clarity regarding service integration across sectors, using Minkman’s Developmental Model for Integrated Care (DMIC) as an analytical framework. Methods: The study methods comprised a literature review (34 articles) and a survey of practice examples across Europe (44 practices). This paper is based on a more comprehensive study published in 2016. Results: The study demonstrates that although the focus of integration across sectors is often on social services and health care, other arrangements are also frequently in place. The review shows that integration may be either tailored to a particular target group or designed for communities in general. Although systems to monitor and evaluate social service integration are often present, they are not yet fully developed. The study also highlights the importance of good leadership and organizational support in integrated service delivery. Discussion: The study shows that the DMIC can work as a conceptual framework for the analysis of service integration across sectors. However, as this is an exploratory study, further in-depth case studies are required to deepen our understanding of the processes involved in service integration across sectors.
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Auschra C. Barriers to the Integration of Care in Inter-Organisational Settings: A Literature Review. Int J Integr Care 2018; 18:5. [PMID: 29632455 PMCID: PMC5887071 DOI: 10.5334/ijic.3068] [Citation(s) in RCA: 117] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 10/31/2017] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION In recent years, inter-organisational collaboration between healthcare organisations has become of increasingly vital importance in order to improve the integration of health service delivery. However, different barriers reported in academic literature seem to hinder the formation and development of such collaboration. THEORY AND METHODS This systematic literature review of forty studies summarises and categorises the barriers to integrated care in inter-organisational settings as reported in previous studies. It analyses how these barriers operate. RESULTS Within these studies, twenty types of barriers have been identified and then categorised in six groups (barriers related to administration and regulation, barriers related to funding, barriers related to the inter-organisational domain, barriers related to the organisational domain, barriers related to service delivery, and barriers related to clinical practices). Not all of these barriers emerge passively, some are set up intentionally. They are not only context-specific, but are also often related and influence each other. DISCUSSION AND CONCLUSION The compilation of these results allows for a better understanding of the characteristics and reasons for the occurrence of barriers that impede collaboration aiming for the integration of care, not only for researchers but also for practitioners. It can help to explain and counteract the slow progress and limited efficiency and effectiveness of some of the inter-organisational collaboration in healthcare settings.
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Affiliation(s)
- Carolin Auschra
- Freie Universität Berlin, Department of Management, Boltzmannstr. 20, 14195 Berlin, DE
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Apantaku-Olajide T, Ducray K, Byrne P, Smyth BP. Perception of unmet needs and association with benzodiazepine misuse among patients on a methadone maintenance treatment programme. ACTA ACUST UNITED AC 2018. [DOI: 10.1192/pb.bp.111.036616] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Aims and methodTo examine patients' perceptions of unmet needs during methadone maintenance treatment (MMT), and to explore the relationship between co-occurring benzodiazepine misuse and severity of needs. A cross-sectional survey was carried out at an MMT programme in Dublin, Ireland. All patients were invited to participate on a voluntary basis. Of the 191 eligible patients, 107 agreed to participate and completed the Camberwell Assessment of Need questionnaire.ResultsUnmet needs for substance misuse treatments, daytime activities, socialisation, money management and psychological distress were high. Fifty-two respondents (49%) reported using non-prescribed benzodiazepines during the past month. Compared with non-users of benzodiazepines, benzodiazepine users reported higher ratings of total and unmet needs (P < 0.05). The number of days using benzodiazepines predicted the severity of needs.Clinical implicationsThe findings highlight the importance of addressing coexisting psychological needs, and further support enhancing treatment interventions for benzodiazepine misuse or dependence among patients on MMT.
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Perumbilly SA, Anderson SA. Indian Perspectives on Treating Substance Use Disorders. ALCOHOLISM TREATMENT QUARTERLY 2017. [DOI: 10.1080/07347324.2017.1322433] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Sebastian A. Perumbilly
- Marriage and Family Therapy Program, Southern Connecticut State University, New Haven, Connecticut, USA
| | - Stephen A. Anderson
- Human Development and Family Studies, University of Connecticut, Storrs, Connecticut, USA
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Wang X, Birch S, Zhu W, Ma H, Embrett M, Meng Q. Coordination of care in the Chinese health care systems: a gap analysis of service delivery from a provider perspective. BMC Health Serv Res 2016; 16:571. [PMID: 27733145 PMCID: PMC5062922 DOI: 10.1186/s12913-016-1813-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 10/01/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Increases in health care utilization and costs, resulting from the rising prevalence of chronic conditions related to the aging population, is exacerbated by a high level of fragmentation that characterizes health care systems in China. There have been several pilot studies in China, aimed at system-level care coordination and its impact on the full integration of health care system, but little is known about their practical effects. Huangzhong County is one of the pilot study sites that introduced organizational integration (a dimension of integrated care) among health care institutions as a means to improve system-level care coordination. The purposes of this study are to examine the effect of organizational integration on system-level care coordination and to identify factors influencing care coordination and hence full integration of county health care systems in rural China. METHODS We chose Huangzhong and Hualong counties in Qinghai province as study sites, with only Huangzhong having implemented organizational integration. A mixed methods approach was used based on (1) document analysis and expert consultation to develop Best Practice intervention packages; (2) doctor questionnaires, identifying care coordination from the perspective of service provision. We measured service provision with gap index, overlap index and over-provision index, by comparing observed performance with Best Practice; (3) semi-structured interviews with Chiefs of Medicine in each institution to identify barriers to system-level care coordination. RESULTS Twenty-nine institutions (11 at county-level, 6 at township-level and 12 at village-level) were selected producing surveys with a total of 19 schizophrenia doctors, 23 diabetes doctors and 29 Chiefs of Medicine. There were more care discontinuities for both diabetes and schizophrenia in Huangzhong than in Hualong. Overall, all three index scores (measuring service gaps, overlaps and over-provision) showed similar tendencies for the two conditions. The gap indices of schizophrenia (> 5.10) were bigger for diabetes (< 2.60) in both counties. The over-provision indices of schizophrenia (> 3.25) were bigger than diabetes (< 1.80) in both counties. Overlap indices for the two conditions exceeded justified overlaps, especially for diabetes. Gap index scores for schizophrenia interventions at the township-level and over-provision index scores for diabetes interventions at both village- and township-level showed big differences between the two counties. Insufficient medical staff with appropriate competencies, lack of motivation for care coordination and related supportive policies as well as unconnected information system were identified as barriers to system-level care coordination in both counties. CONCLUSION Findings demonstrate that organizational integration in Huangzhong has not achieved a higher level of care coordination at this stage. System-level care coordination is most problematic at village-level institutions in Hualong, but at county-level institutions in Huangzhong. These findings suggest that attention be given to other aspects of integration (e.g., clinical and service integration) to promote system-level care coordination and contribute to the full integration of health care system in the pilot county.
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Affiliation(s)
- Xin Wang
- School of Health Care Management, Shandong University, Jinan, China
| | - Stephen Birch
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Canada
| | - Weiming Zhu
- China Center for Health Development Studies, Peking University, 38 Xueyuan Road, Haidian district, Beijing, China
| | - Huifen Ma
- China Center for Health Development Studies, Peking University, 38 Xueyuan Road, Haidian district, Beijing, China
| | - Mark Embrett
- Health policy, Faculty of health science, McMaster University, Hamilton, Canada
| | - Qingyue Meng
- China Center for Health Development Studies, Peking University, 38 Xueyuan Road, Haidian district, Beijing, China.
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Klinga C, Hansson J, Hasson H, Sachs MA. Co-Leadership - A Management Solution for Integrated Health and Social Care. Int J Integr Care 2016; 16:7. [PMID: 27616963 PMCID: PMC5015547 DOI: 10.5334/ijic.2236] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 05/11/2016] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Co-leadership has been identified as one approach to meet the managerial challenges of integrated services, but research on the topic is limited. In the present study, co-leadership, practised by pairs of managers - each manager representing one of the two principal organizations in integrated health and social care services - was explored. AIM To investigate co-leadership in integrated health and social care, identify essential preconditions in fulfilling the management assignment, its operationalization and impact on provision of sustainable integration of health and social care. METHOD Interviews with eight managers exercising co-leadership were analysed using directed content analysis. Respondent validation was conducted through additional interviews with the same managers. RESULTS Key contextual preconditions were an organization-wide model supporting co-leadership and co-location of services. Perception of the management role as a collective activity, continuous communication and lack of prestige were essential personal and interpersonal preconditions. In daily practice, office sharing, being able to give and take and support each other contributed to provision of sustainable integration of health and social care. CONCLUSION AND DISCUSSION Co-leadership promoted robust management by providing broader competence, continuous learning and joint responsibility for services. Integrated health and social care services should consider employing co-leadership as a managerial solution to achieve sustainability.
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Affiliation(s)
- Charlotte Klinga
- Medical Management Centre (MMC), Department of Learning, Informatics,
Management and Ethics, Karolinska Institutet, SE
- Department of Social Work, Karolinska University Hospital, SE
| | - Johan Hansson
- Medical Management Centre (MMC), Department of Learning, Informatics,
Management and Ethics, Karolinska Institutet, SE
| | - Henna Hasson
- Medical Management Centre (MMC), Department of Learning, Informatics,
Management and Ethics, Karolinska Institutet, SE
- Centre for Epidemiology and Community Medicine, Stockholm County
Council, SE
| | - Magna Andreen Sachs
- Medical Management Centre (MMC), Department of Learning, Informatics,
Management and Ethics, Karolinska Institutet, SE
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Sheaff R, Halliday J, Øvretveit J, Byng R, Exworthy M, Peckham S, Asthana S. Integration and continuity of primary care: polyclinics and alternatives – a patient-centred analysis of how organisation constrains care co-ordination. HEALTH SERVICES AND DELIVERY RESEARCH 2015. [DOI: 10.3310/hsdr03350] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundAn ageing population, the increasing specialisation of clinical services and diverse health-care provider ownership make the co-ordination and continuity of complex care increasingly problematic. The way in which the provision of complex health care is co-ordinated produces – or fails to produce – six forms of continuity of care (cross-sectional, longitudinal, flexible, access, informational and relational). Care co-ordination is accomplished by a combination of activities by patients themselves; provider organisations; care networks co-ordinating the separate provider organisations; and overall health-system governance. This research examines how far organisational integration might promote care co-ordination at the clinical level.ObjectivesTo examine (1) what differences the organisational integration of primary care makes, compared with network governance, to horizontal and vertical co-ordination of care; (2) what difference provider ownership (corporate, partnership, public) makes; (3) how much scope either structure allows for managerial discretion and ‘performance’; (4) differences between networked and hierarchical governance regarding the continuity and integration of primary care; and (5) the implications of the above for managerial practice in primary care.MethodsMultiple-methods design combining (1) the assembly of an analytic framework by non-systematic review; (2) a framework analysis of patients’ experiences of the continuities of care; (3) a systematic comparison of organisational case studies made in the same study sites; (4) a cross-country comparison of care co-ordination mechanisms found in our NHS study sites with those in publicly owned and managed Swedish polyclinics; and (5) the analysis and synthesis of data using an ‘inside-out’ analytic strategy. Study sites included professional partnership, corporate and publicly owned and managed primary care providers, and different configurations of organisational integration or separation of community health services, mental health services, social services and acute inpatient care.ResultsStarting from data about patients’ experiences of the co-ordination or under-co-ordination of care, we identified five care co-ordination mechanisms present in both the integrated organisations and the care networks; four main obstacles to care co-ordination within the integrated organisations, of which two were also present in the care networks; seven main obstacles to care co-ordination that were specific to the care networks; and nine care co-ordination mechanisms present in the integrated organisations. Taking everything into consideration, integrated organisations appeared more favourable to producing continuities of care than did care networks. Network structures demonstrated more flexibility in adding services for small care groups temporarily, but the expansion of integrated organisations had advantages when adding new services on a longer term and a larger scale. Ownership differences affected the range of services to which patients had direct access; primary care doctors’ managerial responsibilities (relevant to care co-ordination because of their impact on general practitioner workload); and the scope for doctors to develop special interests. We found little difference between integrated organisations and care networks in terms of managerial discretion and performance.ConclusionsOn balance, an integrated organisation seems more likely to favour the development of care co-ordination and, therefore, continuities of care than a system of care networks. At least four different variants of ownership and management of organisationally integrated primary care providers are practicable in NHS-like settings. Future research is therefore required, above all to evaluate comparatively the different techniques for coordinating patient discharge across the triple interface between hospitals, general practices and community health services; and to discover what effects increasing the scale and scope of general practice activities will have on continuity of care.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Rod Sheaff
- School of Government, Plymouth University, Plymouth, UK
| | | | - John Øvretveit
- Medical Management Centre, Karolinska Institutet Stockholm, Stockholm, Sweden
| | - Richard Byng
- Health Services Management Centre, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK
| | - Mark Exworthy
- Centre for Health Services Studies, University of Birmingham, Birmingham, UK
| | - Stephen Peckham
- Department of Health Services Research and Policy, University of Kent, Kent, UK
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Nicaise P, Dubois V, Lorant V. Mental health care delivery system reform in Belgium: the challenge of achieving deinstitutionalisation whilst addressing fragmentation of care at the same time. Health Policy 2014; 115:120-7. [PMID: 24582489 DOI: 10.1016/j.healthpol.2014.02.007] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Revised: 10/31/2013] [Accepted: 02/05/2014] [Indexed: 10/25/2022]
Abstract
Most mental health care delivery systems in welfare states currently face two major issues: deinstitutionalisation and fragmentation of care. Belgium is in the process of reforming its mental health care delivery system with the aim of simultaneously strengthening community care and improving integration of care. The new policy model attempts to strike a balance between hospitals and community services, and is based on networks of services. We carried out a content analysis of the policy blueprint for the reform and performed an ex-ante evaluation of its plan of operation, based on the current knowledge of mental health service networks. When we examined the policy's multiple aims, intermediate goals, suggested tools, and their articulation, we found that it was unclear how the new policy could achieve its goals. Indeed, deinstitutionalisation and integration of care require different network structures, and different modes of governance. Furthermore, most of the mechanisms contained within the new policy were not sufficiently detailed. Consequently, three major threats to the effectiveness of the reform were identified. These were: issues concerning the relationship between network structure and purpose, the continued influence of hospitals despite the goal of deinstitutionalisation, and the heterogeneity in the actual implementation of the new policy.
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Affiliation(s)
- Pablo Nicaise
- Institute of Health and Society (IRSS), Université catholique de Louvain, Brussels, Belgium.
| | - Vincent Dubois
- Institute of Health and Society (IRSS), Université catholique de Louvain, Brussels, Belgium
| | - Vincent Lorant
- Institute of Health and Society (IRSS), Université catholique de Louvain, Brussels, Belgium
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Fleury MJ, Grenier G, Lesage A, Ma N, Ngui AN. Network collaboration of organisations for homeless individuals in the Montreal region. Int J Integr Care 2014; 14:e003. [PMID: 24520216 PMCID: PMC3920820 DOI: 10.5334/ijic.1138] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2013] [Revised: 11/21/2013] [Accepted: 11/29/2013] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION We know little about the intensity and determinants of interorganisational collaboration within the homeless network. This study describes the characteristics and relationships (along with the variables predicting their degree of interorganisational collaboration) of 68 organisations of such a network in Montreal (Quebec, Canada). THEORY AND METHODS Data were collected primarily through a self-administered questionnaire. Descriptive analyses were conducted followed by social network and multivariate analyses. RESULTS The Montreal homeless network has a high density (50.5%) and a decentralised structure and maintains a mostly informal collaboration with the public and cross-sectorial sectors. The network density showed more frequent contacts among four types of organisations which could point to the existence of cliques. Four variables predicted interorganisational collaboration: organisation type, number of services offered, volume of referrals and satisfaction with the relationships with public organisations. CONCLUSIONS AND DISCUSSION The Montreal homeless network seems adequate to address non-complex homelessness problems. Considering, however, that most homeless individuals present chronic and complex profiles, it appears necessary to have a more formal and better integrated network of homeless organisations, particularly in the health and social service sectors, in order to improve services.
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Affiliation(s)
- Marie-Josée Fleury
- Department of Psychiatry, McGill University and Researcher, Douglas Hospital Research Centre, Montreal, Canada
| | - Guy Grenier
- Douglas Hospital Research Centre, Montreal, Canada
| | - Alain Lesage
- Department of Psychiatry, University of Montreal and Researcher, Fernand-Seguin Research Centre, L-H Lafontaine Hospital, Montréal, Canada
| | - Nan Ma
- Fernand-Seguin Research Centre, L-H Lafontaine Hospital, Montreal, Canada
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Strategic collaboration councils in the mental health services: what are they working with? Int J Integr Care 2013; 13:e009. [PMID: 23687481 PMCID: PMC3653287 DOI: 10.5334/ijic.838] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2012] [Revised: 09/19/2012] [Accepted: 10/15/2012] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION In recent years collaboration has become an important part of the delivery of welfare services. One response to these collaborative efforts has been the introduction of strategic collaboration between different welfare agencies. Strategic collaboration is arguably the most open-ended form of service integration, as both purpose and membership are open to negotiation. This article will examine the work in strategic collaboration councils in the mental health services. METHOD The study is based on observations in eight strategic collaboration councils in Sweden. The councils were observed over 12 months, and every meeting that was held during that time was observed and tape-recorded. RESULTS FOUR BASIC ACTIVITIES WERE IDENTIFIED: the exchange of information, the identification of problems, organizing events and activities, and organizing the councils. Even though these activities were identified, the main focus was to exchange information. The councils' work also varied in terms of how they make decisions and agreements, and whether their focus is more on internal or external issues. CONCLUSION FROM THE IDENTIFIED ACTIVITIES, THE COUNCILS CAN BE CLASSIFIED INTO FOUR IDEAL TYPES: the information council, the problem-identification council, the decision-making council, and the self-organizing council.
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Welbel M, Matanov A, Moskalewicz J, Barros H, Canavan R, Gabor E, Gaddini A, Greacen T, Kluge U, Lorant V, Esteban Peña M, Schene AH, Soares JJ, Straßmayr C, Vondráčková P, Priebe S. Addiction treatment in deprived urban areas in EU countries: Accessibility of care for people from socially marginalized groups. DRUGS-EDUCATION PREVENTION AND POLICY 2012. [DOI: 10.3109/09687637.2012.706757] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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14
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Implementing organisation and management innovations in Swedish healthcare. J Health Organ Manag 2012; 26:237-57. [DOI: 10.1108/14777261211230790] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Carney T. Australian mental health tribunals--'Space' for rights, protection, treatment and governance? INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2012; 35:1-10. [PMID: 22142893 DOI: 10.1016/j.ijlp.2011.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
This paper draws on a multi-year Australian collaborative study of mental health review tribunals ('MHTs') in three jurisdictions (Victoria, New South Wales and the Australian Capital Territory) undertaken in conjunction with the NSW Law and Justice Foundation, using qualitative and quantitative methods to examine the role of MHTs in advancing goals such as fairness, legality and access to treatment. Study findings regarding stakeholder and client concerns - about access to quality treatment and associated support services, review of treatment adequacy and drug regimes, and their 'participation' or dignity of engagement in review processes - are presented as variants of the need for adequate hearing 'space': temporal, jurisdictional, cognate/relational, physical and symbolic, and 'connective'. Building on earlier arguments for MHTs to engage not only legal, but also clinical and social domains, and for adopting some processes more characteristic of case-conferencing, this paper examines the implications of tribunal 'flexibility' and a wider overall 'governance' jurisdiction in mental health.
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Affiliation(s)
- Terry Carney
- Faculty of Law, University of Sydney, Eastern Avenue, University of Sydney, NSW 2006, Australia.
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Hansson J, Øvretveit J, Brommels M. Case study of how successful coordination was achieved between a mental health and social care service in Sweden. Int J Health Plann Manage 2011; 27:e132-45. [DOI: 10.1002/hpm.1099] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Johan Hansson
- LIME, Medical Management Centre (MMC); Karolinska Institutet; Stockholm; Sweden
| | - John Øvretveit
- LIME, Medical Management Centre (MMC); Karolinska Institutet; Stockholm; Sweden
| | - Mats Brommels
- LIME, Medical Management Centre (MMC); Karolinska Institutet; Stockholm; Sweden
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Ahgren B, Axelsson R. A decade of integration and collaboration: the development of integrated health care in Sweden 2000-2010. Int J Integr Care 2011; 11 Spec Ed:e007. [PMID: 21677844 PMCID: PMC3111884 DOI: 10.5334/ijic.566] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
INTRODUCTION The recent history of integrated health care in Sweden is explored in this article, focusing on the first decade of the 2000s. In addition, there are some reflections about successes and setbacks in this development and challenges for the next decade. DESCRIPTION OF POLICY AND PRACTICE The first efforts to integrate health care in Sweden appeared in the beginning of the 1990s. The focus was on integration of intra-organisational processes, aiming at a more cost-effective health care provision. Partly as a reaction to the increasing economism at that time, there was also a growing interest in quality improvement. Out of this work emerged the 'chains of care', integrating all health care providers involved in the care of specific patient groups. During the 2000s, many county councils have also introduced inter-organisational systems of 'local health care'. There has also been increasing collaboration between health professionals and other professional groups in different health and welfare services. DISCUSSION AND CONCLUSION Local health care meant that the chains of care and other forms of integration and collaboration became embedded in a more integrative context. At the same time, however, policy makers have promoted free patient choice in primary health care and also mergers of hospitals and clinical departments. These policies tend to fragment the provision of health care and have an adverse effect on the development of integrated care. As a counterbalance, more efforts should be put into evaluation of integrated health care, in order to replace political convictions with evidence concerning the benefits of such health care provision.
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Affiliation(s)
- Bengt Ahgren
- Nordic School of Public Health, P.O. Box 12133, SE-402 42 Göteborg, Sweden
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