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

Abstract

Background: Health systems globally are faced with a shift in global demographics of ageing and the increasing incidence of chronic conditions. Internationally, key health care reforms rely on improved integration of care to address fragmentation of services and enable better coordinated, more continuous care, with more efficient use of resources. Strengthening integrated care requires greater organisational collaboration across care settings. Objectives: The overall goal of this thesis was to explore a best practice health governance model for integrated care. Within this goal the overall aim was to describe a best practice regional health governance model for integrated care. This was achieved by proposing and achieving the following:- identifying the role of the primary health care organisation in regional health governance for integrated care;- identifying the key elements of health governance for integrated care;- identifying if policy supports health governance for integrated care;- identifying if the elements are in use;- identifying if the elements are perceived as being essential to future integrated health care; and,- identifying barriers and enablers to implementation.Methods: The following studies were conducted:1. A narrative review, with thematic analysis provided a scholarly summary, with interpretation and critique, on the role of primary health care organisations in regional health governance for integrated care.2. A systematic review of peer-reviewed literature with thematic synthesis to analyse a range of evidence types including qualitative evidence.3. A content analysis of health policy used the elements from the prior study.4. An exploratory qualitative research design used case study methodology and data, collected from key informants through semi-structured interviews, which was thematically analysed.Overview of Results: The following are the results of the thesis research:1. Investment in primary health care organisations internationally has provided capacity to impact primary health care transformation significantly, including integration of primary and secondary care. Vital to the delivery of better integrated care in the future, and overcome fragmentation of funding and accountability, are governance arrangements to support primary health care and other meso level organisations implement a regional health governance model.2. Ten key elements of health governance for integrated care across a regional setting were identified. These were joint planning; integrated information communication technology; change management; shared clinical priorities; incentives; population focus; measurement – using data as a quality improvement tool; continuing professional development supporting joint working; patient/community engagement; and, innovation.3. Australian policy support for the essential elements of health governance for integrated care is sporadic.4. The ten elements of health governance for integrated care were essential to developing future integrated care across a region, but most were not in use currently. Several barriers and enablers to use of the key elements at the meso level were identified and would require addressing in order to enable best practice governance for integrated health care.Conclusions: Despite a clear policy direction in support of integrated care many health policies have floundered on the lack of poor governance. The results of this thesis demonstrate there is a key role for meso level organisations in the implementation of a regional health governance model to support integrated care. While, the ten key elements identified in this research are all essential for meso level organisations to implement a regional health governance model, a number of significant barriers were identified and need to be overcome. These include the lack of aligned system drivers, effective leadership styles capable of focusing on system outcomes, and a significant lack of community engagement. In order to overcome these barriers and realise the benefits the system requires from integrated care, the elements for health governance described in this thesis should be at the centre of health policy and practice in the future.