Abstract
BackgroundOngoing challenges to healthcare integration point toward the need to move beyond structural and process issues. While we know what needs to be done to achieve integrated care, there is little that informs us as to how. We need to understand how diverse organizations and professionals develop shared knowledge and beliefs – that is, we need to generate knowledge about normative integration. We present a cognitive perspective on integration, based on shared mental model theory, that may enhance our understanding and ability to measure and influence normative integration. The aim of this paper is to validate and improve the Mental Models of Integrated Care (MMIC) Framework, which outlines important knowledge and beliefs whose convergence or divergence across stakeholder groups may influence inter-professional and inter-organizational relations.MethodsWe used a two-stage web-based modified Delphi process to test the MMIC Framework against expert opinion using a random sample of participants from Canada’s National Symposium on Integrated Care. Respondents were asked to rate the framework’s clarity, comprehensiveness, usefulness, and importance using seven-point ordinal scales. Spaces for open comments were provided. Descriptive statistics were used to describe the structured responses, while open comments were coded and categorized using thematic analysis. The Kruskall-Wallis test was used to examine cross-group agreement by level of integration experience, current workplace, and current role.ResultsIn the first round, 90 individuals responded (52% response rate), representing a wide range of professional roles and organization types from across the continuum of care. In the second round, 68 individuals responded (75.6% response rate). The quantitative and qualitative feedback from experts was used to revise the framework. The re-named “Integration Mindsets Framework” consists of a Strategy Mental Model and a Relationships Mental Model, comprising a total of nineteen content areas.ConclusionsThe Integration Mindsets Framework draws the attention of researchers and practitioners to how various stakeholders think about and conceptualize integration. A cognitive approach to understanding and measuring normative integration complements dominant cultural approaches and allows for more fine-grained analyses. The framework can be used by managers and leaders to facilitate the interpretation, planning, implementation, management and evaluation of integration initiatives.
Highlights
Ongoing challenges to healthcare integration point toward the need to move beyond structural and process issues
We examine the extent to which the Mental Models of Integrated Care (MMIC) Framework, and its dimensions and contents, are relevant, acceptable and useful to those with expertise and experience in integration efforts, and we revise the framework based on this assessment
We evaluated and refined the proposed MMIC Framework using expert opinion in a two-round web-based modified Delphi process
Summary
Ongoing challenges to healthcare integration point toward the need to move beyond structural and process issues. Reports continue to highlight the seemingly intractable problems inherent in fostering collaboration and cooperation across professional and organizational boundaries [6,7,8,9] These problems point toward the need to move beyond the integration of organizational structures and processes to understand the social cognitions that are implicated in integration efforts. Normative integration, defined as “an ethos of shared values and commitment to coordinating work [which] enables trust and collaboration in delivering healthcare”, may be the key to addressing ongoing challenges to integrated care delivery [5]; but we still know little about how to achieve and measure normative integration
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