Dynamic sustainability of integrated health and social care and the importance of adaptive strategic management

Abstract

Introduction: The question of why and how some organizational integration initiatives last and others don’t, is of great interest in times when fragmented care causes difficulties for an ever-growing group of people with complex needs. In the field of implementation research the body of knowledge about the early stages of implementation processes has grown rapidly since the 1990s. However, less is known about how to achieve sustained practice change. More knowledge is also needed on how to manage cross-sectorial integration.Study setting: In the early nineties a shared governance model between mental health care services provided by the county council and municipal social care services was implemented in the region of Stockholm. The vision and primary goal was to provide person-centred care for individuals with complex needs. The evolvement of this integrated health and social care organization has continued ever since, and today, the organization can be said to have accomplished long-lasting close cooperation i.e. organizational sustainability.Aim: To describe factors contributing to the achievement of sustainable integration of health and social care for persons with complex needs.Data Collection: In-depth case study of documents i.e. steering committee meeting minutes covering the time period 1995-2015 and additional interviews with members in the steering committee.Data analysis: The Dynamic Sustainability Framework (DSF) addressing the paradox of sustainment amid on-going change by Chambers et al., (2013) will be used as it distinguish between implementation (initial process of embedding interventions within settings) and sustainability (to what extent the interventions can continue to be delivered over time). This framework has also been chosen to guide the data analysis since its focus on context, the need for on-going evaluation and decision-making and the goal of continuous improvement. It also highlights omnipresent change and the goal to constantly optimize the fit between the multi-component interventions and the context.Results and conclusions: By the time for the conference we will present our findings which will provide a practical contribution by identification and description of key components of strategies used by the strategic management level to achieve dynamic sustainability of integrated health and social care for persons with complex needs. This study will also provide a theoretical contribution by examining whether DSF can be used to increase understanding of the achievement of dynamic sustainability of integrated health and social care.Referemce:1- Chambers, D. A., Glasgow, R. E., & Stange, K. C. The dynamic sustainability framework: addressing the paradox of sustainment amid ongoing change. Implement Sci, 2013;8(1):117.