How personal and standardized coordination impact implementation of integrated care.

Justin K Benzer,David C Mohr,James F Burgess,Martin P Charns,Jennifer L Sullivan,Irene E Cramer

doi:10.1186/s12913-015-1079-6

Abstract

BackgroundIntegrating health care across specialized work units has the potential to lower costs and increase quality and access to mental health care. However, a key challenge for healthcare managers is how to develop policies, procedures, and practices that coordinate care across specialized units. The purpose of this study was to identify how organizational factors impacted coordination, and how to facilitate implementation of integrated care.MethodsSemi-structured interviews were conducted in August 2009 with 30 clinic leaders and 35 frontline staff who were recruited from a convenience sample of 16 primary care and mental health clinics across eight medical centers. Data were drawn from a management evaluation of primary care-mental health integration in the US Department of Veterans Affairs. To protect informant confidentiality, the institutional review board did not allow quotations.ResultsInterviews identified antecedents of organizational coordination processes, and highlighted how these antecedents can impact the implementation of integrated care. Overall, implementing new workflow practices were reported to create conflicts with pre-existing standardized coordination processes. Personal coordination (i.e., interpersonal communication processes) between primary care leaders and staff was reported to be effective in overcoming these barriers both by working around standardized coordination barriers and modifying standardized procedures.DiscussionThis study identifies challenges to integrated care that might be solved with attention to personal and standardized coordination. A key finding was that personal coordination both between primary care and mental health leaders and between frontline staff is important for resolving barriers related to integrated care implementation.ConclusionIntegrated care interventions can involve both new standardized procedures and adjustments to existing procedures. Aligning and integrating procedures between primary care and specialty care requires personal coordination amongst leaders. Interpersonal relationships should be strengthened between staff when personal connections are important for coordinating patient care across clinical settings.

Highlights

Integrating health care across specialized work units has the potential to lower costs and increase quality and access to mental health care
Interpersonal relationships should be strengthened between staff when personal connections are important for coordinating patient care across clinical settings
The concepts of standardized and personal coordination were well represented across the clinics (149 quotations)

Summary

Introduction

Integrating health care across specialized work units has the potential to lower costs and increase quality and access to mental health care. Difficulties include coordinating referrals [15], managing a wide range of appointment types [16], determining the timing and length of appointments [17], clarifying responsibilities between integrated versus specialty mental health clinics [18], and coordinating amongst providers [19]. This prior research demonstrates that organizational changes intended to integrate services between professions may not translate into either patient experiences of integrated care [20] or effective collaborative care among providers. The purpose of this study is to use the implementation of a policy to clinically integrate primary care and mental health to answer the following research questions: Research Question 1: How do organizational factors impact coordination between primary care and mental health?

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