Abstract
We are looking at the process of structuring an integrated care system as an innovative process that swings back and forth between the diversity of the actors involved, local aspirations and national and regional regulations. We believe that innovation is enriched by the variety of the actors involved, but may also be blocked or disrupted by that diversity. Our research aims to add to other research, which, when questioning these integrated systems, analyses how the actors involved deal with diversity without really questioning it. The empirical basis of the paper is provided by case study analysis. The studied integrated care system is a French healthcare network that brings together healthcare professionals and various organisations in order to improve the way in which interventions are coordinated and formalised, in order to promote better detection and diagnosis procedures and the implementation of a care protocol. We consider this case as instrumental in developing theoretical proposals for structuring an integrated care system in light of the diversity of the actors involved. We are proposing a model for structuring an integrated care system in light of the enacted diversity of the actors involved. This model is based on three factors: the diversity enacted by the leaders, three stances for considering the contribution made by diversity in the structuring process and the specific leading role played by those in charge of the structuring process. Through this process, they determined how the actors involved in the project were differentiated, and on what basis those actors were involved. By mobilising enacted diversity, the leaders are seeking to channel the emergence of a network in light of their own representation of that network. This model adds to published research on the structuring of integrated care systems.
Highlights
Integrated care is presented as an appropriate response to the fragmentation of the healthcare sector, which leads to the inefficient use of resources, the redundancy or absence of care consultations, disruptions in patient care and scattered knowledge of patients [1]
We are proposing a model for structuring an integrated care system in light of the enacted diversity of the actors involved. This model is based on three factors: the diversity enacted by the leaders, three stances for considering the contribution made by diversity in the structuring process and the specific leading role played by those in charge of the structuring process
The leaders are seeking to channel the emergence of a network in light of their own representation of that network. This model adds to published research on the structuring of integrated care systems
Summary
Integrated care is presented as an appropriate response to the fragmentation of the healthcare sector, which leads to the inefficient use of resources, the redundancy or absence of care consultations, disruptions in patient care and scattered knowledge of patients [1]. 1], and which ends, in most cases, with the systems being recognised by the competent authorities (who grant them public funding) This development phase is always a delicate balance [2], between public authority requirements and the individual aspirations of local actors, between the frameworks (often the result of regulation) that govern practices and the independent way in which the actors conceive their integration, and between the diversity of the actors and the integration of their interventions beyond institutional or professional barriers. This can lead to uncertainty where the project is concerned (and to the meaning to be assigned to the term ‘integration’), unclear leadership roles [3] and low participation levels, with the actors preferring to safeguard their professional independence [4]
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