Integrated Health Service Delivery Research Articles

Seriously working together: integrated governance models to achieve sustainable partnerships between health care organisations

To identify sustainable governance arrangements for health care organisations undertaking integrated health service delivery based on best available evidence. Systematic review of the literature (1990-2006), supported by key informant interviews as an integrative process. 16 studies met our selection criteria. All described enablers of and barriers to delivering integrated health services. We identified three models for integrated health care governance with a demonstrated ability to be sustained in the medium term. Common themes that emerged as the logical starting point for more ambitious integrated governance arrangements regionally were: the need for a clear separation between governance and operational management; and the need for local communities with the vision, leadership and commitment to extend health service integration. These themes were reinforced by interviews with key informants. Careful measurement of the process, impact and outcomes of such activities was often overlooked. State governments are increasingly attempting to work with non-government organisations and the private sector to maximise scarce resources in the face of increasing health care demand. Ambitious integration agendas must be underpinned by effective governance mechanisms that are appropriate to the undertaking, the stakeholders involved and the scale of delivery.

Reaching Out to Boys at Bars: Utilizing Community Partnerships to Employ a Wellness Strategy for Syphilis Control Among Men Who Have Sex With Men in New York City

To explore the impact of a holistic approach for syphilis control to improve the sexual health and well-being of men who have sex with men (MSM). The New York City Department of Health & Mental Hygiene (NYC DOHMH) developed Hot Shot! to address a variety of general MSM health issues, including syphilis, gonorrhea, chlamydia, and human immunodeficiency virus (HIV)/acquired immunodeficiency virus. Between November 2003 and June 2004, 9 Hot Shot! events were held throughout NYC. Services delivered at events included STD/HIV screening; relevant adult vaccinations, cardiovascular health screenings; and mental health, tobacco, and other drug use assistance. Of 1634 attendees, 445 persons accessed > or =1 service; 4 persons were newly diagnosed with syphilis and 7 with HIV. The Hot Shot! approach to syphilis control can facilitate STD education, screening, and treatment of MSM while addressing comprehensive health issues. Future integrated health service delivery programs may be more successful by using stable venues for events to ensure continuity of care for MSM.

Aboriginal Health Systems in Canada: Nine Case Studies

This paper investigates Aboriginal health systems in Canada, in urban and rural First Nations communities, Inuit communities and Metis Settlements. A summary of the primary strengths and challenges of Aboriginally-controlled health systems is presented. Strengths include holism, synergy of western and traditional health philosophies, focus on primary care, collaboration with provincial services, integrated health service delivery, and administrative reform. Aside from the challenge of health status, Aboriginal health systems must contend with small community size, remoteness, lack of human resources including Aboriginal health professionals, a growing and aging population, inadequacy of funding accompanied with non-sustainability of the system, and jurisdictional barriers. Through nine case studies, successful approaches are presented to providing effective, responsive and culturally-appropriate community health services. These case studies underscore the diversity in Aboriginal health systems necessary to accommodate vast differences in cultural expectations, health service needs, jurisdictional complexity, and geographic location.

An evaluation approach for a new paradigm--health care integration.

This paper explores an approach to the implementation and evaluation of integrated health service delivery. It identifies the key issues involved in integration evaluation, provides a framework for assessment and identifies areas for the development of new tools and measures. A proactive role for evaluators in responding to health service reform is advocated.

Use of telemedicine for children with special health care needs.

In 1995, the Children's Medical Services (CMS) of the State of Georgia contracted with the Department of Pediatrics of the Medical College of Georgia (MCG) and the MCG Telemedicine Center to develop telemedicine programs to provide subspecialty care for children with special health care needs. This article presents project statistics and results of client evaluation of services, as well as physician faculty attitudes toward telemedicine. A demonstration project using telemedicine between a tertiary center and a rural clinic serving children with special health care needs was established. Data were collected and analyzed for December 12, 1995 to May 31, 1997, during which 333 CMS telemedicine consultations were performed. Most CMS telemedicine consultations (35%) involved pediatric allergy/immunology. Other subspecialties included pulmonology (29%), neurology (19%), and genetics (16%). Overall, patients were satisfied with the services received. Initially, physician faculty members were generally positive but conservative in their attitudes toward using telemedicine for delivering clinical consultation. After a year's exposure and/or experience with telemedicine, 28% were more positive, 66% were the same, and only 4% were more negative about telemedicine. The more physicians used telemedicine, the more positive they were about it (r =.30). In terms of family attitudes and individual care, telemedicine is an acceptable means of delivering specific pediatric subspecialty consultation services to children with special health care needs, living in rural areas distant to tertiary centers. Telemedicine is more likely to be successful as part of an integrated health services delivery than when it is the sole mode used for delivery of care.

Applying a Balanced Scorecard to Health Care Organizations

This article looks at the design and implementation of an integrated performance measurement system at a nonprofit community hospital–Community Memorial Hospital of Menomonee Falls, Wisconsin. In particular, the article discusses how the hospital developed and applied a balanced scorecard. Over the past decade, Community Memorial Hospital faced both market deregulation and strong competition. It responded to these environmental pressures by joining an integrated health service delivery network with other hospitals, physicians, and institutional purchasers of health care services. Ultimately, the hospital's management implemented a balanced scorecard. Its goals were to help translate the vision for the hospital and to gain consensus; to communicate the hospital's objectives, set goals, and link strategies; to allocate the hospital's resources and establish milestones; and to provide feedback and ensure learning. The hospital's balanced scorecard consists of one composite financial performance measure and 12 nonfinancial performance measures. Each performance indicator reflects a quantitative measure of a particular strategic objective. These performance measures are expressed in terms of actual performance as a percentage of expected performance and are integrated into a single, overall performance score through a subjective weighting scheme. The balanced scorecard approach to performance measurement at Community Memorial Hospital has provided an efficient and effective way to link day-to-day operating activities to the hospital's strategic objectives. © 2000 John Wiley & Sons, Inc.

Applying a Balanced Scorecard to Health Care Organizations

This article looks at the design and implementation of an integrated performance measurement system at a nonprofit community hospital–Community Memorial Hospital of Menomonee Falls, Wisconsin. In particular, the article discusses how the hospital developed and applied a balanced scorecard. Over the past decade, Community Memorial Hospital faced both market deregulation and strong competition. It responded to these environmental pressures by joining an integrated health service delivery network with other hospitals, physicians, and institutional purchasers of health care services. Ultimately, the hospital's management implemented a balanced scorecard. Its goals were to help translate the vision for the hospital and to gain consensus; to communicate the hospital's objectives, set goals, and link strategies; to allocate the hospital's resources and establish milestones; and to provide feedback and ensure learning. The hospital's balanced scorecard consists of one composite financial performance measure and 12 nonfinancial performance measures. Each performance indicator reflects a quantitative measure of a particular strategic objective. These performance measures are expressed in terms of actual performance as a percentage of expected performance and are integrated into a single, overall performance score through a subjective weighting scheme. The balanced scorecard approach to performance measurement at Community Memorial Hospital has provided an efficient and effective way to link day-to-day operating activities to the hospital's strategic objectives. © 2000 John Wiley & Sons, Inc.