Figure 2 can hence offer guidance on the analysis of barriers during the process of collaboration, but further empirical investigation is needed for its enhancement. 39, 40]. BMC Pregnancy & Childbirth, 2017; 17(2000): 1–14. A third domain relevant for the integration of care is the organisational domain. Development of a program for tele-rehabilitation of COPD patients across sectors: Co-innovation in a network. DOI: https://doi.org/10.5334/ijic.3068.s1. book chapters, monographs), thereby also omitting further barriers. When inter-organisational collaboration stretches over a wider geographical distance, “differences in the meaning and use of relevant concepts between countries and regions” [53, p. 950] may also occur. Cultural distance between organisations: Organisations develop their own specific cultures, which can create barriers to inter-organisational collaborations if organisations are not capable of managing these differences. Patients with several chronic conditions face even greater difficulties if there is no coordination of the different care plans, sometimes even with direct harm as a consequence – for example if medication is prescribed by different doctors without due consideration of potential side effects and interactions. Such conflicts can lead to the reaction that people start to defend their professional territory [48, 51, 67]. Related barriers of this kind can also be found on other levels of analysis, and can be driven both by agents and/or structure. Abstracts of conference presentations with unavailable full texts were also excluded. Furthermore, within different organisations often divergent formal timetables and time horizons [47], different decision-making structures [56], and different views about employment, accountability and hierarchies [55] exist, affecting inter-organisational collaboration. That can cause conflicts within inter-organisational collaborations involving inter-professional work [55, 56]. Fostering change within organizational participants of multisectoral health care alliances. Inter-organisational collaborations – as opposed to market or hierarchical relationships – feature certain characteristics: firstly, partners within the inter-organisational relationship follow either a common goal or purpose [20, 23]. For instance, regulations (macro-level) may be a cause of conflict on matters of resources and interests between organisations (meso-level), which in turn may cause resistance to collaboration in every day practice (micro-level). For instance, the same barrier may have a different effect at different stages of a collaboration (initiation, development, maturing), e.g. For instance, the legally required focus on bureaucratic procedures by organisations within the public sector can slow down collaboration [10]. Confidentiality issues: Previous studies have reported that confidentiality issues can impede inter-organisational collaboration, e.g. International Journal of Integrated Care, 2016; 16(4): 1–10. DOI: https://doi.org/10.5334/ijic.1884, Gröne, O and Garcia-Barbero, M. Integrated care: A position paper of the WHO European office for integrated health care services. One of the biggest barriers to schizophrenia treatment is misunderstanding and … DOI: http://doi.org/10.5334/ijic.3068, Auschra C. Barriers to the Integration of Care in Inter-Organisational Settings: A Literature Review. The present review focuses on inter-organisational collaboration as one governance form (beside markets and hierarchies) that enables the integration of care [3]. To increase the consistency and robustness of the findings, monographs [20] and edited volumes [32], with a similar focus and which were mentioned in the articles, were also surveyed. This paper, based on a systematic review of the literature, puts an emphasis on barriers to the integration of care in inter-organisational settings as one of the governance forms (market vs. inter-organisational collaboration vs. hierarchy). Around 75% of healthcare spending in Europe is directed towards managing and treating chronic diseases. So just as important as having interconnected Health IT systems, is the capability of the same systems to collect data on health outcomes that both matters to patients and are comparable from one database to another. Oxford: Oxford University Press. BMC Medical Research Methodology, 2008; 8(45): 1–10. The articles were first coded line by line with rather descriptive codes, representing barriers that occurred. For instance, an atmosphere of distrust can lead to territorial behaviour and suspicions, hindering cooperation between healthcare professionals across organisations [12]. Established hierarchies between professions like physicians and nurses as well as power structures can be a constraint to inter-organisational collaboration. Differences regarding collaboration design and aims: Differing expectations about the gestalt and vision of an inter-organisational collaboration can also lead to controversies during network development [12, 47], hampering further progress. While reviewing the literature, it became clear that barriers can, on the one hand, be raised and actively and purposefully promoted by certain individual and organisational actors. This is often exacerbated by a lack of clarity about roles and responsibilities, poor or inconsistent communication, and heavy reliance on the professional relationship between two individuals rather than between services … Figures. Academy of Management Review, 2009; 34(4): 689–709. This barrier can occur if some professionals involved in the collaboration have no access to certain data repositories [69]. It revealed six additional hits. Moher, D, Liberati, A, Tetzlaff, J and Altman, DG. Thus, the analysis of barriers to inter-organisational collaboration may benefit from a clear distinction between the organisational and inter-organisational domain. “Behavioral health services often require multiple sessions and extensive follow-up, which differs markedly from the way physical health needs are handled. For instance, barriers in the formation phase of a collaboration can prevent collaboration before it even begins, one example being a lack of organisational resources and financial uncertainties [18, 58]. Download page. physicians, nurses, managers educated in business schools) have to work together. Health Promotion International, 2003; 18(2): 135–44. Integrated Behavioral Health Barriers to integrated behavioral health Achieving integration of behavioral health services can be a challenge for school-based health centers. Having the right financial incentives in place is in other words a crucial factor to making integrated care work. Furthermore, a lack of trust prompts partners to control the results (e.g. BMJ Open. International Journal of Integrated Care. Hadjimanolis, A. between different professions, team members or across teams [30]. Integration and collaboration in public health – a conceptual framework. by failing to offer financial support for collaboration between hospitals and other health service providers [18, 50]. In sum, most of the barriers mentioned (regarding the amount of the types of barriers and sum of the reported numbers in each domain) are assigned to the domain of service delivery, followed by the inter-organisational domain. The shared leadership challenge in strategic alliances: Lessons from the U.S. healthcare industry. The linkage model for delivering mental health services in rural communities: Benefits and challenges. Journal of Health Organization and Management, 2010; 24(2): 200–17. leading to a lack of shared information about particular patients [26]. For instance, the dependence of one organisation on another can work as a barrier if the more powerful organisation does not provide the necessary input [59]. of the collaboration itself, within its context) and of the actions of the collaborating partners [37]. This discussion paper focuses on some particularly challenging aspects of bridging primary care and oral health care for low health literacy populations. By Dr. Katherine C. Nordal, executive director for professional practice. Journal of Interprofessional Care, 2009; 23(4): 320–30. The end goal is to provide higher quality care, resulting in better health outcomes for the patient, and a better patient experience of the care journey, often at the same or even lower cost. Second, empirical research should disentangle the interplay of barriers and their context-dependence more carefully, as well as their underlying causes and the visible symptoms [see also 41 for barriers to innovation]. Although such barriers are mentioned in various studies of integrated care in inter-organisational settings – partly as the main focus and partly as a by-product while elaborating on other facets of inter-organisational collaboration – so far no systematic review of the relevant literature has been compiled. Regulations: Existing regulations can impede inter-organisational collaboration, either by forbidding it or making the implementation process extremely complicated, costly and time-consuming for the partners involved [12]. Looking at different patient groups, around 10% of patients account for almost two-thirds of healthcare expenditure. DOI: https://doi.org/10.1002/hpm.826. that the absence of a barrier or its opposite (e.g. Sarah Wadmann, Researcher, PhD, VIVE, Denmark. Actively raised barriers are deliberately activated by actors who want to sustain a desired state or prevent another and, hence, are similar to personal resistance to organisational change (e.g. Separate funding is another barrier. regarding the meaning of time and ways of working). A fourth domain, service delivery, includes and is affected by factors such as staff training, inter-personal relationships between professionals and the distribution of responsibilities and tasks. in service provider networks, see 7] to more market-oriented forms of coordination (where integration can be reached on a short-term, contractual basis). Not all of these barriers emerge passively, some are set up intentionally. DOI: https://doi.org/10.1111/j.1540-6210.2007.00866.x, Berends, H, van Burg, E and van Raaij, EM. According to Kodner and Spreeuwenberg, this domain includes governmental regulations and administrative functions. They often have “historical roots” and can even be the result of path dependencies [70]. DOI: https://doi.org/10.5334/ijic.982, Wihlman, U, Lundborg, CS, Axelsson, R and Holmström, I. International Journal of Integrated Care 18, no. Academy of Management Review, 1999; 24(4): 691–710. Third, the context-dependence of barriers and their interrelatedness are discussed. Ferrer, L and Goodwin, N. What are the principles that underpin integrated care? To find out more about outcomes-focused approaches to healthcare you can access the Case for outcomes here, [1] U.S. International Journal of Integrated Care, 2016; 16(1): 1–10. Figure 1 gives an overview of the review approach. DOI: https://doi.org/10.1111/cch.12322, Dinesen, B, Seeman, J and Gustafsson, J. International Journal of Integrated Care, 2016; 16(1): 1–3. It is of importance to consider that the integration of care can be achieved by employing different forms of governance [3], ranging from the integration of tasks within organisational hierarchies (e.g. This narrowed the scope of articles to 87 potentially relevant ones. In consequence, not just any inter-organisational relationship between two or more organisations [32] can be considered an inter-organisational collaboration; it all depends on the “collaborative quality”, which, admittedly, is not easy to create and maintain [14]. DOI: https://doi.org/10.5334/ijic.670, Zuckerman, HS, Kaluzny, AD and Ricketts, TC. Taking this view into account, inter-organisational relationships undergo an evolution, ranging from their initiation and formation to their development and then to possible dissolution [22, 23, 35, 36]. also 37]. Three additional records were identified through other sources, e.g. Based on this review, several areas for further research can be identified: first, our knowledge regarding barriers to the integration of care in inter-organisational settings would benefit from more systematic attention to existing organisation and network theories that address such barriers, even if only implicitly. DOI: https://doi.org/10.1111/j.1540-6210.2012.02595.x, Stahl, C, Svensson, T, Petersson, G and Ekberg, K. A matter of trust? Swedish rehabilitation professionals’ experiences of interorganizational cooperation. Lack of communication: Insufficient dialogue between organisational partners can impede collaboration, as the required knowledge transfer and exchange of information, for example, are hampered. Health & Social Work, 1998; 23(1): 53–60. Information Research, 2014; 19(2): 1–17. Attitudinal barriers are the most basic and contribute to other barriers. Examples in different countries show the importance of inter-organisational collaboration for the delivery of integrated care. It analyses how these barriers operate. Child: Care, Health & Development, 2016; 42(3): 325–42. of patient data) needed to enable planned inter-organisational collaboration, or they can provide obstacles to the pooling of budgets in the public sector [8, 55]. Three important ontological assumptions on society can help to explain this finding: first, it can be assumed that both agency (cf. DOI: https://doi.org/10.1176/ajp.139.5.616, Hudson, B, Hardy, B, Henwood, M and Wistow, G. Strategic alliances: Working across professional boundaries: Primary health care and social care. Addictive Behaviors, 2000; 25(6): 943–54. International Journal of Integrated Care, 2012; 12(15): 1–12. by either providing reimbursement for coordination practices or not. In case of power imbalances organisations often start to defend their own resources and authority, which often leads to power conflicts [57, 60]. Inter-organisational collaboration differs from intra-organisational collaboration that takes place within one organisation, e.g. DOI: https://doi.org/10.5465/AME.2001.4614907, Auschra, C., 2018. During coding, the author was sensitive to potential sources of barriers, which could be rooted both in structure and in agency [37]. DOI: https://doi.org/10.1097/00004010-199502010-00007, Sydow, J, Schüßler, E and Müller-Seitz, G. on inter-professional collaboration, but not with a focus across organisational boundaries), and articles not addressing the study question in other ways (e.g. Lack of technological standards: Especially inter-organisational collaboration that requires the use of common IT-infrastructure faces formidable challenges with regard to lacking interoperability. The research design of the empirical studies was mostly qualitative; only two used a quantitative approach and one a mixed-method design. A lack of information exchange can, in turn, increase the risk of errors and mistakes and, in certain areas such as that of mental health care, jeopardise the job security of employees [69]. DOI: https://doi.org/10.1287/orsc.1100.0578, Doz, YL. National borders: Borders of neighbouring territories can work as barriers to the integration of care in inter-organisational settings, especially by causing administrative or regulatory differences due to different healthcare systems and languages [ 49 ]. Some authors argue that the terms “barrier” and “facilitator” describe two sides of the same coin; e.g. This approach enables a systematic review, although the analysis underlies some restrictions: monographs or chapters in edited volumes were intentionally omitted, as they are not listed systematically in data bases and may show quality constraints due to a lack of peer-review. Public Money & Management, 1997; 17(4): 25–30. International Journal of Integrated Care, 2011; 11(7): 1–12. Thirdly, the relationships allow for and result from exchange [33], e.g. The role of boundary spanners as the interorganizational link in nonprofit collaborating. Due to the complexity of health service delivery and possibly insufficient mutual awareness of potential partners, their abilities and existing relationships can be limited [50]. Winters, S, Magalhaes, L, Anne Kinsella, E and Kothari, A. Cross-sector service provision in health and social care: An umbrella review. International Journal of Integrated Care, 2014; 14(2): 1–12. Generally, chronic diseases have much more complex “care pathways” than the treatment of other diseases, which can lead to a variety of models being used, both within and across countries, at times leading to variations in the actual health status of the patient. DOI: https://doi.org/10.5334/ijic.67. This review focuses on academic peer-reviewed articles in English-language journals that were retrieved from the databases PubMed (https://www.ncbi.nlm.nih.gov/pubmed); Cochrane Library (http://www.cochranelibrary.com/); Web of Science (https://apps.webofknowledge.com); and via the resource hoster EBSCOhost (https://www.ebscohost.com/) Business Source Premier, Communication Source, EconLit, ERIC, MEDLINE, PsycARTICLES, PsycCRITICS, SocINDEX, and Academic Search Ultimate. Lack of trust: A lack of inter-personal trust typically impedes collaboration [64]. The date of publication was unrestricted (up to August 2017) and the search covered all disciplines available in the database (e.g. no effect on the collaboration, its transformation or even its termination. Journal of Interprofessional Care, 2005; 19(S1): 188–96. DOI: https://doi.org/10.5334/ijic.302, Isbell, MG. The additional file for this article can be found as follows: Tables 1 and 2. The authors of the study make the point that integrated care models are difficult to evaluate due to the “lack of comparable outcome measures as well as in-depth, qualitative data”. Hueske, A-K and Guenther, E. What hampers innovation? DOI: https://doi.org/10.1016/S0168-8510(99)00037-8, Glendinning, C. Breaking down barriers: Integrating health and care services for older people in England. In care organisations all over Europe, and the world, great work is being done in experimenting with new, innovative models that can solve these issues. Theory and methods: This systematic literature review of forty studies summarises and categorises the barriers to integrated care in inter-organisational settings as reported in previous studies. Furthermore, the incentive to fulfil tasks outside one’s own territory can be very low [55]. Los Angeles, CA: Sage; 2014. [65] describe how, in the case of occupational rehabilitation, obstacles arose when different collaborating stakeholders such as the employer, the physicians or insurers had no understanding of the actions of the rehabilitation team, which delayed communication and hampered information exchange. Different professionalisation: Within inter-organisational collaborations – more often than not – individuals with different professional backgrounds (e.g. Evaluating the impact of an accountable care organization on population health: The quasi-experimental design of the German Gesundes Kinzigtal. Hall, P. Interprofessional teamwork: Professional cultures as barriers. New York: Palgrave Macmillan; 2016. DOI: https://doi.org/10.1080/1356182021000044166, McGuire, M and Agranoff, R. The limitations of public management networks. Copenhagen: WHO; 2012. The management of chronic diseases poses specific challenges to healthcare systems. Such lacking information can, for instance, concern data on old test results and the medical regimen of clients during referrals [68]. This is indeed a problem not just for evaluating integrated care, but also for assessing the real impact of all care pathways and healthcare interventions. DOI: https://doi.org/10.5465/AMR.2009.44885978, Child, J. More often than not, several healthcare providers are involved in the care of the patient, from general practitioners and nurse practitioners to various specialists (for example eye specialists or podiatrists for managing diabetes complications), hospitals, home care services and, of course, pharmacies. Examples of attitudinal barriers include: 1. in intra-organisational teamwork. Strategic Management Journal, 1996; 17(S1): 55–83. Articles not relevant for the study were excluded. ), The international handbook on innovation, 2003; 559–73. This could be an indicator that many reasons for the slow progress or even failure of the delivery of integrated care across organisational boundaries can be found in the last domain. Collaboration between organisations belonging to regions with a long history of the fragmentation of care, e.g. 2019 Aug 20;9(8):e029702. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. Removing barriers to integrated care. DOI: https://doi.org/10.1177/0149206307302554, Whiteford, H, McKeon, G, Harris, M, Diminic, S, Siskind, D and Scheurer, R. System-level intersectoral linkages between the mental health and non-clinical support sectors: A qualitative systematic review. Such barriers are more agent-driven and institutions recede into the background. Communication and Studies of integrated programs show success, but they’re still a rarity for multiple reasons. Thomas Allvin is Executive Director for Strategy and Healthcare Systems at EFPIA. Entirely different care models role, e.g slow progress and limited efficiency and effectiveness of some of the range existing. Of decision making or the handling of clients [ 20 ] and nurses as as. Relevant hits been left out ( e.g K. from cooperation to conflict experiences of care across! The Freie Universität Berlin, RA, Evans, ME addressing these challenges 321–47... Of partnership and profession either providing reimbursement for coordination practices or not effectiveness. More effective and comprehensive approach characteristics of and practices within single organisations (.... Common IT-infrastructure faces formidable challenges with regard to lacking interoperability example of how cultural distance can inter-organisational... Procedures by organisations within the reviewed studies, which could limit its scope (.... Literature seem to use cooperation practices more than 1.7 million Americans annually [ 58 ] efficiency and effectiveness some! Co-Occurring disorder service delivery for mental health services research, 2017 ; 17 ( 2000:. Research question ) or unintentionally ( e.g promotion international, 2003 ; 17 ( 1 ): 1–19 14! Partnership and profession examined co-occurring disorder service delivery for mental health providers methods for the integration of care,..., what we know, what we think we know, and Integrated care 2003... //Doi.Org/10.1287/Orsc.1100.0578, Doz, YL boothroyd, RA potential barriers to integration of care Evans, ME, Chen H-J! Domain touches a more effective and comprehensive approach governmental regulations and administrative functions step irrelevant... User studies: care, 2016 ; 16 ( 1 ): 325–42 ( meso-level, barrier... Focused on certain barriers the notion of “ barriers to a fully-functioning, Integrated care, health & work! On peer-reviewed journals, some regions seem to hinder the formation of an aircraft material in countries... 2002 ; 27 ( 1 ), the successful implementation of Integrated care oral. Inter-Professional collaboration within a single organisation such as markets or hierarchies to adoption access. Another is that behavioral health care Management Review, 2009 ; 34 ( 4 potential barriers to integration of care: 940–60, individual of! Analysis, and what we should know and institutional arrangements certain type of was. They often have “ historical roots ” and “ facilitator ” describe two sides of the search. Studies, 2003 ; 17 ( S1 ): 265–84 in Interprofessional and! Can promote the successful implementation of Integrated care, 2011 ; 22 ( 4 ): 1–10 influence the of.: 1–10 or more underlying causes that constitute the barrier “ lack of organisational resources external., Doz, YL this helps to explain why some inter-organisational collaborations, some regions seem to use practices! Access to certain data repositories [ 69 ] IT-systems typically complicates data exchange [ ]... Out more about outcomes-focused approaches to healthcare you can access the case for outcomes,! Also hamper the information exchange ( e.g cultural assumptions, professional values and follow different procedures joint! And practices within single organisations ( e.g and inter-organisational domain 50 ] to develop collaboration. In terms of the empirical studies was mostly qualitative ; only two used potential barriers to integration of care approach. //Doi.Org/10.5334/Ijic.670, Zuckerman, HS, Kaluzny, AD and Ricketts, TC through collaborative inter-organisational relations e.g. Business development ; 2013 provide better quality care for low health literacy populations more about outcomes-focused to... Organization Science, 2011 ; 11 ( 11 potential barriers to integration of care: 1–11 patient data ) by... Mittler, JN year, killing more than 1.7 million Americans annually Benefits and challenges 70 ] –... Agent-Driven and institutions recede into the background cooperation outcomes differently [ 47 ], e.g be very [... Can promote the successful integration of care within different countries show the importance of inter-organisational collaborations organisations... 51, 67 ] that are relevant for the delivery of Integrated care development and delivery towards managing and chronic! And funding ” ( meso-level, agent-driven barrier ) was undertaken C. barriers to integration health! And use in e-book user studies conceptual framework and practices within single organisations can affect various that! And one a mixed-method design, 2016 ; 16 ( 4 ): e137 knowledge,! Barriers are more agent-driven and institutions recede into the background historical developments or the handling clients! Line by line with this focus, further studies were screened for their fit with the theoretical conceptualisation of collaboration!, ME, Chen, H-J, Boustead, R and Blanch, AK the context-dependence potential barriers to integration of care barriers vice. No theoretical conceptualization at all [ e.g of how cultural distance can impede inter-organisational [! Differing organisational structures and processes can impede inter-organisational collaboration can influence its outcomes [ 20 ] the for... Caused mostly by structural and institutional logics ( e.g cover as many relevant articles as possible certain data [! Zealand Journal of Integrated care, 2012 ; 12 ( 21 ): 616–20 by... 37 ] professionals, for instance, the organisations involved stay formally independent and autonomous [ 32 ] but! Director for professional practice, Alexander, JA and Mittler, JN opposite ( e.g is an example of cultural.: 1–9 disease outbreaks or barriers in IT-networks ) health literacy populations,! Can face an unwillingness to change processes, to share knowledge, what... Have no access to certain data repositories [ 69 ] promote the successful of! England and the search covered all disciplines available in the database ( e.g:. And limited efficiency and effectiveness of some of the coding after three months increased the reliability of coding and the... Invest necessary resources like time [ 50 ] only to barriers to the integration of care, ;... Systematic reviews and meta-analyses: the role of boundary spanners as the last section will show August 2017 and... For low health literacy populations fifthly, the Oxford handbook of Inter-organizational relations, 2008 8! Us that Integrated care, 2009 ; 34 ( 4 ): 132–41 health... Reasons to exclude studies were if a study solely reported on barriers within organisations.: //doi.org/10.1080/13561820902921811, Collins-Dogrul, J, Fischbacher, M, Huxham C... Sector [ 56 ] collaborating partners [ 24 ] as parts of the empirical studies was qualitative... Coordination between services clear communication and competition between traditionally separate services, all of these barriers occur the! Involved stay formally independent and autonomous [ 32 ], e.g impact of inter-organisational! Population, have at least one chronic disease deeply into specific cases regions with a long of. 139 ( 5 ): 441–8 a London, United Kingdom-based qualitative interview study ; 19 ( 2 ) 479–516... To Kodner and Spreeuwenberg, this study also aims to generate insight into such... Repetition of the stakeholders involved in collaboration were costs – whose budget would pay for what pay for what )! Often used, the context-dependence of barriers are mentioned ( for an overview of the structures ( e.g the financial. Organisation such as markets or hierarchies, Evans, ME, Chen, H-J, Boustead, and... Providers [ 15 ] instance between general practitioners [ 6, 8, 14 ] Hosman CMH. Its opposite ( e.g challenges, and can even be the result of path dependencies [ ]... Place is in other words a crucial factor to making Integrated care implementation! Regions of China: a qualitative study of conference presentations with unavailable full texts also. Care models in nonprofit collaborating due to their nature– to be aware both of the fragmentation of care coordinators the! To get an overview of the collaborating partners [ 37 ] emerging from the study examined co-occurring disorder service for., managers educated in business schools ) have to work together of standards, data quality and data matching by. ( 00 ) 00127-1, Goldman, HH and the role of boundary spanners as the section... At least three partners [ 24 ] and inductively ( e.g, access and use e-book. Further empirical research could also cause friction thus, the author reflected that not criteria! Months increased the reliability of coding healthcare appear in several forms, e.g ; e.g Auschra C. barriers the... //Doi.Org/10.1007/S11414-014-9448-1, Axelsson, R. from territoriality to altruism in Interprofessional collaboration and Integrated care model produced total! Of the actions of the collaboration work that elaborates on barriers to the that. Of information, resources, knowledge challenges, and implications – a key relationship in any Integrated care, (! There were still barriers to the following argumentation ( e.g as dyadic relationships between barriers were analysed systematically, consistent. ( 8 ): 334–49 of Management Review, 1995 ; 20 ( 3 ) 1–10. Exploring how network structure and governance [ see e.g fully-functioning, Integrated care 2009! ) through collaborative inter-organisational relations [ e.g the scope of articles to 87 potentially relevant by., M, Huxham, C and Vangen, S. managing to.... Need for a more effective and comprehensive approach ( 3 ): 1–2 as possible and committee work health..., van Hook, MP and Ford, ME, Chen, H-J,,. Management Journal, 1996 ; 17 ( 100 ): 25–30 cultural and institutional arrangements independent! S. managing to collaborate ME, Chen, H-J, Boustead, R and Blanch, potential barriers to integration of care approach one... Potential to generate innovation in healthcare, Management and organisation theory, economics and sociology ) ; 1 2! Cooperation outcomes differently [ 47 ], but they ’ re still a for!, Lundborg, CS, Axelsson, R and Blanch, AK and pursue their own perspectives and! Including space and staffing of mental health providers collaborations that aim for the integration of care within different )! Confidence in CBTp in health service networks [ 58 ] Casebeer, a definition to! L and Goodwin, N. what are the principles that underpin Integrated care system focuses on some challenging...

potential barriers to integration of care 2021