The Joint Future Initiative in Scotland: The Development and Early                 Implementation Experience of an Integrated Care Policy

PurposeIn Canada, integrated care pilot projects are often implemented as a local reform strategy to improve the quality of patient care and system efficiencies. In the qualitative study reported here, the authors explored the experiences of healthcare professionals when first implementing integrated care pilot projects, bringing together physical and mental health services, in a community hospital setting.Design/methodology/approachEngaging a qualitative descriptive study design, semi-structured interviews were conducted with 24 healthcare professionals who discussed their experiences with implementing three integrated care pilot projects one year following project launch. The thematic analysis captured early implementation issues and was informed by an institutional logics framework.FindingsThree themes highlight disruptions to established logics reported by healthcare professionals during the early implementation phase: (1) integrated care practices increased workload and impacted clinical workflows; (2) integrating mental and physical health services altered patient and healthcare provider relationships; and (3) the introduction of integrated care practices disrupted healthcare team relations.Originality/valueStudy findings highlight the importance of considering existing logics in healthcare settings when planning integrated care initiatives. While integrated care pilot projects can contribute to organizational, team and individual practice changes, the priorities of healthcare stakeholders, relational work required and limited project resources can create significant implementation barriers.

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Managing care integration during the implementation of large-scale reforms

Journal of Integrated Care ◽

10.1108/jica-07-2016-0026 ◽

2017 ◽

Vol 25 (1) ◽

pp. 6-16 ◽

Cited By ~ 10

Author(s):

Helen Dickinson ◽

Gemma Carey

Keyword(s):

Large Scale ◽

Structured Interviews ◽

Content Type ◽

Care Integration ◽

Early Implementation ◽

Commonwealth Government ◽

Boundary Issues ◽

And Control ◽

Institutional Boundaries ◽

Implementation Experience

Purpose The National Disability Insurance Scheme (NDIS) is a new program for the provision of support to people with disabilities in Australia. The purpose of this paper is to explore the early implementation experience of this scheme, with a particular focus on the implications of this scheme for issues of care integration. Design/methodology/approach Semi-structured interviews were conducted with 26 policymakers in the Commonwealth government charged with the design and implementation of the NDIS. Findings The authors find somewhat of a lack of clarity concerning the boundaries of the NDIS and how it will work with a range of different services in the provision of seamless and consumer-directed care. Many of the same kinds of debates about interfaces with services were detected in this study as have been highlighted in relation to UK individual funding schemes. If the NDIS is truly to support individuals with disabilities to achieve choice and control, important work will need to be undertaken in to overcome organizational and institutional boundaries. Originality/value There is little empirical data relating to the implementation of the NDIS to date. This is the first study to explore boundary issues in relation to care integration.

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