A general lack of funding for collaboration, i.e. Ring, PS and Van de Ven, AH. International Journal of Integrated Care, vol. Third, the context-dependence of barriers and their interrelatedness are discussed. For example, some people may not be aware that difficulties in getting to or into a place can limit a person with a disability from participating in everyday life and common daily activities. Passively emerging barriers like historical developments or the existence of national borders, in contrast, are caused mostly by structural and institutional arrangements. This definition gives a reference point to two important concepts to which this paper refers: inter-organisational collaboration and domains relevant for the practice and the scientific analysis of integrated care. more actively raised barriers) and structure (more passively induced barriers) are recursively related to each other, mutually (re-) producing and transforming each other [37]. 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. DOI: https://doi.org/10.1186/s12884-017-1381-x. A repetition of the coding after three months increased the reliability of coding. due to the research question) or unintentionally (e.g. This leaves room for further conceptual work, as the last section will show. The management of chronic diseases poses specific challenges to healthcare systems. The existence of different IT-systems typically complicates data exchange [10] and can act as a barrier to inter-organisational collaboration. In a final step of the search strategy, a PubMed-search was conducted with MeSH terms covering the integration of care (intersectoral collaboration; cooperative behaviour; public-private sector partnerships; community networks; delivery of health care, integrated) which replaced other synonyms for integrated care. Fifth, empirical research should analyse how the existence of barriers to inter-organisational collaborations affects the outcome of integrated care, as barriers do not necessarily prevent or terminate collaboration, but merely slow down collaborative processes [20]. no effect on the collaboration, its transformation or even its termination. [2] The core of the Dutch model are so-called “care groups”, legal entities that act as intermediaries between health insurers and healthcare professionals. For instance, in the U.S., community-based health and human services are often delivered by networks of independent providers [15]. DOI: https://doi.org/10.5334/ijic.302, Isbell, MG. International Journal of Integrated Care, 2011; 11(11): e137. DOI: https://doi.org/10.1287/orsc.1100.0578, Doz, YL. Organization Science, 2011; 22(4): 940–60. Contacts and contracts: Cross-level network dynamics in the development of an aircraft material. 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. We are usually good at measuring if the right process has been implemented – how many healthcare professionals follow clinical guidelines, for example – but not as good when it comes to measuring what actually matters in the end: the health of the patient. e.g. For instance, the failure to include a local hospital in a network of integrated care can cause difficulties. A very broad definition in organisation theory describes inter-organisational collaboration in the middle of a continuum delimited by market and hierarchy as “a cooperative, inter-organisational relationship that is negotiated in an ongoing communicative process, and which relies on neither market nor hierarchical mechanisms of control” [31, p. 323]. The barriers identified in this literature review can be grouped into six main categories that stretch across different domains (see Figure 2). Barriers of inter-organisational integration in vocational rehabilitation. DOI: https://doi.org/10.5334/ijic.1437. In: Shavinina, LV (ed. Barriers to Integrated Care and How to Overcome Them. “Behavioral health services often require multiple sessions and extensive follow-up, which differs markedly from the way physical health needs are handled. DOI: https://doi.org/10.5334/ijic.843, Pate, J, Fischbacher, M and Mackinnon, J. More often than not, the integration of care faces barriers [8–11] caused by contextual, institutional and professional factors in different domains of integrated care [1]. Sociology, 1972; 6(1): 1–22. Despite linguistic differences, the terms barrier, impediment, hurdle or obstacle are often used interchangeably [39]. Second, and building on the first assumption, structures and actions – and thereby barriers – on different levels of analysis (ranging from macro to micro) influence each other. Examples of attitudinal barriers include: 1. If these interests are conflicting, barriers impeding the inter-organisational collaboration emerge and conflicting agendas arise. of information, resources, activities and capabilities, and include social interaction [24]. International Journal of Integrated Care, 2012; 12(5): 1–11. DOI: https://doi.org/10.5334/ijic.511, Sydow, J, Schreyögg, G and Koch, J. Furthermore, in some cases, the surrounding context traditionally sets no incentive to inter-organisational collaboration – e.g. The purpose of this paper is to report on the findings of the first stage of a project seeking to evaluate and overcome inter-professional barriers between health and social care staff within a single, co-located, integrated community team. DOI: https://doi.org/10.1016/B978-008044198-6/50038-3, Sun, X, Tang, W, Ye, T, Zhang, Y, Bo, W and Zhang, L. Integrated care: A comprehensive bibliometric analysis and literature review. The fifth domain relevant for the integration of care is the clinical domain, involving, for instance, common professional languages, agreed understandings, practices and standards related to certain diseases, and ongoing communication with patients [1]. Moher, D, Liberati, A, Tetzlaff, J and Altman, DG. World Health Organization. Barriers to behavioral health integration included cultural differences and incomplete information flow between behavioral and nonbehavioral health clinicians on patients’ electronic health … “Barriers to the Integration of Care in Inter-organisational Settings: A Literature Review”. After the passage of Proposition 63—the Mental Health Services Act (MHSA)—in 2004, the California mental health system became an exemplar of the transformation envisioned by the New Freedom Commission. DOI: https://doi.org/10.1186/1471-2288-8-45. 1, 2018, p. 5. Legal requirements can also hamper the information exchange (e.g. Examples in different countries show the importance of inter-organisational collaboration for the delivery of integrated care. Los Angeles, CA: Sage; 2014. Barriers to the Integration of Care in Inter-Organisational Settings: A Literature Review. Missing actors: The lack of important actors can be a barrier to successful collaboration in a certain nexus of health service delivery [12]. If they have gathered experiences from former collaborations, organisations assess cooperation outcomes differently [47]. When organisations start to protect their interests very strongly within an inter-organisational collaboration, this can lead to the situation that nobody will take on responsibility for common issues [18]. It was believed that one important factor behind this was that the specialists were not reimbursed on a fee-for-service model, and therefore didn’t resist when the care of patients started to shift from specialist care to primary care. International Journal of Integrated Care, 2009; 9(3): 5–22. DOI: https://doi.org/10.1007/978-1-137-37003-7, Provan, KG, Milward, HB and Isett, KR. Flow chart of the identification and selection process. These criteria help to get an overview of the applied research methods, and theoretical and contextual embedding of the reviewed studies. One such example is the implementation of integrated care for Type 2 Diabetes in the Netherlands, a model that was recently subject to a case study under the EU-funded Project INTEGRATE. 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. Health Policy, 1999; 48(2): 87–105. Journal of Occupational Rehabilitation, 2011; 21(3): 441–8. One hundred thirty-three million Americans, 45 percent of the population, have at least one chronic disease. good vs. poor management) can facilitate an implementation process [10, 12]. The general practice perspective on barriers to integration between primary and social care: a London, United Kingdom-based qualitative interview study. This first search produced a total of 914 potentially relevant hits. Obviously, inter-organisational collaboration can include or overlap with inter-professional and intra-organisational collaboration, especially in the context of integrated care. One such example is the implementation of integrated care for Type 2 Diabetes in the Netherlands, a model that was recently subject to a case study under the EU-funded Project INTEGRATE. 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. It is important to note that, in contrast to the rather static definition of inter-organisational collaboration as a governance form between market and hierarchy, each inter-organisational collaboration underlies a dynamic, context-dependent, and history-laden process. Additionally, such regulations can also include historically grown institutions not set up by the government, but established by habit and/or through other actors [38]. doi: 10.1136/bmjopen-2019-029702. DOI: https://doi.org/10.5334/ijic.234, Andersson, J, Bengt, A, Axelsson, SB, Eriksson, A and Axelsson, R. Organizational approaches to collaboration in vocational rehabilitation – An international literature review. 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. The variety of such collaborations in healthcare includes, among others, healthcare alliances [28], urban healthcare-delivery networks [15], digital health platforms that rely on interorganisational collaboration [29], and regional networks of service providers that negotiate population-based care contracts [16]. Background: Care coordinators are increasingly featured in patient-centered medical home (PCMH) projects, yet little research examines how coordinators themselves define and experience their role. Fourth, probably more barriers exist than those captured by the papers reviewed here. 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. Journal of Occupational Rehabilitation, 2005; 15(4): 581–90. of the collaboration itself, within its context) and of the actions of the collaborating partners [37]. Fleury, M-J, Perreault, M, Grenier, G, Imboua, A and Brochu, S. Implementing key strategies for successful network integration in the Quebec substance-use disorders programme. Barriers. 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. 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]. Academy of Management Executive, 2001; 15(2): 71–9. The author has no competing interests to declare. Thus, the analysis of barriers to inter-organisational collaboration may benefit from a clear distinction between the organisational and inter-organisational domain. International Journal of Integrated Care, 2010; 10(3): 1–9. 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 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. 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. Power imbalances can also slow down planning and committee work in health service networks [58]. A study of coordination of Swedish stakeholders in return-to-work. 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). Amsterdam: Elsevier. Furthermore, different professions underlie divergent cultural assumptions, professional values and follow different procedures. This is also the domain where the management of a collaboration can influence its outcomes [20]. Objectives: The goal of this study was to assess pediatric oncology providers' perceptions of palliative care in order to validate previously identified barriers and facilitators to early integration of a pediatric palliative care team (PCT) in the care of children with cancer. Results: Within these studies, twenty types of barriers have been identified and then categorised in six groups (barriers related to administration and regulation, barriers related to funding, barriers related to the inter-organisational domain, barriers related to the organisational domain, barriers related to service delivery, and barriers related to clinical practices). 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