Sunday, March 22, 2015

Healthcare Integration Self Assessment.

Those of us working in healthcare management and even those working to evolve and improve the system can all have days where we feel bogged down by the complexities, or what seems to simply be a lack of a good system. 

Its understandable!  Some people will even argue that modern healthcare systems in countries like Australia, New Zealand or the UK are not actually single coordinated systems, but a complex collection of inter-related services and products that can vary extremely in levels of integration.  In simple times it can appear to be a bit of an overwhelming mess!

When we have days like this and we're feeling a bit overwhelmed, it can be useful to have a reference point to turn to.  A simple set of reminders, that clarifies what we are striving to work towards and achieve.  With that in mind, the following systemic review, published by Karoline Nicholson and colleagues from the Western University in London, provides just that.  Published in December 2013, it still holds relevance today.  The systemic review is written in article format and offers 'A Governance model for Integrated Primary/Secondary Care for the Health-Reforming First World'.

They explain clearly that their aim is to synthesise the existing published literature on elements of current integrated primary/seconday health care.  Their focus was clearly on studies that evaluated the structure and governance models of services rather than those that evaluated the success of the actual intervention.

In summary, they identified ten elements that are relevant for integrated primary/secondary health care governance across a regional setting. 
  1. Joint planning
  2. integrated infomration communication technology
  3. change management
  4. shared clinical priorities
  5. incentives
  6. population focus
  7. measurement - using data as a quality improvement tool
  8. continuing professional development supporting joint working
  9. patient/community engagement; and,
  10. innovation
They found that 'all examples of successful primary/secondary care integration reported in the literature have focused on a combination of some, if not all, of the ten elements.'  They highlighted that ' whilst no one model fits all systems, these elements provide a focus for setting up integration initiatives which need to be flexible for adapting to local conditions and settings.'    

So if you are a health management professional and you are feeling stuck, or bogged down by the system, try something different.  Go and find a quiet place to review your program or your project against these ten elements.  You can make it as simple:
  1. assessing how well your project scores against each of the elements
  2. create an action plan to address one or more of the low scorers.
I am managing occupational health programs in my current role, and have even been able to apply this review process to my work as a 'check in'.  For access to the fully article visit


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