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Table 4 Elements of the integrated governance models identified in published papers (n = 21)

From: A governance model for integrated primary/secondary care for the health-reforming first world – results of a systematic review

Element

Interventions shown to be effective

n = *[references]

1. Joint planning

Joint strategic needs assessment agreed; formalising relationships between stakeholders; joint boards; promotion of a community focus and organisational autonomy; guide for collective decision making; multi-level partnerships; focus on continuum of care with input from providers and users.

18

[13, 16–18, 25, 26, 28–37, 39, 40]

2. Integrated information communication technology

Systems designed to support shared clinical exchange i.e. Shared Electronic Health Record; a tool for systems integration linking clinical processes, outcomes and financial measures.

17

[13, 16, 17, 24, 25, 27–30, 32–37, 39, 40]

3. Change management

Managed locally; committed resources; strategies to manage change and align organisational cultural values; executive and clinical leadership; vision; commitment at meso and micro levels.

17

[13, 16–18, 24, 25, 28–30, 32–36, 38–40]

4. Shared clinical priorities

Agreed target areas for redesign; role of multi-disciplinary clinical networks/clinical panels; pathways across the continuum.

16

[13, 16–18, 24, 25, 27, 29, 30, 32–36, 39, 40]

5. Incentives

Incentives are provided to strengthen care co-ordination e.g. pooling multiple funding streams and incentive structures, such as equitable funding distribution; incentives for innovative and development of alternative models.

15

[13, 16, 17, 24, 26, 28–30, 32, 35–40]

6. Population focus

Geographical population health focus.

13

[13, 16, 24–26, 29, 30, 34–36, 38–40]

7. Measurement – using data as quality improvement tool

Shared population clinical data to use for planning, measurement of utilisation focusing on quality improvement and redesign; collaborative approach to measuring performance provides transparency across organisational boundaries.

12

[13, 17, 18, 24, 28, 29, 33–36, 38, 39]

8. Continuing professional development supporting the value of joint working

Inter-professional and inter-organisational learning opportunities provide training to support new way and align cultures; clearly identifying roles and responsibilities and guidelines across the continuum.

11

[13, 18, 24, 25, 29, 32–34, 37, 39, 40]

9. Patient/community engagement

Involve patient and community participation by use of patient narratives of experience and wider community engagement.

8

[13, 18, 25, 29, 35, 36, 39, 40]

10. Innovation

Resources are available and innovative models of care are supported.

7

[13, 18, 29, 33, 34, 36, 40]

  1. *Number of studies reporting the specified element.
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BMC Health Services Research

ISSN: 1472-6963

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