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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, 1618, 25, 26, 2837, 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, 2730, 3237, 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, 1618, 24, 25, 2830, 3236, 3840]
4. Shared clinical priorities Agreed target areas for redesign; role of multi-disciplinary clinical networks/clinical panels; pathways across the continuum. 16
[13, 1618, 24, 25, 27, 29, 30, 3236, 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, 2830, 32, 3540]
6. Population focus Geographical population health focus. 13
[13, 16, 2426, 29, 30, 3436, 3840]
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, 3336, 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, 3234, 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.