Skip to main content

Table 2 Integrated care dimensions and determinants of the Rainbow Model of Integrated care

From: Typology of birth centres in the Netherlands using the Rainbow model of integrated care: results of the Dutch Birth Centre Study

Level Dimension Description dimension Determinant Description determinant
Micro Clinical integration The coordination of person-focused care in a single process across time, place and discipline. Case management Coordination of care for clients’ with a high-risk profile (e.g. identifying risks, developing policies and guidance).
Continuity The organization of care is aimed to provide fluid care delivery for an individual client.
Individual multidisciplinary care plan Implementation of a multidisciplinary care plan at the individual client level.
Client participation Clients are (pro) actively involved in the design, organization and provision of care at the operational level.
Meso Professional integration Inter-professional partnerships based on shared competences, roles, responsibilities and accountability to deliver a comprehensive continuum of care to a defined population. Inter-professional education Inter-professional education for professionals focused on interdisciplinary collaboration.
Shared vision between professionals A shared vision between professionals focused on the content of care.
Multidisciplinary guidelines and protocols Multidisciplinary guidelines and protocols are implemented in coherence at the operational level.
Inter-professional governance Inter-professional governance focused on openness, integrity and accountability between professionals at the operational level (e.g. joint accountability, appeal on pursued policies and responsibilities).
Meso Organizational integration Inter-organizational relationships (e.g. contracting, strategic alliances, knowledge networks, mergers), including common governance mechanisms, to deliver omprehensive services to a defined population. Interest management A climate that attempts to bridge the various interests (e.g. social, organizational and personal interests) at the operational, tactical and strategic level.
Performance management Collective elaborated performance management between organizations within the collaboration.
Learning organisations Collective learning power between the organizations within the collaboration (e.g. joint research and development programs).
Complaints procedure
Macro System integration A horizontal and vertical integrated system, based on a coherent set of (informal and formal) rules and policies between care providers and external stakeholders for the benefit of people and populations. Available resources Available resources in the environment of the collaboration (e.g. usable buildings, (over) capacity, professionals and funding streams).
Stakeholder management Engagement of various stakeholders (e.g. municipality, patient organizations and health insurance company).
Good governance Creating trust towards external stakeholders (e.g. municipality and health insurance company) due to working method, reputation, management, control and/or supervision.
Environmental climate Political, economic and social climate in the environment of the collaboration (e.g. market characteristics, regulatory framework, competition).
Micro, meso, macro Functional integration Key support functions and activities (i.e. financial, management and information systems) structured around the primary process of service delivery, to coordinate and support accountability and decision making between organizations and professionals to add overall value to the system. Information management Aligned information management systems accessible at operational, tactical and strategic level (e.g. monitoring and benchmarking systems).
Resource management Coherent use of resources (e.g. collective real estate and funding).
Service management Aligned service management for the client (e.g. collective telephone number, counter assistance and 24-h access)
Regular feedback of performance indicators Regular feedback of performance indicators for professionals at the operational level to enable them to improve their performance.
Micro, meso, macro Normative integration The development and maintenance of a common frame of reference (i.e. shared mission, vision, values and culture) between organizations, professional groups and individuals. Reliable behaviour The extent to which the agreements and promises within the collaboration are fulfilled at operational, tactical and strategic levels.
Visionary leadership Leadership based on a personal vision that inspires and mobilizes people.
Quality features of the informal collaboration Effectiveness and efficiency of the informal collaboration at the operational, tactical and strategic levels (e.g. group dynamics and attention to the undercurrent).
Trust The extent to which those involved in the collaboration at operational, tactical and strategic levels trusts each other.
  1. Adapted with permission from: “Towards a taxonomy for integrated care; a mixed-methods study” (Valentijn 2015)