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Health systems integration: competing or shared mental models?

International Journal of Integrated Care

Igitur publishing

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      Shared mental models of integrated care aligning multiple stakeholder perspectives

      Purpose Health service organizations and professionals are under increasing pressure to work together to deliver integrated patient care. A common understanding of integration strategies may facilitate the delivery of integrated care across interorganizational and interprofessional boundaries. This paper aims to build a framework for exploring and potentially aligning multiple stakeholder perspectives of systems integration. Designmethodologyapproach The authors draw from the literature on shared mental models, strategic management and change, framing, stakeholder management, and systems theory to develop a new construct, Mental Models of Integrated Care MMIC, which consists of three types of mental models, i.e. integrationtask, systemrole, and integrationbelief. Findings The MMIC construct encompasses many of the known barriers and enablers to integrating care while also providing a comprehensive, theorybased framework of psychological factors that may influence interorganizational and interprofessional relations. While the existing literature on integration focuses on optimizing structures and processes, the MMIC construct emphasizes the convergence and divergence of stakeholders' knowledge and beliefs, and how these underlying cognitions influence interactions or lack thereof across the continuum of care. Practical implications MMIC may help to explain what differentiates effective from ineffective integration initiatives determine system readiness to integrate diagnose integration problems and develop interventions for enhancing integrative processes and ultimately the delivery of integrated care. Originalityvalue Global interest and ongoing challenges in integrating care underline the need for research on the mental models that characterize the behaviors of actors within health systems the proposed framework offers a starting point for applying a cognitive perspective to health systems integration.
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        Shared mental models in expert team decision-making

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          A cognitive perspective on health systems integration: results of a Canadian Delphi study

          Background Ongoing challenges to healthcare integration point toward the need to move beyond structural and process issues. While we know what needs to be done to achieve integrated care, there is little that informs us as to how. We need to understand how diverse organizations and professionals develop shared knowledge and beliefs – that is, we need to generate knowledge about normative integration. We present a cognitive perspective on integration, based on shared mental model theory, that may enhance our understanding and ability to measure and influence normative integration. The aim of this paper is to validate and improve the Mental Models of Integrated Care (MMIC) Framework, which outlines important knowledge and beliefs whose convergence or divergence across stakeholder groups may influence inter-professional and inter-organizational relations. Methods We used a two-stage web-based modified Delphi process to test the MMIC Framework against expert opinion using a random sample of participants from Canada’s National Symposium on Integrated Care. Respondents were asked to rate the framework’s clarity, comprehensiveness, usefulness, and importance using seven-point ordinal scales. Spaces for open comments were provided. Descriptive statistics were used to describe the structured responses, while open comments were coded and categorized using thematic analysis. The Kruskall-Wallis test was used to examine cross-group agreement by level of integration experience, current workplace, and current role. Results In the first round, 90 individuals responded (52% response rate), representing a wide range of professional roles and organization types from across the continuum of care. In the second round, 68 individuals responded (75.6% response rate). The quantitative and qualitative feedback from experts was used to revise the framework. The re-named “Integration Mindsets Framework” consists of a Strategy Mental Model and a Relationships Mental Model, comprising a total of nineteen content areas. Conclusions The Integration Mindsets Framework draws the attention of researchers and practitioners to how various stakeholders think about and conceptualize integration. A cognitive approach to understanding and measuring normative integration complements dominant cultural approaches and allows for more fine-grained analyses. The framework can be used by managers and leaders to facilitate the interpretation, planning, implementation, management and evaluation of integration initiatives.
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            Author and article information

            Affiliations
            2013. Institute of Health Policy, Management & Evaluation, University of Toronto, Canada
            Author notes
            Jenna M. Evans, Institute of Health Policy, Management & Evaluation, University of Toronto, Canada, E-mail: jenna.evans@ 123456utoronto.ca
            Contributors
            2013. Institute of Health Policy, Management & Evaluation, University of Toronto, Canada
            Journal
            Int J Integr Care
            Int J Integr Care
            ijic
            International Journal of Integrated Care
            Igitur publishing (Utrecht, The Netherlands )
            1568-4156
            Oct-Dec 2014
            9 October 2014
            : 14
            4203114 IJIC-14-2014028
            Copyright 2014, Authors retain the copyright of their article

            This work is licensed under a ( http://creativecommons.org/licenses/by/3.0) Creative Commons Attribution 3.0 Unported License

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            Int J Integr Care 2014; Oct–Dec; URN:NBN:NL:UI:10-1-114795

            Health & Social care

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