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

Evans JM, Baker GR, Berta W, Barnsley J - BMC Health Serv Res (2014)

Bottom Line: 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.

View Article: PubMed Central - HTML - PubMed

Affiliation: Institute of Health Policy, Management & Evaluation, Faculty of Medicine, University of Toronto, Health Sciences Building, 155 College Street, Suite 425, Toronto, Ontario M5T3M6, Canada. jenna.evans@utoronto.ca.

ABSTRACT

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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Delphi results: Attributes of the mental models. Are the definition, description and contents of the Strategy/Relationships Mental Model clear, comprehensive, and useful? Average percent strongly agree (rating of 6 or 7 on a 7-point scale).
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Figure 1: Delphi results: Attributes of the mental models. Are the definition, description and contents of the Strategy/Relationships Mental Model clear, comprehensive, and useful? Average percent strongly agree (rating of 6 or 7 on a 7-point scale).

Mentions: In the first round of the Delphi process, a total of 90 individuals responded from nine provinces across Canada (52% response rate). As outlined in Table 1, respondents represented a wide range of roles and organizations in the healthcare system, and 96.7% had direct experience in integration activities. Over 250 comments were made in total. The responses to the questions are shown in Figures 1 and 2, comparing the results of both rounds of the study. Participants were asked to rate the importance of having shared knowledge/beliefs for each of the mental model contents only once – either in the first round for the original set of contents or in the second round for newly added contents. In both rounds, the average ratings for importance were high: 75% and 84% respectively (percent strongly agree, defined as a score of 6 or 7 on a 7-point scale); hence these results are not included in the Figures. The ratings for the clarity, comprehensiveness and usefulness of the terms and definitions were lower than those for importance with, on average, only half of respondents providing a high rating (defined as a score of 6 or 7 on a 7-point scale); the results were similar for respondent views of how useful the framework is for interpreting, planning, implementing, managing and evaluating integration initiatives.


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

Evans JM, Baker GR, Berta W, Barnsley J - BMC Health Serv Res (2014)

Delphi results: Attributes of the mental models. Are the definition, description and contents of the Strategy/Relationships Mental Model clear, comprehensive, and useful? Average percent strongly agree (rating of 6 or 7 on a 7-point scale).
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4066828&req=5

Figure 1: Delphi results: Attributes of the mental models. Are the definition, description and contents of the Strategy/Relationships Mental Model clear, comprehensive, and useful? Average percent strongly agree (rating of 6 or 7 on a 7-point scale).
Mentions: In the first round of the Delphi process, a total of 90 individuals responded from nine provinces across Canada (52% response rate). As outlined in Table 1, respondents represented a wide range of roles and organizations in the healthcare system, and 96.7% had direct experience in integration activities. Over 250 comments were made in total. The responses to the questions are shown in Figures 1 and 2, comparing the results of both rounds of the study. Participants were asked to rate the importance of having shared knowledge/beliefs for each of the mental model contents only once – either in the first round for the original set of contents or in the second round for newly added contents. In both rounds, the average ratings for importance were high: 75% and 84% respectively (percent strongly agree, defined as a score of 6 or 7 on a 7-point scale); hence these results are not included in the Figures. The ratings for the clarity, comprehensiveness and usefulness of the terms and definitions were lower than those for importance with, on average, only half of respondents providing a high rating (defined as a score of 6 or 7 on a 7-point scale); the results were similar for respondent views of how useful the framework is for interpreting, planning, implementing, managing and evaluating integration initiatives.

Bottom Line: 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.

View Article: PubMed Central - HTML - PubMed

Affiliation: Institute of Health Policy, Management & Evaluation, Faculty of Medicine, University of Toronto, Health Sciences Building, 155 College Street, Suite 425, Toronto, Ontario M5T3M6, Canada. jenna.evans@utoronto.ca.

ABSTRACT

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.

Show MeSH