Index
How to Deliver Integrated Care
ISBN: 978-1-83867-530-1, eISBN: 978-1-83867-527-1
Publication date: 11 January 2021
This content is currently only available as a PDF
Citation
(2021), "Index", Kaehne, A. and Nies, H. (Ed.) How to Deliver Integrated Care (European Health Management in Transition), Emerald Publishing Limited, Leeds, pp. 183-192. https://doi.org/10.1108/978-1-83867-527-120211017
Publisher
:Emerald Publishing Limited
Copyright © 2021 Axel Kaehne and Henk Nies. Published under exclusive licence by Emerald Publishing Limited.
INDEX
Accountability, 101–102
Activation, 47
Activity-based payments, 24–26
Actors, 82–83, 90
Adaptation, 3
Adaptive approaches to leadership, 53–54
Additional payment, 19–20
Adoption, 116–117, 120
Ageing Well in Digital World AAL programme, 119
Agency, 141
Alternative funding, 23, 26, 29, 31
Alternative payment, 19–20
Asset-based approaches, 4
Base funding, 20, 23–25
Base models, 29–30
Base payment, 19–20
Behaviour, 44
prosocial, 83–84
Beta test, 121–122
Better Evaluation collaboration, 176
Boundaries, 78
Brainstorming, 63–64, 68
Brainwriting, 86
Budgets, 19
capitated budgets, 25
pooled budgets, 28
Bundled payments. See Episode-based payments
Capitated budgets, 25
Care
community care, 13
hospital care, 31, 168
nursing care, 26
primary care, 25, 65
social care, 15, 18–19
Care integration, 4, 13, 75
practice example, 76, 80–81, 84, 87, 89
social dimension, 76
Care organizations, 79
Case management, 95–96
Case rates, 24–25
Centres of Excellence, 30
Change, 71
non-linear change, 139
organisational change, 138
Change programmes in health care organizations, 139
Clinical nature of change, 144
Co-design models, 120
Co-ordination, 99
Co-production, 99
Collaboration, 3, 45, 100, 105
Collaborative values session, 107–109
Combined commissioning, 31
Commissioner or payer model, 18–19, 30, 33–34
Commissioning, 15
Communication, 150–151
Competence framework, 78
Competencies, 40, 42–43
Competitors, 82
Complex adaptive systems, 177
Complex intervention, 161, 163
Complexity, 177
emergence, 69
feedback loop, 152
Comprehensiveness, 100
Conditional cash transfers, 20–23
Context, 95–96
Context and Capabilities for Integrating Care (CCIC), 165–166
Contingency, 142
Continuity, 99
of care, 8
Convenor model, 28–29
Coordinated networks, 8
Core problems, 63
Core values underpinning integrated care, 98–101
Cost
and benefits across organizations, 144
of care, 174
savings, 28
COVID-19
crisis, 6–7
pandemics, 3
Craft, 138–139
skills, 41–42
Critical thinking, 89–90
Culture, 50–52
Data capture, 175
Decision making, 79–80
shared decision making, 7
Delphi methodology, 98–99
Design thinking, 59, 62–63, 70
example of using design thinking to involving patients in integrated care, 64–69
in health care, 62–64
Developmental evaluations, 162–163
Developmental Model of Integrated Care, 165–166
Diagnosis Related Groups-based payments (DRGs-based payments), 24–25
Difference, 54
Digital assets, 120
Digital health
implementation challenges, 123
in integrated care, 116–118
solutions, 115
technologies, 117
technology, 119–123
tools, 116
‘users’ of, 118–119
Diversity, 54
‘Doing for’ patients, 60
Dutch care organization, 97
Effectiveness, 101
Efficiency, 100
Emergence. See Complexity
Empathy, 63
mapping, 67
Empowerment, 100
Enablers and inhibitors of change, 71–72
Episode-based payments, 27
EuroQOL EQ-5D-5L scale, 173
Evaluation, 162–163
developmental, 162–163
dynamic, 162–163
formative, 162–163
realist, 163
summative, 162–163
Evaluation design, 163
Evidence, 11–12
evidence based practice, 39
Fee-for-service, 24–25
Feedback loop. See Complexity
Financial incentives, 18, 27
Fixed payments, 24
Flexibility, 99–100
Follow through, 54
Formative evaluations, 162–163
Framing, 47
Full integration, 8–9
Functional integration, 7
Fund holding, 28
Funding, 15–16
models, 17–18
Gainsharing, 28
General practitioner, 25, 98
Gold Coast Health, 64–65
Gold Coast Primary Health Network, 64–65
Governance, 10, 101–102
shared governance, 101–102
Health
impact bonds, 31
plans, 23
savings accounts, 23
systems, 2
Health care
organization, 3
provider, 17–18, 32–33
services, 97–98
workers, 3
Health maintenance organization (HMO), 30
Holism, 99
Housing, 98
Human service organizations, 17–18
Humility, approach with, 53–54
ICT, 140–141
Impact, 10, 59
Implementation, 137–138, 140
characteristics, 138
frameworks of change, 145, 157
integrated care, 142–144
key domains of implementing change, 140–141
Kotter' framework for change, 145–157
Incremental payment, 19–20
Individual interviews, 68
Informal care, 7
Informal caregivers, 173–174
Innovation, 155–156
Institute of Medicine model (IOM model), 17
Insurance, 18–19
health insurance, 30
Integrated care (IC), 1, 4, 39, 95–96
analysis, feedback and reporting, 175–176
approaches to evaluation, 162–163, 168
approaches to summative evaluation, 178–179
challenges and enablers in leading and managing in, 40–42
comparative effectiveness, 179–180
consortium, 104–105
data capture, 175
dealing with complexity, 177
digital health in, 116–118
dynamic evaluation, 177
framework for, 5
leadership competencies, 44
logic model development, 169–172
measurement, 172–176
mechanisms, 47–54
nuts and bolts of, 8–9
person-oriented outcome measurement, 173–175
personal characteristics of IC leaders, 46
practice, 6–7
programs, 161
qualitative approaches to evaluation, 177–178
settings, 40
solutions, 142
theory, 165–166
Integrated Care Alliance (ICA), 64–65
Integration, 105
framework, 19
horizontal, 4–5
model, 105
theory, 165
vertical, 4–5
Integrators of care, 17–19
base payment vs. alternative payment, 19–20
commissioner or payer model, 18–19
health care provider, 17–18
patient, 17
Joint decision-making, 78
Kotter’s model, 138, 145, 156–157
change, 155–156
communicating vision, 150–152
creating urgency, 146–147
empowering action, 152–154
frameworks of change, 145–157
powerful coalition, 147–149
quick wins, 154–155
vision for change, 149–150
Leadership, 39–40, 101–102
competency frameworks, 42–47
IC leadership competencies, 44
shared, 107
Learning, 53
shared learning, 156
Line-item budget, 24
Linkage, 8
Listening, 53
Local authorities, 95–96
Logic model
constituting, 169–170
development, 169–172
importance for evaluating integrated care, 167–168
program activities/processes, 171–172
program inputs and resources, 172
program outcomes, 170–171
program outputs, 171
Lump-sum
or global budget, 24
payment for professionals, 24
Macro-Level mechanisms, 5–6, 50
Management, 39–40
competency frameworks, 42–47
Managers, 62
Maturation, 179–180
Measurement, 172–176
Measures, 172–173
Medical Leadership Competency Framework, 42–43
Meso-Level mechanisms, 5–6, 50, 52
mHealth, 118
Micro-Level mechanisms, 5–6, 53–54
Mission statement of organizations, 97
Mobilizing, 47
Model of effect. See Logic model
Monetary cash transfers, 20–23
Motivation, prosocial, 79–80, 83–84
Multiagency interventions, 1
Multidisciplinary teams, 69–70
Multiprofessional
character of integrated care, 143
episode-based payment, 27
service, 102–104
Municipalities, 88
Needs assessment, 17–18
Networks, 29–30
Non-adoption, Abandonment, Scale-up, Spread and Sustainability framework (NASSS framework), 122–123
Normative integration, 6–7
Norms, 6–7, 97
Nuka System of Care, 60–61
Nursing, 65
community, 137–138
district, 88
Off-the-shelf technology, adopting and adapting, 122–123
One sided risk model, 28
‘One-size-fits-all’ model, 2
Organizational
changes, 138, 144
level, 5
Outcome accountability, 90–91
‘Outside the box’ approach, 72
Parallel governance, 143–144
Partial capitation, 25
Partners, 82
Partnership, 86–87
Patient, 17, 31–32
patient engagement, 59, 62
patient involvement, 10
patient participation, 60
workshops, 68
Patient engagement, 59, 62
design thinking in health care, 62–64
enablers and inhibitors of change, 71–72
example of using design thinking to involving patients in integrated care, 64–69
existing models and approaches to, 61
findings and reflections, 70–71
with lived experiences in service design, 60–61
outcomes, 69–70
value of, 59
Pay for performance, 27
Payer, 18–19, 33–34
Payment models, 16, 20
activity base payment, 20
actor specific limitations to integrating care, 31–34
alternative payment, 19–20
base payment, 19–20
with commissioner or payer as integrator, 29–31
incremental payment, 19–20
key elements of framework, 16–20
with patient as integrator, 20–23
pay for performance, 27
with provider as integrator, 24–29
top up payment, 19–20
value based payment, 27
Person-centred care, 4
Person-centredness, 100
person centred services, 3
Person-oriented outcome measurement, 173–175
Personal budgets, 20–23
Personal or clinical level, 4–5
Personal values session, 109–111
Personal vouchers, 20–23
Plan-Do-Study-Act framework (Deming), 138
Planned implementation, 139
Planning, 12
Pooled commissioning, 31
Population-based payments, 25–26
Post-Study System Usability Questionnaire, 121–122
Power imbalances, 86–87
Prerequisites, 78–79, 83–84, 87
Prevention, 100
Primary care budget, 25
Prime contractor model, 28–29
Principal agent problem, 18
Principles, 10
Private funding of care, 20–23
Problem solving behaviour, 81
Process accountability, 90–91
Professional level, 5
Program
activities/processes, 171–172
inputs and resources, 172
outcomes, 170–171
outputs, 171
theory, 165–166
Programme theory, 153
Proself motivation, 79–80
Prosocial motivation, 79–80, 83–84
increasing actors, 81–84
Protocols, 6
assessment protocols, 7
care protocols, 7
Prototyping, 64, 68
Provider, 15, 17–18
‘Quadruple-Aim’ set of outcomes, 170–171, 174–175
Qualitative approaches to evaluation, 177–178
Quality of care, 17
Rainbow Model of Integrated Care (RMIC), 60, 98, 105, 109, 133, 166
Readiness, 140
readiness for change, 153
Realistic evaluations, 163
Reciprocity, 100–101
Regional stakeholders, 107–108
Resilience, 3–4
Respect, 100
Retainer fee, 25
Risk, 18–19
pooling of risk, 18–19
Roles, 3
Scale, 122
Self-management, 3–4, 169
Service commissioning, 16
Service design, 60–61
Shared governance, 101–102
Shared responsibility and accountability, 99
Shared risk, 28
Shared savings, 28
Short window of opportunity, 144
Skills, 7
Social dimension of care, 76
Social motivation, 79
Social motives, 81
Social services, 4
Social stakeholder alignment, 76–78
Specific, measurable, assignable, realistic and time-related measurement approach (SMART measurement approach), 172–173
Staff
development, 152–153
training, 154
Stakeholders, 97–98
Standards, 6
standards of behaviour, 96
Status, 2
Strategy, 102
Structural elements, 75–76
Summative evaluations, 162–163, 178–179
Supervision, 101–102
Sustainability, 138
Sustaining, 48
SWOT analysis, 141, 146–147
Synthesizing, 47–48
System level, 5
System Usability Questionnaire, 121–122
Technology, 11
Testing phase, 64
Theory of change, 169
Third-party funding, 31
‘Tick the box’ method, 173–174
Tokenism, 60–61
Tool, 7
tool development, 121
Top up payment, 19–20
Transformation, 12
Transparency, 101
‘Triple-Aim’ set of outcomes, 170–171
Trust, 99
Two-sided model, 28
Usability testing, 121–122
User
service user, 13
user-centred co-design approach, 120
Validation, 65
Value-based payment, 27
Values, 96–98
core values underpinning integrated care, 98–101
dealing with value conflict as manager, 105–111
in integrated care governance, 101–105
mapping exercise, 106–107
Variation, 24–25
Veterans Rand VR-12 scale, 173
Vision
programme vision, 152
statement of organizations, 97
Voice behaviour, engaging in, 84
Voucher, 20
WHO-QOL-BREF scale, 173
Whole-systems thinking, 100
Willingness
and ability to speaking, 85–87
increasing actors, 85–87
to understanding, 89–91
‘Win-win’ agreements, 81
Accountability
, 101–102
Activation
, 47
Activity-based payments
, 24–26
Actors
, 82–83, 90
Adaptation
, 3
Adaptive approaches to leadership
, 53–54
Additional payment
, 19–20
Adoption
, 116–117, 120
Ageing Well in Digital World AAL programme
, 119
Agency
, 141
Alternative funding
, 23, 26, 29, 31
Alternative payment
, 19–20
Asset-based approaches
, 4
Base funding
, 20, 23–25
Base models
, 29–30
Base payment
, 19–20
Behaviour
, 44
prosocial
, 83–84
Beta test
, 121–122
Better Evaluation collaboration
, 176
Boundaries
, 78
Brainstorming
, 63–64, 68
Brainwriting
, 86
Budgets
, 19
capitated budgets
, 25
pooled budgets
, 28
Bundled payments. See Episode-based payments
Capitated budgets, 25
Care
community care, 13
hospital care, 31, 168
nursing care, 26
primary care, 25, 65
social care, 15, 18–19
Care integration, 4, 13, 75
practice example, 76, 80–81, 84, 87, 89
social dimension, 76
Care organizations, 79
Case management, 95–96
Case rates, 24–25
Centres of Excellence, 30
Change, 71
non-linear change, 139
organisational change, 138
Change programmes in health care organizations, 139
Clinical nature of change, 144
Co-design models, 120
Co-ordination, 99
Co-production, 99
Collaboration, 3, 45, 100, 105
Collaborative values session, 107–109
Combined commissioning, 31
Commissioner or payer model, 18–19, 30, 33–34
Commissioning, 15
Communication, 150–151
Competence framework, 78
Competencies, 40, 42–43
Competitors, 82
Complex adaptive systems, 177
Complex intervention, 161, 163
Complexity, 177
emergence, 69
feedback loop, 152
Comprehensiveness, 100
Conditional cash transfers, 20–23
Context, 95–96
Context and Capabilities for Integrating Care (CCIC), 165–166
Contingency, 142
Continuity, 99
of care, 8
Convenor model, 28–29
Coordinated networks, 8
Core problems, 63
Core values underpinning integrated care, 98–101
Cost
and benefits across organizations, 144
of care, 174
savings, 28
COVID-19
crisis, 6–7
pandemics, 3
Craft, 138–139
skills, 41–42
Critical thinking, 89–90
Culture, 50–52
Data capture, 175
Decision making, 79–80
shared decision making, 7
Delphi methodology, 98–99
Design thinking, 59, 62–63, 70
example of using design thinking to involving patients in integrated care, 64–69
in health care, 62–64
Developmental evaluations, 162–163
Developmental Model of Integrated Care, 165–166
Diagnosis Related Groups-based payments (DRGs-based payments), 24–25
Difference, 54
Digital assets, 120
Digital health
implementation challenges, 123
in integrated care, 116–118
solutions, 115
technologies, 117
technology, 119–123
tools, 116
‘users’ of, 118–119
Diversity, 54
‘Doing for’ patients, 60
Dutch care organization, 97
Effectiveness, 101
Efficiency, 100
Emergence. See Complexity
Empathy, 63
mapping, 67
Empowerment, 100
Enablers and inhibitors of change, 71–72
Episode-based payments, 27
EuroQOL EQ-5D-5L scale, 173
Evaluation, 162–163
developmental, 162–163
dynamic, 162–163
formative, 162–163
realist, 163
summative, 162–163
Evaluation design, 163
Evidence, 11–12
evidence based practice, 39
Fee-for-service, 24–25
Feedback loop. See Complexity
Financial incentives, 18, 27
Fixed payments, 24
Flexibility, 99–100
Follow through, 54
Formative evaluations, 162–163
Framing, 47
Full integration, 8–9
Functional integration, 7
Fund holding, 28
Funding, 15–16
models, 17–18
Gainsharing, 28
General practitioner, 25, 98
Gold Coast Health, 64–65
Gold Coast Primary Health Network, 64–65
Governance, 10, 101–102
shared governance, 101–102
Health
impact bonds, 31
plans, 23
savings accounts, 23
systems, 2
Health care
organization, 3
provider, 17–18, 32–33
services, 97–98
workers, 3
Health maintenance organization (HMO), 30
Holism, 99
Housing, 98
Human service organizations, 17–18
Humility, approach with, 53–54
ICT, 140–141
Impact, 10, 59
Implementation, 137–138, 140
characteristics, 138
frameworks of change, 145, 157
integrated care, 142–144
key domains of implementing change, 140–141
Kotter' framework for change, 145–157
Incremental payment, 19–20
Individual interviews, 68
Informal care, 7
Informal caregivers, 173–174
Innovation, 155–156
Institute of Medicine model (IOM model), 17
Insurance, 18–19
health insurance, 30
Integrated care (IC), 1, 4, 39, 95–96
analysis, feedback and reporting, 175–176
approaches to evaluation, 162–163, 168
approaches to summative evaluation, 178–179
challenges and enablers in leading and managing in, 40–42
comparative effectiveness, 179–180
consortium, 104–105
data capture, 175
dealing with complexity, 177
digital health in, 116–118
dynamic evaluation, 177
framework for, 5
leadership competencies, 44
logic model development, 169–172
measurement, 172–176
mechanisms, 47–54
nuts and bolts of, 8–9
person-oriented outcome measurement, 173–175
personal characteristics of IC leaders, 46
practice, 6–7
programs, 161
qualitative approaches to evaluation, 177–178
settings, 40
solutions, 142
theory, 165–166
Integrated Care Alliance (ICA), 64–65
Integration, 105
framework, 19
horizontal, 4–5
model, 105
theory, 165
vertical, 4–5
Integrators of care, 17–19
base payment vs. alternative payment, 19–20
commissioner or payer model, 18–19
health care provider, 17–18
patient, 17
Joint decision-making, 78
Kotter’s model, 138, 145, 156–157
change, 155–156
communicating vision, 150–152
creating urgency, 146–147
empowering action, 152–154
frameworks of change, 145–157
powerful coalition, 147–149
quick wins, 154–155
vision for change, 149–150
Leadership, 39–40, 101–102
competency frameworks, 42–47
IC leadership competencies, 44
shared, 107
Learning, 53
shared learning, 156
Line-item budget, 24
Linkage, 8
Listening, 53
Local authorities, 95–96
Logic model
constituting, 169–170
development, 169–172
importance for evaluating integrated care, 167–168
program activities/processes, 171–172
program inputs and resources, 172
program outcomes, 170–171
program outputs, 171
Lump-sum
or global budget, 24
payment for professionals, 24
Macro-Level mechanisms, 5–6, 50
Management, 39–40
competency frameworks, 42–47
Managers, 62
Maturation, 179–180
Measurement, 172–176
Measures, 172–173
Medical Leadership Competency Framework, 42–43
Meso-Level mechanisms, 5–6, 50, 52
mHealth, 118
Micro-Level mechanisms, 5–6, 53–54
Mission statement of organizations, 97
Mobilizing, 47
Model of effect. See Logic model
Monetary cash transfers, 20–23
Motivation, prosocial, 79–80, 83–84
Multiagency interventions, 1
Multidisciplinary teams, 69–70
Multiprofessional
character of integrated care, 143
episode-based payment, 27
service, 102–104
Municipalities, 88
Needs assessment, 17–18
Networks, 29–30
Non-adoption, Abandonment, Scale-up, Spread and Sustainability framework (NASSS framework), 122–123
Normative integration, 6–7
Norms, 6–7, 97
Nuka System of Care, 60–61
Nursing, 65
community, 137–138
district, 88
Off-the-shelf technology, adopting and adapting, 122–123
One sided risk model, 28
‘One-size-fits-all’ model, 2
Organizational
changes, 138, 144
level, 5
Outcome accountability, 90–91
‘Outside the box’ approach, 72
Parallel governance, 143–144
Partial capitation, 25
Partners, 82
Partnership, 86–87
Patient, 17, 31–32
patient engagement, 59, 62
patient involvement, 10
patient participation, 60
workshops, 68
Patient engagement, 59, 62
design thinking in health care, 62–64
enablers and inhibitors of change, 71–72
example of using design thinking to involving patients in integrated care, 64–69
existing models and approaches to, 61
findings and reflections, 70–71
with lived experiences in service design, 60–61
outcomes, 69–70
value of, 59
Pay for performance, 27
Payer, 18–19, 33–34
Payment models, 16, 20
activity base payment, 20
actor specific limitations to integrating care, 31–34
alternative payment, 19–20
base payment, 19–20
with commissioner or payer as integrator, 29–31
incremental payment, 19–20
key elements of framework, 16–20
with patient as integrator, 20–23
pay for performance, 27
with provider as integrator, 24–29
top up payment, 19–20
value based payment, 27
Person-centred care, 4
Person-centredness, 100
person centred services, 3
Person-oriented outcome measurement, 173–175
Personal budgets, 20–23
Personal or clinical level, 4–5
Personal values session, 109–111
Personal vouchers, 20–23
Plan-Do-Study-Act framework (Deming), 138
Planned implementation, 139
Planning, 12
Pooled commissioning, 31
Population-based payments, 25–26
Post-Study System Usability Questionnaire, 121–122
Power imbalances, 86–87
Prerequisites, 78–79, 83–84, 87
Prevention, 100
Primary care budget, 25
Prime contractor model, 28–29
Principal agent problem, 18
Principles, 10
Private funding of care, 20–23
Problem solving behaviour, 81
Process accountability, 90–91
Professional level, 5
Program
activities/processes, 171–172
inputs and resources, 172
outcomes, 170–171
outputs, 171
theory, 165–166
Programme theory, 153
Proself motivation, 79–80
Prosocial motivation, 79–80, 83–84
increasing actors, 81–84
Protocols, 6
assessment protocols, 7
care protocols, 7
Prototyping, 64, 68
Provider, 15, 17–18
‘Quadruple-Aim’ set of outcomes, 170–171, 174–175
Qualitative approaches to evaluation, 177–178
Quality of care, 17
Rainbow Model of Integrated Care (RMIC), 60, 98, 105, 109, 133, 166
Readiness, 140
readiness for change, 153
Realistic evaluations, 163
Reciprocity, 100–101
Regional stakeholders, 107–108
Resilience, 3–4
Respect, 100
Retainer fee, 25
Risk, 18–19
pooling of risk, 18–19
Roles, 3
Scale, 122
Self-management, 3–4, 169
Service commissioning, 16
Service design, 60–61
Shared governance, 101–102
Shared responsibility and accountability, 99
Shared risk, 28
Shared savings, 28
Short window of opportunity, 144
Skills, 7
Social dimension of care, 76
Social motivation, 79
Social motives, 81
Social services, 4
Social stakeholder alignment, 76–78
Specific, measurable, assignable, realistic and time-related measurement approach (SMART measurement approach), 172–173
Staff
development, 152–153
training, 154
Stakeholders, 97–98
Standards, 6
standards of behaviour, 96
Status, 2
Strategy, 102
Structural elements, 75–76
Summative evaluations, 162–163, 178–179
Supervision, 101–102
Sustainability, 138
Sustaining, 48
SWOT analysis, 141, 146–147
Synthesizing, 47–48
System level, 5
System Usability Questionnaire, 121–122
Technology, 11
Testing phase, 64
Theory of change, 169
Third-party funding, 31
‘Tick the box’ method, 173–174
Tokenism, 60–61
Tool, 7
tool development, 121
Top up payment, 19–20
Transformation, 12
Transparency, 101
‘Triple-Aim’ set of outcomes, 170–171
Trust, 99
Two-sided model, 28
Usability testing, 121–122
User
service user, 13
user-centred co-design approach, 120
Validation, 65
Value-based payment, 27
Values, 96–98
core values underpinning integrated care, 98–101
dealing with value conflict as manager, 105–111
in integrated care governance, 101–105
mapping exercise, 106–107
Variation, 24–25
Veterans Rand VR-12 scale, 173
Vision
programme vision, 152
statement of organizations, 97
Voice behaviour, engaging in, 84
Voucher, 20
WHO-QOL-BREF scale, 173
Whole-systems thinking, 100
Willingness
and ability to speaking, 85–87
increasing actors, 85–87
to understanding, 89–91
‘Win-win’ agreements, 81
Capitated budgets
, 25
Care
community care
, 13
hospital care
, 31, 168
nursing care
, 26
primary care
, 25, 65
social care
, 15, 18–19
Care integration
, 4, 13, 75
practice example
, 76, 80–81, 84, 87, 89
social dimension
, 76
Care organizations
, 79
Case management
, 95–96
Case rates
, 24–25
Centres of Excellence
, 30
Change
, 71
non-linear change
, 139
organisational change
, 138
Change programmes in health care organizations
, 139
Clinical nature of change
, 144
Co-design models
, 120
Co-ordination
, 99
Co-production
, 99
Collaboration
, 3, 45, 100, 105
Collaborative values session
, 107–109
Combined commissioning
, 31
Commissioner or payer model
, 18–19, 30, 33–34
Commissioning
, 15
Communication
, 150–151
Competence framework
, 78
Competencies
, 40, 42–43
Competitors
, 82
Complex adaptive systems
, 177
Complex intervention
, 161, 163
Complexity
, 177
emergence
, 69
feedback loop
, 152
Comprehensiveness
, 100
Conditional cash transfers
, 20–23
Context
, 95–96
Context and Capabilities for Integrating Care (CCIC)
, 165–166
Contingency
, 142
Continuity
, 99
of care
, 8
Convenor model
, 28–29
Coordinated networks
, 8
Core problems
, 63
Core values underpinning integrated care
, 98–101
Cost
and benefits across organizations
, 144
of care
, 174
savings
, 28
COVID-19
crisis
, 6–7
pandemics
, 3
Craft
, 138–139
skills
, 41–42
Critical thinking
, 89–90
Culture
, 50–52
Data capture
, 175
Decision making
, 79–80
shared decision making
, 7
Delphi methodology
, 98–99
Design thinking
, 59, 62–63, 70
example of using design thinking to involving patients in integrated care
, 64–69
in health care
, 62–64
Developmental evaluations
, 162–163
Developmental Model of Integrated Care
, 165–166
Diagnosis Related Groups-based payments (DRGs-based payments)
, 24–25
Difference
, 54
Digital assets
, 120
Digital health
implementation challenges
, 123
in integrated care
, 116–118
solutions
, 115
technologies
, 117
technology
, 119–123
tools
, 116
‘users’ of
, 118–119
Diversity
, 54
‘Doing for’ patients
, 60
Dutch care organization
, 97
Effectiveness, 101
Efficiency, 100
Emergence. See Complexity
Empathy, 63
mapping, 67
Empowerment, 100
Enablers and inhibitors of change, 71–72
Episode-based payments, 27
EuroQOL EQ-5D-5L scale, 173
Evaluation, 162–163
developmental, 162–163
dynamic, 162–163
formative, 162–163
realist, 163
summative, 162–163
Evaluation design, 163
Evidence, 11–12
evidence based practice, 39
Fee-for-service, 24–25
Feedback loop. See Complexity
Financial incentives, 18, 27
Fixed payments, 24
Flexibility, 99–100
Follow through, 54
Formative evaluations, 162–163
Framing, 47
Full integration, 8–9
Functional integration, 7
Fund holding, 28
Funding, 15–16
models, 17–18
Gainsharing, 28
General practitioner, 25, 98
Gold Coast Health, 64–65
Gold Coast Primary Health Network, 64–65
Governance, 10, 101–102
shared governance, 101–102
Health
impact bonds, 31
plans, 23
savings accounts, 23
systems, 2
Health care
organization, 3
provider, 17–18, 32–33
services, 97–98
workers, 3
Health maintenance organization (HMO), 30
Holism, 99
Housing, 98
Human service organizations, 17–18
Humility, approach with, 53–54
ICT, 140–141
Impact, 10, 59
Implementation, 137–138, 140
characteristics, 138
frameworks of change, 145, 157
integrated care, 142–144
key domains of implementing change, 140–141
Kotter' framework for change, 145–157
Incremental payment, 19–20
Individual interviews, 68
Informal care, 7
Informal caregivers, 173–174
Innovation, 155–156
Institute of Medicine model (IOM model), 17
Insurance, 18–19
health insurance, 30
Integrated care (IC), 1, 4, 39, 95–96
analysis, feedback and reporting, 175–176
approaches to evaluation, 162–163, 168
approaches to summative evaluation, 178–179
challenges and enablers in leading and managing in, 40–42
comparative effectiveness, 179–180
consortium, 104–105
data capture, 175
dealing with complexity, 177
digital health in, 116–118
dynamic evaluation, 177
framework for, 5
leadership competencies, 44
logic model development, 169–172
measurement, 172–176
mechanisms, 47–54
nuts and bolts of, 8–9
person-oriented outcome measurement, 173–175
personal characteristics of IC leaders, 46
practice, 6–7
programs, 161
qualitative approaches to evaluation, 177–178
settings, 40
solutions, 142
theory, 165–166
Integrated Care Alliance (ICA), 64–65
Integration, 105
framework, 19
horizontal, 4–5
model, 105
theory, 165
vertical, 4–5
Integrators of care, 17–19
base payment vs. alternative payment, 19–20
commissioner or payer model, 18–19
health care provider, 17–18
patient, 17
Joint decision-making, 78
Kotter’s model, 138, 145, 156–157
change, 155–156
communicating vision, 150–152
creating urgency, 146–147
empowering action, 152–154
frameworks of change, 145–157
powerful coalition, 147–149
quick wins, 154–155
vision for change, 149–150
Leadership, 39–40, 101–102
competency frameworks, 42–47
IC leadership competencies, 44
shared, 107
Learning, 53
shared learning, 156
Line-item budget, 24
Linkage, 8
Listening, 53
Local authorities, 95–96
Logic model
constituting, 169–170
development, 169–172
importance for evaluating integrated care, 167–168
program activities/processes, 171–172
program inputs and resources, 172
program outcomes, 170–171
program outputs, 171
Lump-sum
or global budget, 24
payment for professionals, 24
Macro-Level mechanisms, 5–6, 50
Management, 39–40
competency frameworks, 42–47
Managers, 62
Maturation, 179–180
Measurement, 172–176
Measures, 172–173
Medical Leadership Competency Framework, 42–43
Meso-Level mechanisms, 5–6, 50, 52
mHealth, 118
Micro-Level mechanisms, 5–6, 53–54
Mission statement of organizations, 97
Mobilizing, 47
Model of effect. See Logic model
Monetary cash transfers, 20–23
Motivation, prosocial, 79–80, 83–84
Multiagency interventions, 1
Multidisciplinary teams, 69–70
Multiprofessional
character of integrated care, 143
episode-based payment, 27
service, 102–104
Municipalities, 88
Needs assessment, 17–18
Networks, 29–30
Non-adoption, Abandonment, Scale-up, Spread and Sustainability framework (NASSS framework), 122–123
Normative integration, 6–7
Norms, 6–7, 97
Nuka System of Care, 60–61
Nursing, 65
community, 137–138
district, 88
Off-the-shelf technology, adopting and adapting, 122–123
One sided risk model, 28
‘One-size-fits-all’ model, 2
Organizational
changes, 138, 144
level, 5
Outcome accountability, 90–91
‘Outside the box’ approach, 72
Parallel governance, 143–144
Partial capitation, 25
Partners, 82
Partnership, 86–87
Patient, 17, 31–32
patient engagement, 59, 62
patient involvement, 10
patient participation, 60
workshops, 68
Patient engagement, 59, 62
design thinking in health care, 62–64
enablers and inhibitors of change, 71–72
example of using design thinking to involving patients in integrated care, 64–69
existing models and approaches to, 61
findings and reflections, 70–71
with lived experiences in service design, 60–61
outcomes, 69–70
value of, 59
Pay for performance, 27
Payer, 18–19, 33–34
Payment models, 16, 20
activity base payment, 20
actor specific limitations to integrating care, 31–34
alternative payment, 19–20
base payment, 19–20
with commissioner or payer as integrator, 29–31
incremental payment, 19–20
key elements of framework, 16–20
with patient as integrator, 20–23
pay for performance, 27
with provider as integrator, 24–29
top up payment, 19–20
value based payment, 27
Person-centred care, 4
Person-centredness, 100
person centred services, 3
Person-oriented outcome measurement, 173–175
Personal budgets, 20–23
Personal or clinical level, 4–5
Personal values session, 109–111
Personal vouchers, 20–23
Plan-Do-Study-Act framework (Deming), 138
Planned implementation, 139
Planning, 12
Pooled commissioning, 31
Population-based payments, 25–26
Post-Study System Usability Questionnaire, 121–122
Power imbalances, 86–87
Prerequisites, 78–79, 83–84, 87
Prevention, 100
Primary care budget, 25
Prime contractor model, 28–29
Principal agent problem, 18
Principles, 10
Private funding of care, 20–23
Problem solving behaviour, 81
Process accountability, 90–91
Professional level, 5
Program
activities/processes, 171–172
inputs and resources, 172
outcomes, 170–171
outputs, 171
theory, 165–166
Programme theory, 153
Proself motivation, 79–80
Prosocial motivation, 79–80, 83–84
increasing actors, 81–84
Protocols, 6
assessment protocols, 7
care protocols, 7
Prototyping, 64, 68
Provider, 15, 17–18
‘Quadruple-Aim’ set of outcomes, 170–171, 174–175
Qualitative approaches to evaluation, 177–178
Quality of care, 17
Rainbow Model of Integrated Care (RMIC), 60, 98, 105, 109, 133, 166
Readiness, 140
readiness for change, 153
Realistic evaluations, 163
Reciprocity, 100–101
Regional stakeholders, 107–108
Resilience, 3–4
Respect, 100
Retainer fee, 25
Risk, 18–19
pooling of risk, 18–19
Roles, 3
Scale, 122
Self-management, 3–4, 169
Service commissioning, 16
Service design, 60–61
Shared governance, 101–102
Shared responsibility and accountability, 99
Shared risk, 28
Shared savings, 28
Short window of opportunity, 144
Skills, 7
Social dimension of care, 76
Social motivation, 79
Social motives, 81
Social services, 4
Social stakeholder alignment, 76–78
Specific, measurable, assignable, realistic and time-related measurement approach (SMART measurement approach), 172–173
Staff
development, 152–153
training, 154
Stakeholders, 97–98
Standards, 6
standards of behaviour, 96
Status, 2
Strategy, 102
Structural elements, 75–76
Summative evaluations, 162–163, 178–179
Supervision, 101–102
Sustainability, 138
Sustaining, 48
SWOT analysis, 141, 146–147
Synthesizing, 47–48
System level, 5
System Usability Questionnaire, 121–122
Technology, 11
Testing phase, 64
Theory of change, 169
Third-party funding, 31
‘Tick the box’ method, 173–174
Tokenism, 60–61
Tool, 7
tool development, 121
Top up payment, 19–20
Transformation, 12
Transparency, 101
‘Triple-Aim’ set of outcomes, 170–171
Trust, 99
Two-sided model, 28
Usability testing, 121–122
User
service user, 13
user-centred co-design approach, 120
Validation, 65
Value-based payment, 27
Values, 96–98
core values underpinning integrated care, 98–101
dealing with value conflict as manager, 105–111
in integrated care governance, 101–105
mapping exercise, 106–107
Variation, 24–25
Veterans Rand VR-12 scale, 173
Vision
programme vision, 152
statement of organizations, 97
Voice behaviour, engaging in, 84
Voucher, 20
WHO-QOL-BREF scale, 173
Whole-systems thinking, 100
Willingness
and ability to speaking, 85–87
increasing actors, 85–87
to understanding, 89–91
‘Win-win’ agreements, 81
Effectiveness
, 101
Efficiency
, 100
Emergence. See Complexity
Empathy
, 63
mapping
, 67
Empowerment
, 100
Enablers and inhibitors of change
, 71–72
Episode-based payments
, 27
EuroQOL EQ-5D-5L scale
, 173
Evaluation
, 162–163
developmental
, 162–163
dynamic
, 162–163
formative
, 162–163
realist
, 163
summative
, 162–163
Evaluation design
, 163
Evidence
, 11–12
evidence based practice
, 39
Fee-for-service
, 24–25
Feedback loop. See Complexity
Financial incentives
, 18, 27
Fixed payments
, 24
Flexibility
, 99–100
Follow through
, 54
Formative evaluations
, 162–163
Framing
, 47
Full integration
, 8–9
Functional integration
, 7
Fund holding
, 28
Funding
, 15–16
models
, 17–18
Gainsharing, 28
General practitioner, 25, 98
Gold Coast Health, 64–65
Gold Coast Primary Health Network, 64–65
Governance, 10, 101–102
shared governance, 101–102
Health
impact bonds, 31
plans, 23
savings accounts, 23
systems, 2
Health care
organization, 3
provider, 17–18, 32–33
services, 97–98
workers, 3
Health maintenance organization (HMO), 30
Holism, 99
Housing, 98
Human service organizations, 17–18
Humility, approach with, 53–54
ICT, 140–141
Impact, 10, 59
Implementation, 137–138, 140
characteristics, 138
frameworks of change, 145, 157
integrated care, 142–144
key domains of implementing change, 140–141
Kotter' framework for change, 145–157
Incremental payment, 19–20
Individual interviews, 68
Informal care, 7
Informal caregivers, 173–174
Innovation, 155–156
Institute of Medicine model (IOM model), 17
Insurance, 18–19
health insurance, 30
Integrated care (IC), 1, 4, 39, 95–96
analysis, feedback and reporting, 175–176
approaches to evaluation, 162–163, 168
approaches to summative evaluation, 178–179
challenges and enablers in leading and managing in, 40–42
comparative effectiveness, 179–180
consortium, 104–105
data capture, 175
dealing with complexity, 177
digital health in, 116–118
dynamic evaluation, 177
framework for, 5
leadership competencies, 44
logic model development, 169–172
measurement, 172–176
mechanisms, 47–54
nuts and bolts of, 8–9
person-oriented outcome measurement, 173–175
personal characteristics of IC leaders, 46
practice, 6–7
programs, 161
qualitative approaches to evaluation, 177–178
settings, 40
solutions, 142
theory, 165–166
Integrated Care Alliance (ICA), 64–65
Integration, 105
framework, 19
horizontal, 4–5
model, 105
theory, 165
vertical, 4–5
Integrators of care, 17–19
base payment vs. alternative payment, 19–20
commissioner or payer model, 18–19
health care provider, 17–18
patient, 17
Joint decision-making, 78
Kotter’s model, 138, 145, 156–157
change, 155–156
communicating vision, 150–152
creating urgency, 146–147
empowering action, 152–154
frameworks of change, 145–157
powerful coalition, 147–149
quick wins, 154–155
vision for change, 149–150
Leadership, 39–40, 101–102
competency frameworks, 42–47
IC leadership competencies, 44
shared, 107
Learning, 53
shared learning, 156
Line-item budget, 24
Linkage, 8
Listening, 53
Local authorities, 95–96
Logic model
constituting, 169–170
development, 169–172
importance for evaluating integrated care, 167–168
program activities/processes, 171–172
program inputs and resources, 172
program outcomes, 170–171
program outputs, 171
Lump-sum
or global budget, 24
payment for professionals, 24
Macro-Level mechanisms, 5–6, 50
Management, 39–40
competency frameworks, 42–47
Managers, 62
Maturation, 179–180
Measurement, 172–176
Measures, 172–173
Medical Leadership Competency Framework, 42–43
Meso-Level mechanisms, 5–6, 50, 52
mHealth, 118
Micro-Level mechanisms, 5–6, 53–54
Mission statement of organizations, 97
Mobilizing, 47
Model of effect. See Logic model
Monetary cash transfers, 20–23
Motivation, prosocial, 79–80, 83–84
Multiagency interventions, 1
Multidisciplinary teams, 69–70
Multiprofessional
character of integrated care, 143
episode-based payment, 27
service, 102–104
Municipalities, 88
Needs assessment, 17–18
Networks, 29–30
Non-adoption, Abandonment, Scale-up, Spread and Sustainability framework (NASSS framework), 122–123
Normative integration, 6–7
Norms, 6–7, 97
Nuka System of Care, 60–61
Nursing, 65
community, 137–138
district, 88
Off-the-shelf technology, adopting and adapting, 122–123
One sided risk model, 28
‘One-size-fits-all’ model, 2
Organizational
changes, 138, 144
level, 5
Outcome accountability, 90–91
‘Outside the box’ approach, 72
Parallel governance, 143–144
Partial capitation, 25
Partners, 82
Partnership, 86–87
Patient, 17, 31–32
patient engagement, 59, 62
patient involvement, 10
patient participation, 60
workshops, 68
Patient engagement, 59, 62
design thinking in health care, 62–64
enablers and inhibitors of change, 71–72
example of using design thinking to involving patients in integrated care, 64–69
existing models and approaches to, 61
findings and reflections, 70–71
with lived experiences in service design, 60–61
outcomes, 69–70
value of, 59
Pay for performance, 27
Payer, 18–19, 33–34
Payment models, 16, 20
activity base payment, 20
actor specific limitations to integrating care, 31–34
alternative payment, 19–20
base payment, 19–20
with commissioner or payer as integrator, 29–31
incremental payment, 19–20
key elements of framework, 16–20
with patient as integrator, 20–23
pay for performance, 27
with provider as integrator, 24–29
top up payment, 19–20
value based payment, 27
Person-centred care, 4
Person-centredness, 100
person centred services, 3
Person-oriented outcome measurement, 173–175
Personal budgets, 20–23
Personal or clinical level, 4–5
Personal values session, 109–111
Personal vouchers, 20–23
Plan-Do-Study-Act framework (Deming), 138
Planned implementation, 139
Planning, 12
Pooled commissioning, 31
Population-based payments, 25–26
Post-Study System Usability Questionnaire, 121–122
Power imbalances, 86–87
Prerequisites, 78–79, 83–84, 87
Prevention, 100
Primary care budget, 25
Prime contractor model, 28–29
Principal agent problem, 18
Principles, 10
Private funding of care, 20–23
Problem solving behaviour, 81
Process accountability, 90–91
Professional level, 5
Program
activities/processes, 171–172
inputs and resources, 172
outcomes, 170–171
outputs, 171
theory, 165–166
Programme theory, 153
Proself motivation, 79–80
Prosocial motivation, 79–80, 83–84
increasing actors, 81–84
Protocols, 6
assessment protocols, 7
care protocols, 7
Prototyping, 64, 68
Provider, 15, 17–18
‘Quadruple-Aim’ set of outcomes, 170–171, 174–175
Qualitative approaches to evaluation, 177–178
Quality of care, 17
Rainbow Model of Integrated Care (RMIC), 60, 98, 105, 109, 133, 166
Readiness, 140
readiness for change, 153
Realistic evaluations, 163
Reciprocity, 100–101
Regional stakeholders, 107–108
Resilience, 3–4
Respect, 100
Retainer fee, 25
Risk, 18–19
pooling of risk, 18–19
Roles, 3
Scale, 122
Self-management, 3–4, 169
Service commissioning, 16
Service design, 60–61
Shared governance, 101–102
Shared responsibility and accountability, 99
Shared risk, 28
Shared savings, 28
Short window of opportunity, 144
Skills, 7
Social dimension of care, 76
Social motivation, 79
Social motives, 81
Social services, 4
Social stakeholder alignment, 76–78
Specific, measurable, assignable, realistic and time-related measurement approach (SMART measurement approach), 172–173
Staff
development, 152–153
training, 154
Stakeholders, 97–98
Standards, 6
standards of behaviour, 96
Status, 2
Strategy, 102
Structural elements, 75–76
Summative evaluations, 162–163, 178–179
Supervision, 101–102
Sustainability, 138
Sustaining, 48
SWOT analysis, 141, 146–147
Synthesizing, 47–48
System level, 5
System Usability Questionnaire, 121–122
Technology, 11
Testing phase, 64
Theory of change, 169
Third-party funding, 31
‘Tick the box’ method, 173–174
Tokenism, 60–61
Tool, 7
tool development, 121
Top up payment, 19–20
Transformation, 12
Transparency, 101
‘Triple-Aim’ set of outcomes, 170–171
Trust, 99
Two-sided model, 28
Usability testing, 121–122
User
service user, 13
user-centred co-design approach, 120
Validation, 65
Value-based payment, 27
Values, 96–98
core values underpinning integrated care, 98–101
dealing with value conflict as manager, 105–111
in integrated care governance, 101–105
mapping exercise, 106–107
Variation, 24–25
Veterans Rand VR-12 scale, 173
Vision
programme vision, 152
statement of organizations, 97
Voice behaviour, engaging in, 84
Voucher, 20
WHO-QOL-BREF scale, 173
Whole-systems thinking, 100
Willingness
and ability to speaking, 85–87
increasing actors, 85–87
to understanding, 89–91
‘Win-win’ agreements, 81
Gainsharing
, 28
General practitioner
, 25, 98
Gold Coast Health
, 64–65
Gold Coast Primary Health Network
, 64–65
Governance
, 10, 101–102
shared governance
, 101–102
Health
impact bonds
, 31
plans
, 23
savings accounts
, 23
systems
, 2
Health care
organization
, 3
provider
, 17–18, 32–33
services
, 97–98
workers
, 3
Health maintenance organization (HMO)
, 30
Holism
, 99
Housing
, 98
Human service organizations
, 17–18
Humility, approach with
, 53–54
ICT, 140–141
Impact, 10, 59
Implementation, 137–138, 140
characteristics, 138
frameworks of change, 145, 157
integrated care, 142–144
key domains of implementing change, 140–141
Kotter' framework for change, 145–157
Incremental payment, 19–20
Individual interviews, 68
Informal care, 7
Informal caregivers, 173–174
Innovation, 155–156
Institute of Medicine model (IOM model), 17
Insurance, 18–19
health insurance, 30
Integrated care (IC), 1, 4, 39, 95–96
analysis, feedback and reporting, 175–176
approaches to evaluation, 162–163, 168
approaches to summative evaluation, 178–179
challenges and enablers in leading and managing in, 40–42
comparative effectiveness, 179–180
consortium, 104–105
data capture, 175
dealing with complexity, 177
digital health in, 116–118
dynamic evaluation, 177
framework for, 5
leadership competencies, 44
logic model development, 169–172
measurement, 172–176
mechanisms, 47–54
nuts and bolts of, 8–9
person-oriented outcome measurement, 173–175
personal characteristics of IC leaders, 46
practice, 6–7
programs, 161
qualitative approaches to evaluation, 177–178
settings, 40
solutions, 142
theory, 165–166
Integrated Care Alliance (ICA), 64–65
Integration, 105
framework, 19
horizontal, 4–5
model, 105
theory, 165
vertical, 4–5
Integrators of care, 17–19
base payment vs. alternative payment, 19–20
commissioner or payer model, 18–19
health care provider, 17–18
patient, 17
Joint decision-making, 78
Kotter’s model, 138, 145, 156–157
change, 155–156
communicating vision, 150–152
creating urgency, 146–147
empowering action, 152–154
frameworks of change, 145–157
powerful coalition, 147–149
quick wins, 154–155
vision for change, 149–150
Leadership, 39–40, 101–102
competency frameworks, 42–47
IC leadership competencies, 44
shared, 107
Learning, 53
shared learning, 156
Line-item budget, 24
Linkage, 8
Listening, 53
Local authorities, 95–96
Logic model
constituting, 169–170
development, 169–172
importance for evaluating integrated care, 167–168
program activities/processes, 171–172
program inputs and resources, 172
program outcomes, 170–171
program outputs, 171
Lump-sum
or global budget, 24
payment for professionals, 24
Macro-Level mechanisms, 5–6, 50
Management, 39–40
competency frameworks, 42–47
Managers, 62
Maturation, 179–180
Measurement, 172–176
Measures, 172–173
Medical Leadership Competency Framework, 42–43
Meso-Level mechanisms, 5–6, 50, 52
mHealth, 118
Micro-Level mechanisms, 5–6, 53–54
Mission statement of organizations, 97
Mobilizing, 47
Model of effect. See Logic model
Monetary cash transfers, 20–23
Motivation, prosocial, 79–80, 83–84
Multiagency interventions, 1
Multidisciplinary teams, 69–70
Multiprofessional
character of integrated care, 143
episode-based payment, 27
service, 102–104
Municipalities, 88
Needs assessment, 17–18
Networks, 29–30
Non-adoption, Abandonment, Scale-up, Spread and Sustainability framework (NASSS framework), 122–123
Normative integration, 6–7
Norms, 6–7, 97
Nuka System of Care, 60–61
Nursing, 65
community, 137–138
district, 88
Off-the-shelf technology, adopting and adapting, 122–123
One sided risk model, 28
‘One-size-fits-all’ model, 2
Organizational
changes, 138, 144
level, 5
Outcome accountability, 90–91
‘Outside the box’ approach, 72
Parallel governance, 143–144
Partial capitation, 25
Partners, 82
Partnership, 86–87
Patient, 17, 31–32
patient engagement, 59, 62
patient involvement, 10
patient participation, 60
workshops, 68
Patient engagement, 59, 62
design thinking in health care, 62–64
enablers and inhibitors of change, 71–72
example of using design thinking to involving patients in integrated care, 64–69
existing models and approaches to, 61
findings and reflections, 70–71
with lived experiences in service design, 60–61
outcomes, 69–70
value of, 59
Pay for performance, 27
Payer, 18–19, 33–34
Payment models, 16, 20
activity base payment, 20
actor specific limitations to integrating care, 31–34
alternative payment, 19–20
base payment, 19–20
with commissioner or payer as integrator, 29–31
incremental payment, 19–20
key elements of framework, 16–20
with patient as integrator, 20–23
pay for performance, 27
with provider as integrator, 24–29
top up payment, 19–20
value based payment, 27
Person-centred care, 4
Person-centredness, 100
person centred services, 3
Person-oriented outcome measurement, 173–175
Personal budgets, 20–23
Personal or clinical level, 4–5
Personal values session, 109–111
Personal vouchers, 20–23
Plan-Do-Study-Act framework (Deming), 138
Planned implementation, 139
Planning, 12
Pooled commissioning, 31
Population-based payments, 25–26
Post-Study System Usability Questionnaire, 121–122
Power imbalances, 86–87
Prerequisites, 78–79, 83–84, 87
Prevention, 100
Primary care budget, 25
Prime contractor model, 28–29
Principal agent problem, 18
Principles, 10
Private funding of care, 20–23
Problem solving behaviour, 81
Process accountability, 90–91
Professional level, 5
Program
activities/processes, 171–172
inputs and resources, 172
outcomes, 170–171
outputs, 171
theory, 165–166
Programme theory, 153
Proself motivation, 79–80
Prosocial motivation, 79–80, 83–84
increasing actors, 81–84
Protocols, 6
assessment protocols, 7
care protocols, 7
Prototyping, 64, 68
Provider, 15, 17–18
‘Quadruple-Aim’ set of outcomes, 170–171, 174–175
Qualitative approaches to evaluation, 177–178
Quality of care, 17
Rainbow Model of Integrated Care (RMIC), 60, 98, 105, 109, 133, 166
Readiness, 140
readiness for change, 153
Realistic evaluations, 163
Reciprocity, 100–101
Regional stakeholders, 107–108
Resilience, 3–4
Respect, 100
Retainer fee, 25
Risk, 18–19
pooling of risk, 18–19
Roles, 3
Scale, 122
Self-management, 3–4, 169
Service commissioning, 16
Service design, 60–61
Shared governance, 101–102
Shared responsibility and accountability, 99
Shared risk, 28
Shared savings, 28
Short window of opportunity, 144
Skills, 7
Social dimension of care, 76
Social motivation, 79
Social motives, 81
Social services, 4
Social stakeholder alignment, 76–78
Specific, measurable, assignable, realistic and time-related measurement approach (SMART measurement approach), 172–173
Staff
development, 152–153
training, 154
Stakeholders, 97–98
Standards, 6
standards of behaviour, 96
Status, 2
Strategy, 102
Structural elements, 75–76
Summative evaluations, 162–163, 178–179
Supervision, 101–102
Sustainability, 138
Sustaining, 48
SWOT analysis, 141, 146–147
Synthesizing, 47–48
System level, 5
System Usability Questionnaire, 121–122
Technology, 11
Testing phase, 64
Theory of change, 169
Third-party funding, 31
‘Tick the box’ method, 173–174
Tokenism, 60–61
Tool, 7
tool development, 121
Top up payment, 19–20
Transformation, 12
Transparency, 101
‘Triple-Aim’ set of outcomes, 170–171
Trust, 99
Two-sided model, 28
Usability testing, 121–122
User
service user, 13
user-centred co-design approach, 120
Validation, 65
Value-based payment, 27
Values, 96–98
core values underpinning integrated care, 98–101
dealing with value conflict as manager, 105–111
in integrated care governance, 101–105
mapping exercise, 106–107
Variation, 24–25
Veterans Rand VR-12 scale, 173
Vision
programme vision, 152
statement of organizations, 97
Voice behaviour, engaging in, 84
Voucher, 20
WHO-QOL-BREF scale, 173
Whole-systems thinking, 100
Willingness
and ability to speaking, 85–87
increasing actors, 85–87
to understanding, 89–91
‘Win-win’ agreements, 81
ICT
, 140–141
Impact
, 10, 59
Implementation
, 137–138, 140
characteristics
, 138
frameworks of change
, 145, 157
integrated care
, 142–144
key domains of implementing change
, 140–141
Kotter' framework for change
, 145–157
Incremental payment
, 19–20
Individual interviews
, 68
Informal care
, 7
Informal caregivers
, 173–174
Innovation
, 155–156
Institute of Medicine model (IOM model)
, 17
Insurance
, 18–19
health insurance
, 30
Integrated care (IC)
, 1, 4, 39, 95–96
analysis, feedback and reporting
, 175–176
approaches to evaluation
, 162–163, 168
approaches to summative evaluation
, 178–179
challenges and enablers in leading and managing in
, 40–42
comparative effectiveness
, 179–180
consortium
, 104–105
data capture
, 175
dealing with complexity
, 177
digital health in
, 116–118
dynamic evaluation
, 177
framework for
, 5
leadership competencies
, 44
logic model development
, 169–172
measurement
, 172–176
mechanisms
, 47–54
nuts and bolts of
, 8–9
person-oriented outcome measurement
, 173–175
personal characteristics of IC leaders
, 46
practice
, 6–7
programs
, 161
qualitative approaches to evaluation
, 177–178
settings
, 40
solutions
, 142
theory
, 165–166
Integrated Care Alliance (ICA)
, 64–65
Integration
, 105
framework
, 19
horizontal
, 4–5
model
, 105
theory
, 165
vertical
, 4–5
Integrators of care
, 17–19
base payment vs. alternative payment
, 19–20
commissioner or payer model
, 18–19
health care provider
, 17–18
patient
, 17
Joint decision-making
, 78
Kotter’s model, 138, 145, 156–157
change, 155–156
communicating vision, 150–152
creating urgency, 146–147
empowering action, 152–154
frameworks of change, 145–157
powerful coalition, 147–149
quick wins, 154–155
vision for change, 149–150
Leadership, 39–40, 101–102
competency frameworks, 42–47
IC leadership competencies, 44
shared, 107
Learning, 53
shared learning, 156
Line-item budget, 24
Linkage, 8
Listening, 53
Local authorities, 95–96
Logic model
constituting, 169–170
development, 169–172
importance for evaluating integrated care, 167–168
program activities/processes, 171–172
program inputs and resources, 172
program outcomes, 170–171
program outputs, 171
Lump-sum
or global budget, 24
payment for professionals, 24
Macro-Level mechanisms, 5–6, 50
Management, 39–40
competency frameworks, 42–47
Managers, 62
Maturation, 179–180
Measurement, 172–176
Measures, 172–173
Medical Leadership Competency Framework, 42–43
Meso-Level mechanisms, 5–6, 50, 52
mHealth, 118
Micro-Level mechanisms, 5–6, 53–54
Mission statement of organizations, 97
Mobilizing, 47
Model of effect. See Logic model
Monetary cash transfers, 20–23
Motivation, prosocial, 79–80, 83–84
Multiagency interventions, 1
Multidisciplinary teams, 69–70
Multiprofessional
character of integrated care, 143
episode-based payment, 27
service, 102–104
Municipalities, 88
Needs assessment, 17–18
Networks, 29–30
Non-adoption, Abandonment, Scale-up, Spread and Sustainability framework (NASSS framework), 122–123
Normative integration, 6–7
Norms, 6–7, 97
Nuka System of Care, 60–61
Nursing, 65
community, 137–138
district, 88
Off-the-shelf technology, adopting and adapting, 122–123
One sided risk model, 28
‘One-size-fits-all’ model, 2
Organizational
changes, 138, 144
level, 5
Outcome accountability, 90–91
‘Outside the box’ approach, 72
Parallel governance, 143–144
Partial capitation, 25
Partners, 82
Partnership, 86–87
Patient, 17, 31–32
patient engagement, 59, 62
patient involvement, 10
patient participation, 60
workshops, 68
Patient engagement, 59, 62
design thinking in health care, 62–64
enablers and inhibitors of change, 71–72
example of using design thinking to involving patients in integrated care, 64–69
existing models and approaches to, 61
findings and reflections, 70–71
with lived experiences in service design, 60–61
outcomes, 69–70
value of, 59
Pay for performance, 27
Payer, 18–19, 33–34
Payment models, 16, 20
activity base payment, 20
actor specific limitations to integrating care, 31–34
alternative payment, 19–20
base payment, 19–20
with commissioner or payer as integrator, 29–31
incremental payment, 19–20
key elements of framework, 16–20
with patient as integrator, 20–23
pay for performance, 27
with provider as integrator, 24–29
top up payment, 19–20
value based payment, 27
Person-centred care, 4
Person-centredness, 100
person centred services, 3
Person-oriented outcome measurement, 173–175
Personal budgets, 20–23
Personal or clinical level, 4–5
Personal values session, 109–111
Personal vouchers, 20–23
Plan-Do-Study-Act framework (Deming), 138
Planned implementation, 139
Planning, 12
Pooled commissioning, 31
Population-based payments, 25–26
Post-Study System Usability Questionnaire, 121–122
Power imbalances, 86–87
Prerequisites, 78–79, 83–84, 87
Prevention, 100
Primary care budget, 25
Prime contractor model, 28–29
Principal agent problem, 18
Principles, 10
Private funding of care, 20–23
Problem solving behaviour, 81
Process accountability, 90–91
Professional level, 5
Program
activities/processes, 171–172
inputs and resources, 172
outcomes, 170–171
outputs, 171
theory, 165–166
Programme theory, 153
Proself motivation, 79–80
Prosocial motivation, 79–80, 83–84
increasing actors, 81–84
Protocols, 6
assessment protocols, 7
care protocols, 7
Prototyping, 64, 68
Provider, 15, 17–18
‘Quadruple-Aim’ set of outcomes, 170–171, 174–175
Qualitative approaches to evaluation, 177–178
Quality of care, 17
Rainbow Model of Integrated Care (RMIC), 60, 98, 105, 109, 133, 166
Readiness, 140
readiness for change, 153
Realistic evaluations, 163
Reciprocity, 100–101
Regional stakeholders, 107–108
Resilience, 3–4
Respect, 100
Retainer fee, 25
Risk, 18–19
pooling of risk, 18–19
Roles, 3
Scale, 122
Self-management, 3–4, 169
Service commissioning, 16
Service design, 60–61
Shared governance, 101–102
Shared responsibility and accountability, 99
Shared risk, 28
Shared savings, 28
Short window of opportunity, 144
Skills, 7
Social dimension of care, 76
Social motivation, 79
Social motives, 81
Social services, 4
Social stakeholder alignment, 76–78
Specific, measurable, assignable, realistic and time-related measurement approach (SMART measurement approach), 172–173
Staff
development, 152–153
training, 154
Stakeholders, 97–98
Standards, 6
standards of behaviour, 96
Status, 2
Strategy, 102
Structural elements, 75–76
Summative evaluations, 162–163, 178–179
Supervision, 101–102
Sustainability, 138
Sustaining, 48
SWOT analysis, 141, 146–147
Synthesizing, 47–48
System level, 5
System Usability Questionnaire, 121–122
Technology, 11
Testing phase, 64
Theory of change, 169
Third-party funding, 31
‘Tick the box’ method, 173–174
Tokenism, 60–61
Tool, 7
tool development, 121
Top up payment, 19–20
Transformation, 12
Transparency, 101
‘Triple-Aim’ set of outcomes, 170–171
Trust, 99
Two-sided model, 28
Usability testing, 121–122
User
service user, 13
user-centred co-design approach, 120
Validation, 65
Value-based payment, 27
Values, 96–98
core values underpinning integrated care, 98–101
dealing with value conflict as manager, 105–111
in integrated care governance, 101–105
mapping exercise, 106–107
Variation, 24–25
Veterans Rand VR-12 scale, 173
Vision
programme vision, 152
statement of organizations, 97
Voice behaviour, engaging in, 84
Voucher, 20
WHO-QOL-BREF scale, 173
Whole-systems thinking, 100
Willingness
and ability to speaking, 85–87
increasing actors, 85–87
to understanding, 89–91
‘Win-win’ agreements, 81
Kotter’s model
, 138, 145, 156–157
change
, 155–156
communicating vision
, 150–152
creating urgency
, 146–147
empowering action
, 152–154
frameworks of change
, 145–157
powerful coalition
, 147–149
quick wins
, 154–155
vision for change
, 149–150
Leadership
, 39–40, 101–102
competency frameworks
, 42–47
IC leadership competencies
, 44
shared
, 107
Learning
, 53
shared learning
, 156
Line-item budget
, 24
Linkage
, 8
Listening
, 53
Local authorities
, 95–96
Logic model
constituting
, 169–170
development
, 169–172
importance for evaluating integrated care
, 167–168
program activities/processes
, 171–172
program inputs and resources
, 172
program outcomes
, 170–171
program outputs
, 171
Lump-sum
or global budget
, 24
payment for professionals
, 24
Macro-Level mechanisms, 5–6, 50
Management, 39–40
competency frameworks, 42–47
Managers, 62
Maturation, 179–180
Measurement, 172–176
Measures, 172–173
Medical Leadership Competency Framework, 42–43
Meso-Level mechanisms, 5–6, 50, 52
mHealth, 118
Micro-Level mechanisms, 5–6, 53–54
Mission statement of organizations, 97
Mobilizing, 47
Model of effect. See Logic model
Monetary cash transfers, 20–23
Motivation, prosocial, 79–80, 83–84
Multiagency interventions, 1
Multidisciplinary teams, 69–70
Multiprofessional
character of integrated care, 143
episode-based payment, 27
service, 102–104
Municipalities, 88
Needs assessment, 17–18
Networks, 29–30
Non-adoption, Abandonment, Scale-up, Spread and Sustainability framework (NASSS framework), 122–123
Normative integration, 6–7
Norms, 6–7, 97
Nuka System of Care, 60–61
Nursing, 65
community, 137–138
district, 88
Off-the-shelf technology, adopting and adapting, 122–123
One sided risk model, 28
‘One-size-fits-all’ model, 2
Organizational
changes, 138, 144
level, 5
Outcome accountability, 90–91
‘Outside the box’ approach, 72
Parallel governance, 143–144
Partial capitation, 25
Partners, 82
Partnership, 86–87
Patient, 17, 31–32
patient engagement, 59, 62
patient involvement, 10
patient participation, 60
workshops, 68
Patient engagement, 59, 62
design thinking in health care, 62–64
enablers and inhibitors of change, 71–72
example of using design thinking to involving patients in integrated care, 64–69
existing models and approaches to, 61
findings and reflections, 70–71
with lived experiences in service design, 60–61
outcomes, 69–70
value of, 59
Pay for performance, 27
Payer, 18–19, 33–34
Payment models, 16, 20
activity base payment, 20
actor specific limitations to integrating care, 31–34
alternative payment, 19–20
base payment, 19–20
with commissioner or payer as integrator, 29–31
incremental payment, 19–20
key elements of framework, 16–20
with patient as integrator, 20–23
pay for performance, 27
with provider as integrator, 24–29
top up payment, 19–20
value based payment, 27
Person-centred care, 4
Person-centredness, 100
person centred services, 3
Person-oriented outcome measurement, 173–175
Personal budgets, 20–23
Personal or clinical level, 4–5
Personal values session, 109–111
Personal vouchers, 20–23
Plan-Do-Study-Act framework (Deming), 138
Planned implementation, 139
Planning, 12
Pooled commissioning, 31
Population-based payments, 25–26
Post-Study System Usability Questionnaire, 121–122
Power imbalances, 86–87
Prerequisites, 78–79, 83–84, 87
Prevention, 100
Primary care budget, 25
Prime contractor model, 28–29
Principal agent problem, 18
Principles, 10
Private funding of care, 20–23
Problem solving behaviour, 81
Process accountability, 90–91
Professional level, 5
Program
activities/processes, 171–172
inputs and resources, 172
outcomes, 170–171
outputs, 171
theory, 165–166
Programme theory, 153
Proself motivation, 79–80
Prosocial motivation, 79–80, 83–84
increasing actors, 81–84
Protocols, 6
assessment protocols, 7
care protocols, 7
Prototyping, 64, 68
Provider, 15, 17–18
‘Quadruple-Aim’ set of outcomes, 170–171, 174–175
Qualitative approaches to evaluation, 177–178
Quality of care, 17
Rainbow Model of Integrated Care (RMIC), 60, 98, 105, 109, 133, 166
Readiness, 140
readiness for change, 153
Realistic evaluations, 163
Reciprocity, 100–101
Regional stakeholders, 107–108
Resilience, 3–4
Respect, 100
Retainer fee, 25
Risk, 18–19
pooling of risk, 18–19
Roles, 3
Scale, 122
Self-management, 3–4, 169
Service commissioning, 16
Service design, 60–61
Shared governance, 101–102
Shared responsibility and accountability, 99
Shared risk, 28
Shared savings, 28
Short window of opportunity, 144
Skills, 7
Social dimension of care, 76
Social motivation, 79
Social motives, 81
Social services, 4
Social stakeholder alignment, 76–78
Specific, measurable, assignable, realistic and time-related measurement approach (SMART measurement approach), 172–173
Staff
development, 152–153
training, 154
Stakeholders, 97–98
Standards, 6
standards of behaviour, 96
Status, 2
Strategy, 102
Structural elements, 75–76
Summative evaluations, 162–163, 178–179
Supervision, 101–102
Sustainability, 138
Sustaining, 48
SWOT analysis, 141, 146–147
Synthesizing, 47–48
System level, 5
System Usability Questionnaire, 121–122
Technology, 11
Testing phase, 64
Theory of change, 169
Third-party funding, 31
‘Tick the box’ method, 173–174
Tokenism, 60–61
Tool, 7
tool development, 121
Top up payment, 19–20
Transformation, 12
Transparency, 101
‘Triple-Aim’ set of outcomes, 170–171
Trust, 99
Two-sided model, 28
Usability testing, 121–122
User
service user, 13
user-centred co-design approach, 120
Validation, 65
Value-based payment, 27
Values, 96–98
core values underpinning integrated care, 98–101
dealing with value conflict as manager, 105–111
in integrated care governance, 101–105
mapping exercise, 106–107
Variation, 24–25
Veterans Rand VR-12 scale, 173
Vision
programme vision, 152
statement of organizations, 97
Voice behaviour, engaging in, 84
Voucher, 20
WHO-QOL-BREF scale, 173
Whole-systems thinking, 100
Willingness
and ability to speaking, 85–87
increasing actors, 85–87
to understanding, 89–91
‘Win-win’ agreements, 81
Macro-Level mechanisms
, 5–6, 50
Management
, 39–40
competency frameworks
, 42–47
Managers
, 62
Maturation
, 179–180
Measurement
, 172–176
Measures
, 172–173
Medical Leadership Competency Framework
, 42–43
Meso-Level mechanisms
, 5–6, 50, 52
mHealth
, 118
Micro-Level mechanisms
, 5–6, 53–54
Mission statement of organizations
, 97
Mobilizing
, 47
Model of effect. See Logic model
Monetary cash transfers
, 20–23
Motivation, prosocial
, 79–80, 83–84
Multiagency interventions
, 1
Multidisciplinary teams
, 69–70
Multiprofessional
character of integrated care
, 143
episode-based payment
, 27
service
, 102–104
Municipalities
, 88
Needs assessment
, 17–18
Networks
, 29–30
Non-adoption, Abandonment, Scale-up, Spread and Sustainability framework (NASSS framework)
, 122–123
Normative integration
, 6–7
Norms
, 6–7, 97
Nuka System of Care
, 60–61
Nursing
, 65
community
, 137–138
district
, 88
Off-the-shelf technology, adopting and adapting, 122–123
One sided risk model, 28
‘One-size-fits-all’ model, 2
Organizational
changes, 138, 144
level, 5
Outcome accountability, 90–91
‘Outside the box’ approach, 72
Parallel governance, 143–144
Partial capitation, 25
Partners, 82
Partnership, 86–87
Patient, 17, 31–32
patient engagement, 59, 62
patient involvement, 10
patient participation, 60
workshops, 68
Patient engagement, 59, 62
design thinking in health care, 62–64
enablers and inhibitors of change, 71–72
example of using design thinking to involving patients in integrated care, 64–69
existing models and approaches to, 61
findings and reflections, 70–71
with lived experiences in service design, 60–61
outcomes, 69–70
value of, 59
Pay for performance, 27
Payer, 18–19, 33–34
Payment models, 16, 20
activity base payment, 20
actor specific limitations to integrating care, 31–34
alternative payment, 19–20
base payment, 19–20
with commissioner or payer as integrator, 29–31
incremental payment, 19–20
key elements of framework, 16–20
with patient as integrator, 20–23
pay for performance, 27
with provider as integrator, 24–29
top up payment, 19–20
value based payment, 27
Person-centred care, 4
Person-centredness, 100
person centred services, 3
Person-oriented outcome measurement, 173–175
Personal budgets, 20–23
Personal or clinical level, 4–5
Personal values session, 109–111
Personal vouchers, 20–23
Plan-Do-Study-Act framework (Deming), 138
Planned implementation, 139
Planning, 12
Pooled commissioning, 31
Population-based payments, 25–26
Post-Study System Usability Questionnaire, 121–122
Power imbalances, 86–87
Prerequisites, 78–79, 83–84, 87
Prevention, 100
Primary care budget, 25
Prime contractor model, 28–29
Principal agent problem, 18
Principles, 10
Private funding of care, 20–23
Problem solving behaviour, 81
Process accountability, 90–91
Professional level, 5
Program
activities/processes, 171–172
inputs and resources, 172
outcomes, 170–171
outputs, 171
theory, 165–166
Programme theory, 153
Proself motivation, 79–80
Prosocial motivation, 79–80, 83–84
increasing actors, 81–84
Protocols, 6
assessment protocols, 7
care protocols, 7
Prototyping, 64, 68
Provider, 15, 17–18
‘Quadruple-Aim’ set of outcomes, 170–171, 174–175
Qualitative approaches to evaluation, 177–178
Quality of care, 17
Rainbow Model of Integrated Care (RMIC), 60, 98, 105, 109, 133, 166
Readiness, 140
readiness for change, 153
Realistic evaluations, 163
Reciprocity, 100–101
Regional stakeholders, 107–108
Resilience, 3–4
Respect, 100
Retainer fee, 25
Risk, 18–19
pooling of risk, 18–19
Roles, 3
Scale, 122
Self-management, 3–4, 169
Service commissioning, 16
Service design, 60–61
Shared governance, 101–102
Shared responsibility and accountability, 99
Shared risk, 28
Shared savings, 28
Short window of opportunity, 144
Skills, 7
Social dimension of care, 76
Social motivation, 79
Social motives, 81
Social services, 4
Social stakeholder alignment, 76–78
Specific, measurable, assignable, realistic and time-related measurement approach (SMART measurement approach), 172–173
Staff
development, 152–153
training, 154
Stakeholders, 97–98
Standards, 6
standards of behaviour, 96
Status, 2
Strategy, 102
Structural elements, 75–76
Summative evaluations, 162–163, 178–179
Supervision, 101–102
Sustainability, 138
Sustaining, 48
SWOT analysis, 141, 146–147
Synthesizing, 47–48
System level, 5
System Usability Questionnaire, 121–122
Technology, 11
Testing phase, 64
Theory of change, 169
Third-party funding, 31
‘Tick the box’ method, 173–174
Tokenism, 60–61
Tool, 7
tool development, 121
Top up payment, 19–20
Transformation, 12
Transparency, 101
‘Triple-Aim’ set of outcomes, 170–171
Trust, 99
Two-sided model, 28
Usability testing, 121–122
User
service user, 13
user-centred co-design approach, 120
Validation, 65
Value-based payment, 27
Values, 96–98
core values underpinning integrated care, 98–101
dealing with value conflict as manager, 105–111
in integrated care governance, 101–105
mapping exercise, 106–107
Variation, 24–25
Veterans Rand VR-12 scale, 173
Vision
programme vision, 152
statement of organizations, 97
Voice behaviour, engaging in, 84
Voucher, 20
WHO-QOL-BREF scale, 173
Whole-systems thinking, 100
Willingness
and ability to speaking, 85–87
increasing actors, 85–87
to understanding, 89–91
‘Win-win’ agreements, 81
Off-the-shelf technology, adopting and adapting
, 122–123
One sided risk model
, 28
‘One-size-fits-all’ model
, 2
Organizational
changes
, 138, 144
level
, 5
Outcome accountability
, 90–91
‘Outside the box’ approach
, 72
Parallel governance
, 143–144
Partial capitation
, 25
Partners
, 82
Partnership
, 86–87
Patient
, 17, 31–32
patient engagement
, 59, 62
patient involvement
, 10
patient participation
, 60
workshops
, 68
Patient engagement
, 59, 62
design thinking in health care
, 62–64
enablers and inhibitors of change
, 71–72
example of using design thinking to involving patients in integrated care
, 64–69
existing models and approaches to
, 61
findings and reflections
, 70–71
with lived experiences in service design
, 60–61
outcomes
, 69–70
value of
, 59
Pay for performance
, 27
Payer
, 18–19, 33–34
Payment models
, 16, 20
activity base payment
, 20
actor specific limitations to integrating care
, 31–34
alternative payment
, 19–20
base payment
, 19–20
with commissioner or payer as integrator
, 29–31
incremental payment
, 19–20
key elements of framework
, 16–20
with patient as integrator
, 20–23
pay for performance
, 27
with provider as integrator
, 24–29
top up payment
, 19–20
value based payment
, 27
Person-centred care
, 4
Person-centredness
, 100
person centred services
, 3
Person-oriented outcome measurement
, 173–175
Personal budgets
, 20–23
Personal or clinical level
, 4–5
Personal values session
, 109–111
Personal vouchers
, 20–23
Plan-Do-Study-Act framework (Deming)
, 138
Planned implementation
, 139
Planning
, 12
Pooled commissioning
, 31
Population-based payments
, 25–26
Post-Study System Usability Questionnaire
, 121–122
Power imbalances
, 86–87
Prerequisites
, 78–79, 83–84, 87
Prevention
, 100
Primary care budget
, 25
Prime contractor model
, 28–29
Principal agent problem
, 18
Principles
, 10
Private funding of care
, 20–23
Problem solving behaviour
, 81
Process accountability
, 90–91
Professional level
, 5
Program
activities/processes
, 171–172
inputs and resources
, 172
outcomes
, 170–171
outputs
, 171
theory
, 165–166
Programme theory
, 153
Proself motivation
, 79–80
Prosocial motivation
, 79–80, 83–84
increasing actors
, 81–84
Protocols
, 6
assessment protocols
, 7
care protocols
, 7
Prototyping
, 64, 68
Provider
, 15, 17–18
‘Quadruple-Aim’ set of outcomes, 170–171, 174–175
Qualitative approaches to evaluation, 177–178
Quality of care, 17
Rainbow Model of Integrated Care (RMIC), 60, 98, 105, 109, 133, 166
Readiness, 140
readiness for change, 153
Realistic evaluations, 163
Reciprocity, 100–101
Regional stakeholders, 107–108
Resilience, 3–4
Respect, 100
Retainer fee, 25
Risk, 18–19
pooling of risk, 18–19
Roles, 3
Scale, 122
Self-management, 3–4, 169
Service commissioning, 16
Service design, 60–61
Shared governance, 101–102
Shared responsibility and accountability, 99
Shared risk, 28
Shared savings, 28
Short window of opportunity, 144
Skills, 7
Social dimension of care, 76
Social motivation, 79
Social motives, 81
Social services, 4
Social stakeholder alignment, 76–78
Specific, measurable, assignable, realistic and time-related measurement approach (SMART measurement approach), 172–173
Staff
development, 152–153
training, 154
Stakeholders, 97–98
Standards, 6
standards of behaviour, 96
Status, 2
Strategy, 102
Structural elements, 75–76
Summative evaluations, 162–163, 178–179
Supervision, 101–102
Sustainability, 138
Sustaining, 48
SWOT analysis, 141, 146–147
Synthesizing, 47–48
System level, 5
System Usability Questionnaire, 121–122
Technology, 11
Testing phase, 64
Theory of change, 169
Third-party funding, 31
‘Tick the box’ method, 173–174
Tokenism, 60–61
Tool, 7
tool development, 121
Top up payment, 19–20
Transformation, 12
Transparency, 101
‘Triple-Aim’ set of outcomes, 170–171
Trust, 99
Two-sided model, 28
Usability testing, 121–122
User
service user, 13
user-centred co-design approach, 120
Validation, 65
Value-based payment, 27
Values, 96–98
core values underpinning integrated care, 98–101
dealing with value conflict as manager, 105–111
in integrated care governance, 101–105
mapping exercise, 106–107
Variation, 24–25
Veterans Rand VR-12 scale, 173
Vision
programme vision, 152
statement of organizations, 97
Voice behaviour, engaging in, 84
Voucher, 20
WHO-QOL-BREF scale, 173
Whole-systems thinking, 100
Willingness
and ability to speaking, 85–87
increasing actors, 85–87
to understanding, 89–91
‘Win-win’ agreements, 81
‘Quadruple-Aim’ set of outcomes
, 170–171, 174–175
Qualitative approaches to evaluation
, 177–178
Quality of care
, 17
Rainbow Model of Integrated Care (RMIC)
, 60, 98, 105, 109, 133, 166
Readiness
, 140
readiness for change
, 153
Realistic evaluations
, 163
Reciprocity
, 100–101
Regional stakeholders
, 107–108
Resilience
, 3–4
Respect
, 100
Retainer fee
, 25
Risk
, 18–19
pooling of risk
, 18–19
Roles
, 3
Scale, 122
Self-management, 3–4, 169
Service commissioning, 16
Service design, 60–61
Shared governance, 101–102
Shared responsibility and accountability, 99
Shared risk, 28
Shared savings, 28
Short window of opportunity, 144
Skills, 7
Social dimension of care, 76
Social motivation, 79
Social motives, 81
Social services, 4
Social stakeholder alignment, 76–78
Specific, measurable, assignable, realistic and time-related measurement approach (SMART measurement approach), 172–173
Staff
development, 152–153
training, 154
Stakeholders, 97–98
Standards, 6
standards of behaviour, 96
Status, 2
Strategy, 102
Structural elements, 75–76
Summative evaluations, 162–163, 178–179
Supervision, 101–102
Sustainability, 138
Sustaining, 48
SWOT analysis, 141, 146–147
Synthesizing, 47–48
System level, 5
System Usability Questionnaire, 121–122
Technology, 11
Testing phase, 64
Theory of change, 169
Third-party funding, 31
‘Tick the box’ method, 173–174
Tokenism, 60–61
Tool, 7
tool development, 121
Top up payment, 19–20
Transformation, 12
Transparency, 101
‘Triple-Aim’ set of outcomes, 170–171
Trust, 99
Two-sided model, 28
Usability testing, 121–122
User
service user, 13
user-centred co-design approach, 120
Validation, 65
Value-based payment, 27
Values, 96–98
core values underpinning integrated care, 98–101
dealing with value conflict as manager, 105–111
in integrated care governance, 101–105
mapping exercise, 106–107
Variation, 24–25
Veterans Rand VR-12 scale, 173
Vision
programme vision, 152
statement of organizations, 97
Voice behaviour, engaging in, 84
Voucher, 20
WHO-QOL-BREF scale, 173
Whole-systems thinking, 100
Willingness
and ability to speaking, 85–87
increasing actors, 85–87
to understanding, 89–91
‘Win-win’ agreements, 81
Scale
, 122
Self-management
, 3–4, 169
Service commissioning
, 16
Service design
, 60–61
Shared governance
, 101–102
Shared responsibility and accountability
, 99
Shared risk
, 28
Shared savings
, 28
Short window of opportunity
, 144
Skills
, 7
Social dimension of care
, 76
Social motivation
, 79
Social motives
, 81
Social services
, 4
Social stakeholder alignment
, 76–78
Specific, measurable, assignable, realistic and time-related measurement approach (SMART measurement approach)
, 172–173
Staff
development
, 152–153
training
, 154
Stakeholders
, 97–98
Standards
, 6
standards of behaviour
, 96
Status
, 2
Strategy
, 102
Structural elements
, 75–76
Summative evaluations
, 162–163, 178–179
Supervision
, 101–102
Sustainability
, 138
Sustaining
, 48
SWOT analysis
, 141, 146–147
Synthesizing
, 47–48
System level
, 5
System Usability Questionnaire
, 121–122
Technology
, 11
Testing phase
, 64
Theory of change
, 169
Third-party funding
, 31
‘Tick the box’ method
, 173–174
Tokenism
, 60–61
Tool
, 7
tool development
, 121
Top up payment
, 19–20
Transformation
, 12
Transparency
, 101
‘Triple-Aim’ set of outcomes
, 170–171
Trust
, 99
Two-sided model
, 28
Usability testing, 121–122
User
service user, 13
user-centred co-design approach, 120
Validation, 65
Value-based payment, 27
Values, 96–98
core values underpinning integrated care, 98–101
dealing with value conflict as manager, 105–111
in integrated care governance, 101–105
mapping exercise, 106–107
Variation, 24–25
Veterans Rand VR-12 scale, 173
Vision
programme vision, 152
statement of organizations, 97
Voice behaviour, engaging in, 84
Voucher, 20
WHO-QOL-BREF scale, 173
Whole-systems thinking, 100
Willingness
and ability to speaking, 85–87
increasing actors, 85–87
to understanding, 89–91
‘Win-win’ agreements, 81
Usability testing
, 121–122
User
service user
, 13
user-centred co-design approach
, 120
Validation
, 65
Value-based payment
, 27
Values
, 96–98
core values underpinning integrated care
, 98–101
dealing with value conflict as manager
, 105–111
in integrated care governance
, 101–105
mapping exercise
, 106–107
Variation
, 24–25
Veterans Rand VR-12 scale
, 173
Vision
programme vision
, 152
statement of organizations
, 97
Voice behaviour, engaging in
, 84
Voucher
, 20
WHO-QOL-BREF scale, 173
Whole-systems thinking, 100
Willingness
and ability to speaking, 85–87
increasing actors, 85–87
to understanding, 89–91
‘Win-win’ agreements, 81
WHO-QOL-BREF scale
, 173
Whole-systems thinking
, 100
Willingness
and ability to speaking
, 85–87
increasing actors
, 85–87
to understanding
, 89–91
‘Win-win’ agreements
, 81
- Prelims
- 1 Integrated Care – An Introduction
- 2 Financing Care Integration: A Conceptual Framework of Payment Models That Support Integrated Care
- 3 Leadership in Integrated Care
- 4 Engaging Patients for Integrating Care
- 5 Social Dimensions of Care Integration
- 6 Values in Integrated Care
- 7 Digital Health Enabling Integrated Care
- 8 Implementing Integrated Care
- 9 Evaluating Integrated Care
- Index