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A local healthcare organisation providing healthcare to 288,000 residents in Sweden struggled with a longstanding budget deficit. Several attempts to overcome the demanding financial situation have failed. A decommissioning programme was launched, and two years later, an evaluation indicated positive outcomes. The aim of this study was to explore factors politicians and public servants perceived as enablers to the successful implementation of the programme.

A deductive content analysis approach using a framework of factors facilitating successful implementation of decommissioning decisions was applied to analyse interviews with 18 informants.

Important factors were: (1) a review report contributing to the clarity of evidence, which (2) made the clarity of the rationale for change undeniable and (3) strengthened the political support for change. Additional factors were: (4) the strength of executive leadership, (5) the strength of clinical leadership supported by (6) the quality of project management and (7) a cultural and behavioural change seen as an important outcome for the path forward. A way to maximise the potential for a successful implementation of a large-scale decommissioning programme is to build a shared vision and a collaboration grounded in convincing evidence. Include public servants with a clinical background in the executive leadership team to contribute with legitimacy, competence, and trust in the decommissioning programme’s intention.

The paper addresses the limited knowledge of best practices in decommissioning processes and contributes empirical knowledge from a successful case.

The European funded project ADLIFE focuses on the application of digitally enabled integrated care for people with advanced chronic diseases. The implementation of the ADLIFE intervention required a robust practical tool that would be common to all pilot sites while allowing flexibility for local variations as well as the ability to adapt to unanticipated changes and problems.

The ADLIFE project combined the concepts of implementation research and formative evaluation with the standardized operating procedures (SOP) methodology. The ADLIFE project significantly modified the SOP approach and used it as a means to not only to define and organize the tasks that needed to be performed in preparing and implementing the ADLIFE intervention but also to create a deeper understanding of the unique challenges faced in each site, as well as a method for achieving a consensus.

The ADLIFE SOPs were developed by a dedicated working group, and they encompassed the preparatory phase leading up to implementation of the intervention. The SOP was also the basis for monitoring the implementation, and this created a structure for the dynamic ongoing tactical and even strategic changes necessitated by local diversity as well as many unanticipated changes.

The SOP methodology was useful in supporting the development of the ADLIFE SOP, which was a consensus-based approach to guide for managing the implementation process, both at project and local levels. It has supported continuous improvement and learning throughout the project. Both the process and the SOP produced by the process can be readily adapted and used in other similar projects.

In this paper, we aim to test the usefulness and contribute to the further development of analytical frameworks that guide research into integrated health and social care initiatives.

This study uses case studies based in decentralised administrative areas within the New South Wales state health system using (1) the Innovative Policy Supports for Integrated Health and Social Care Programs Framework, (2) the Consolidated Framework for Implementation Research and (3) the Framework on the Emergence and Effectiveness of Global Health Networks to assess the quality of international policies and/or strategies and integrated health and social care networks.

This study facilitates and advances integrated health and social care knowledge, moving from the study of local initiatives to a higher-level taxonomy of integrated care initiatives and exploring the emergence and effectiveness of global integrated care knowledge exchange networks. This paper proposes the use of three different frameworks to assess enhancement of the integrated health and social care using an array of multi-level innovation efforts as case studies.

This paper highlights the need for further research, and additional supports for formulating a single unified integrated health and social care framework that can assess innovations at multiple levels beyond local settings.

A stronger partnership with key stakeholders to enhance integrated health and social care research capabilities would be a feasible way to increase care and research capabilities in all sectors.

Health and social care clinicians, consumer representatives, service managers, policymakers and network knowledge partners must co-design a unified framework that better reflects the large multi-level agenda for integrated health and social care system change.

This novel study examines the level of integration of local space-based health and social care interventions, develops a taxonomy of local health district and/or primary care network integrated care initiatives to locate the “local” within a broader policy context and evaluates the quality of international policies and/or strategies and integrated health and social care networks.