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Effective integrated healthcare systems require capable, trained workforces with leadership, shared governance and co-ordination. The purpose of this paper is to characterise roles and responsibilities in relation to integrated care from the perspective of massive open online course (MOOC) participants.

MOOC discussion board posts were analysed using framework analysis consisting of transcription, familiarisation, coding, developing an analytical framework and application of the framework.

Boundaries and key issues surrounding roles and responsibilities were highlighted and participants suggested a number of enablers which could enhance integrated care in addition to barriers to consider and overcome.

Enablers included introduction of shared communication and IT systems to support continuity of care. Awareness and understanding of dementia was seen as crucial to promote person-centred care and care planning. The roles of education and experience were highlighted. Barriers preventing effective roles and suitable responsibility include funding, role conflicts, time constraints and time-consuming paperwork.

In Canada, integrated care pilot projects are often implemented as a local reform strategy to improve the quality of patient care and system efficiencies. In the qualitative study reported here, the authors explored the experiences of healthcare professionals when first implementing integrated care pilot projects, bringing together physical and mental health services, in a community hospital setting.

Engaging a qualitative descriptive study design, semi-structured interviews were conducted with 24 healthcare professionals who discussed their experiences with implementing three integrated care pilot projects one year following project launch. The thematic analysis captured early implementation issues and was informed by an institutional logics framework.

Three themes highlight disruptions to established logics reported by healthcare professionals during the early implementation phase: (1) integrated care practices increased workload and impacted clinical workflows; (2) integrating mental and physical health services altered patient and healthcare provider relationships; and (3) the introduction of integrated care practices disrupted healthcare team relations.

Study findings highlight the importance of considering existing logics in healthcare settings when planning integrated care initiatives. While integrated care pilot projects can contribute to organizational, team and individual practice changes, the priorities of healthcare stakeholders, relational work required and limited project resources can create significant implementation barriers.

Integrated health care lacks a theoretical concept of the user figure that is appropriate to reflect users’ various claims and multi-dimensional interrelations in the care process. The paper aims to discuss this issue.

Key goals of integrated health care, such as a continuity of care, seamless services and better health outcomes depend strongly on users’ capabilities to engage themselves in the care process. These goals are hardly reachable if integrated health care schemes operate with a one-dimensional understanding of users’ identity.

The suggested concept of users’ identity facets suggests that users draw from different sources while receiving integrated health care. Thus, users are patients, co-producers, citizens, consumers and community members in one person and at the same time. Each facet of the user identity gains or loses relevance depending on health care contexts, health statuses, personal values and the design of service arrangements. As demonstrated by the example of disease management programmes (DMPs), care schemes for chronically ill persons, users have to apply different facets of their identities in order to benefit best from service provision. Moreover, addressing users’ identity may facilitate the extent of integration in DMPs.

Integrated health care schemes are challenged to invent strategies that facilitate and support coherence among users’ diverse identities in the process of service provision. Lessons could be learned from small-scale and localized integrated health care networks.

The purpose of this paper is to explore the presence and nature of integrated care in community hospitals.

Staff reported their views and experiences of integrated care in 48 questionnaires for a Community Hospitals Association programme. An analytical framework was developed based on eight types of integration, and the community hospital services concerned were grouped into nine service categories.

Staff reported multiple types of integration, averaging four types (median), with a range of two to eight (of the eight types studied). The types of integration most frequently reported were multidisciplinary care, and community hospital/secondary care and community hospital/primary care. Integration with communities, patients and the third sector featured in many of the services. Integration with social care and local authorities were least frequently reported. Services with the highest number of types of integration (5+) included palliative care, maternity services and health promotion. Staff reported that commitment was a positive factor whilst a lack of staff resources hindered partnership working.

Staff volunteered to be part of the programme which promoted good practice, and although the findings from the study cannot be generalised, they do contribute knowledge on key partnerships in local hospitals. Further research on the types, levels and outcomes of integrated care in a larger sample of community hospitals would build on this study and enable further exploration of partnership working.

The analytical framework developed for the study is being applied by staff and community groups as a tool to help assess appropriate partnership working and help identify the scope for further developing integrated care. The evidence of integrated working is available to inform those commissioning and providing community health services.

This study has shown that integrated working is present in community hospitals. This research provides new knowledge on the types of integrated care present in a range of community hospital services. The study shows a tradition of joint working, the presence of multiple simultaneous types of integration and demonstrated that integrated care can be provided in a range of services to patients of all ages in local communities.

The purpose of this paper is to use theories of institutional logics and institutional entrepreneurship to examine how and why macro-, meso-, and micro-level influences inter-relate in the implementation of integrated transitional care out of hospital in the English National Health Service.

The authors conducted an ethnographic case study of a hospital and surrounding services within a large urban centre in England. Specific methods included qualitative interviews with patients/caregivers, health/social care providers, and organizational leaders; observations of hospital transition planning meetings, community “hub” meetings, and other instances of transition planning; reviews of patient records; and analysis of key policy documents. Analysis was iterative and informed by theory on institutional logics and institutional entrepreneurship.

Organizational leaders at the meso-level of health and social care promoted a partnership logic of integrated care in response to conflicting institutional ideas found within a key macro-level policy enacted in 2003 (The Community Care (Delayed Discharges) Act). Through institutional entrepreneurship at the micro-level, the partnership logic became manifest in the form of relationship work among health and social care providers; they sought to build strong interpersonal relationships to enact more integrated transitional care.

This study has three key implications. First, efforts to promote integrated care should strategically include institutional entrepreneurs at the organizational and clinical levels. Second, integrated care initiatives should emphasize relationship-building among health and social care providers. Finally, theoretical development on institutional logics should further examine the role of interpersonal relationships in facilitating the “spread” of logics between macro-, meso-, and micro-level influences on inter-organizational change.

Policy has identified the need for integrated dementia services for older people. However, the role of the formal carer within an integrated framework of service delivery has not been well articulated in practice. The aim of this paper is to understand the experiences of formal carers working with the context of an integrated dementia service by exploring findings from a research‐based evaluation.

The evaluation captured the experiences of formal carers working within the service via observations, semi‐structured interviews and focus groups.

Working with an integrated service brings about individual, social and organisational challenges to the role of the formal carer, in terms of: delivering flexibility and responsiveness, providing continuity of care, ensuring cross‐organisational working and acquiring skills, knowledge and expertise.

To facilitate the successful delivery of integrated care, the emerging role of the formal carer needs to be more clearly articulated and supported within a service context.

This study examined the contribution of adult social work in integrated teams in the UK.

The study design was realist, evaluation research using a mixed methods approach. Data collection methods included interviews and focus groups. Types of social work activities were extracted from older adults' case records and used to calculate costs of care. The presence or absence of indicators of care quality was recorded using the same sample of case records. Data were collected from three primary care teams in which social work was integrated. They were compared with data from three social-work-only teams in the same districts. Narrative data was analysed thematically. Inferential and descriptive statistics were used to compare costs and care quality.

When social work was embedded or attached to a primary care team, costs of care delivery were lower than in their social-work-only team and more indicators of good quality care outcomes were recorded. Results suggest that embedding social work in integrated primary care teams contributes to cost-effective, quality care for older people if certain conditions for integration are met.

This is the first study to triangulate three data sources to quantify the social work contribution to integrated primary health care teams for older adults.

The purpose of this paper is to reflect on the experience of the Advancing Quality Alliance's (AQuA) regional Integrated Care Discovery Community created to translate integrated care theory into practice at scale and to test ways to address the system enablers of integrated care.

Principles of flexibility, agility, credibility and scale influenced Community design. The theoretical framework drew on relevant complexity, learning community and change management theories. Co-designed with stakeholders, the discovery-based Community model incorporated emergent learning from change in complex adaptive environments and focused bespoke support on leadership capability building.

In total, 19 health and social care economies participated. Kotter's eight-step change model proved flexible in conjunction with large-scale change theories. The tension between programme management, learning communities and the emergent nature of change in complex adaptive systems can be harnessed to inject pace and urgency. Mental models and simple rules were helpful in managing participant's desire for a directive approach in the context of a discovery programme.

This is a viewpoint from a regional improvement organisation in North West England.

The Discovery Community was a useful construct through which to rapidly develop multiple integrated health and social care economies. Flexible design and bespoke delivery is crucial in a complex adaptive environment. Capability building needs to be agile enough to meet the emergent needs of a changing workforce. Collaborative leadership has emerged as an area requiring particular attention.

Learning from AQuA's approach may assist others in structuring large-scale integrated care or complex change initiatives.

This paper presents a comparison of the views of staff working in 18 integrated care settings, undertaken as part of the PROCARE study of integrated health and social care. The data reveals some apparent commonalities across the nine European countries. Increased job satisfaction was an advantage of integrated working, but respondents also reported difficulties in working with hospitals or medical professionals, and continued barriers to integrated working generally. Overall, single standalone organisations such as home care teams reported the clearest benefits from integrated working, while cross‐agency models continued to encounter significant barriers to health and social care integration.

Integrated care has been identified as essential to delivering the reforms required in health and social care across the UK and other healthcare systems. Given this suggests new ways of working for health and social care professionals, little research has considered how different professions manage and mobilise their professional identity (PI) whilst working in an integrated team. The paper aims to discuss these issues.

A qualitative cross-sectional study was designed using eight focus groups with community-based health and social care practitioners from across Wales in the UK during 2017.

Participants reported key factors influencing practice were communication, goal congruence and training. The key characteristics of PI for that enabled integrated working were open mindedness, professional trust, scope of practice and uniqueness. Blurring of boundaries was found to enable and hinder integrated working.

This research was conducted in the UK which limits the geographic coverage of the study. Nevertheless, the insight provided on PI and integrated teams is relevant to other healthcare systems.

This study codifies for health and social care practitioners the enabling and inhibiting factors that influence PI when working in integrated teams.

Recommendations in terms of how healthcare professionals manage and mobilise their PI when working in integrated teams are somewhat scarce. This paper identifies the key factors that influence PI which could impact the performance of integrated teams and ultimately, patient care.