Developing a framework to guide managers on the key factors for success

Developing a framework to guide managers on the key factors for success in integrated care initiatives

One of the key outcomes of Project INTEGRATE will be to provide managers and policy-makers with guidance on how to implement and sustain integrated care initiatives in practice. This is an important aspiration of the research since lessons from experience highlight significant difficulties across Europe in moving from the pilot phases of integrated care projects that are often limited to specific geographical localities or which fail to progress effectively as the key components in building integrated care systems are overlooked.

Led by Stefano Calciolari at the University of Italian Switzerland (USI), with support from IFIC, phase 3 of Project INTEGRATE across 2015/16 has commenced an ‘international check’ that has to-date brought together a comprehensive literature review, combined with the evidence from earlier phases in the project, to produce a framework that seeks to identify the most relevant factors influencing the progress of integrated care initiatives.

The framework is intended to enable our research to produce comparable descriptions of integrated care initiatives implemented in different contexts and settings across Europe in a user-friendly way to managers tasked with leading and implementing change. The framework is currently at the validation stage with key experts in the field, and will be further ‘road-tested’ with the four case sites investigated in the first phase of the project and, additionally, across key informants from 16 case examples internationally. The purpose here will be to refine the framework and so develop a useful tool to support self-assessment.

In recent years there have been many advances in the development of useful conceptual frameworks on which to judge progress and guide implementation. These range from the development of the well-used Chronic Care Management model and its variants to the more recent work by Valentijn et al – the Rainbow of Chaos – that was subject to IFIC’s Inaugural Integrated Award back in 2014. In building on such work, we aim to develop a user-friendly, clear and relevant framework that may itself be effectively integrated into managerial and policy decision-making processes.

Of key added value through our work will be the potential to determine the impact of key contextual differences (for example, related to the way care is financed or organised, or to the nature of the user-groups in receipt of integrated services). This is potentially important since we know that ‘no one size fits all’ in integrated care and that the characteristics of local contexts play a hugely significant part in its development. We hypothesise, for example, that the strength of key factors will vary between disease-based approaches (e.g. to people with COPD and diabetes) versus those that seek to provide more holistic care to older people with multiple needs or to address mental health. It remains to be seen whether this is true and whilst our research will obviously not be able to give a definitive answer it will at least alert decision-makers that strategies for adoption may require more emphasis on some components of integrated care rather than others.

The interim findings of the international check will be presented and debated on May 23rd 2016 at Project INTEGRATE’s end-of-project conference held during the 16th International Congress on Integrated Care in Barcelona. We look forward to seeing you there!


Nick Goodwin bw
Nick Goodwin,
International Foundation for Integrated Care (IFIC)