The only constant is change : exploring the evolvement of health and social care integration

Introduction: Health and social care services, in Sweden and worldwide, struggle to provide comprehensive care and support for people with complex needs. As these services are currently structured, it is difficult to provide service users with such care. This difficulty is especially acute for patients with mental illness. However, many challenges exist in the effort to achieve cross-sectoral cooperation of health and social care services. This thesis addresses one of these challenges: the evolvement of long-lasting integrated health and social care services in mental health care.

Aim: This thesis explores the organisational dynamics of long-term health and social care integration.

Methods: A qualitative research approach is taken in a longitudinal case study. The research consists of three studies on integrated health and social care: two studies take an organisational (managerial) perspective; one study takes a service user perspective. Data were collected in individual and group interviews and from steering committee minutes.

Findings: The findings from the three studies are summarized using four theoretically and empirically based themes related to the evolvement of long-term mental health and social care integration.

Shared structure and ongoing refinement: The integrated services were co-located under co-leadership management. A shared mission on the value of integrated health and social care was essential for establishing a culture of shared values and for sustaining the required long-term collaboration and cooperation.

Continuous learning: The continuous exchange of competencies and experiences was prioritized. Forums were established in which the various stakeholders could exchange information, interact, and learn in a culture of improvement. Team members were encouraged to help find effective solutions to the problems encountered when providing equal health and social care.

Cooperation as a guiding principle: The integration of health and social care services, which was based on the principle of cooperation, encouraged the participation of informal caregivers and of other parties such as stakeholder/service user associations, service user representatives, and municipal and county representatives.

Service user centeredness: The central role of the service user was formalized by an agreement that specified the individual care and rehabilitations plans. Attention was paid to service users’ holistic needs and to their abilities and strengths in the focus on finding best-possible solutions to their individual circumstances.

Conclusion: This thesis identified three main factors that proved to play a central role in the achievement of long-term integration of health and social care services. First, partnership building between the health and social care services, as well as with service users and service user associations, enabled the sharing of responsibility for the integrated services and a long-term orientation in decision-making. The formulation of an overall agreement, a shared mission, and the involvement of all stakeholders in the steering committee of the integrated services were activities that exemplified this. Second, person-centeredness was important in the design and provision of the integrated services, as well as during encounters with service users. Co-location of services, co-leadership, and interprofessional-teams were some of the strategies that were used to meet service users’ holistic needs. Third, organisational learning was a strategy to overcome obstacles resulting from cross-sectoral cooperation, and to continually adapt and align services to the changing needs of service users. In conclusion, the findings in this thesis suggest that the emergence and long-lasting integration of health and social care services were based in the capacity to manage differences and changes by relying on the concepts of partnership, person-centeredness, and continuous learning.

List of scientific papers

I. Klinga, C., Hansson, J., Hasson, H., & Sachs, M. A. (2016). Co-leadership –A management solution for integrated health and social care. International Journal of Integrated Care. 16(2):7.
https://doi.org/10.5334/ijic.2236

II. Klinga, C., Hasson, H., Sachs, M. A., & Hansson, J. (2018). Understanding the dynamics of sustainable change: A 20-year case study of integrated health and social care. BMC Health Services Research. 18:400.
https://doi.org/10.1186/s12913-018-3061-6

III. Klinga, C., Hasson, H., Sachs, M. A., Hansson, J., & Wannheden C. Through the eye of the service user representative: What key components contribute to value in integrated mental health and social care services? [Submitted]