The goal of integrated patient care remains elusive while there are so many barriers to the various services and professions working together.
The barriers reflect structural and financing factors, as well as the competing priorities, perceptions, and interests of those working in different systems, roles and professions.
As University of Toronto researchers recently put it:
“When an integrated care strategy or initiative is introduced, representatives from different healthcare sectors (home care, acute care, mental health, etc.) and professions (clinical, managerial, governance, etc.) must collaborate; yet they often experience cognitive disorder while making sense of change, and fail to develop shared perceptions and common goals.
Even when believing their actions are in the best interests of the system and its patients, individuals may exhibit bias toward the interests of their respective sector, organization, or function.”
The researchers, writing in the Journal of Health Organization and Management, suggest that one solution may lie in helping leaders and staff to create shared mental models of integrated care.
This approach posits that members of a team must have a shared understanding of their tasks and roles to maximise team effectiveness and has been mainly used to date in military, information technology, and engineering contexts.
Its potential for the health sector is explored in the latest update below from the Primary Health Care Research & Information Service.
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Finding the common ground in integrated care through shared mental models
Amanda Carne writes:
Health service organisations and professionals are under increasing pressure to work together to deliver integrated patient care.
There is global interest in the associated challenges to understand, predict and support the characteristic behaviours of actors within health systems.
Mental models, or psychological representations of the environment, are one tool that can help individuals to describe system purpose (eg why the system exists), explain system functioning (eg what the system does), and predict future system states (eg what the system is likely to do).
Drawing from previous literature on shared mental models, strategic management and change, framing, stakeholder management, and systems theory, the authors explore ways to synthesise multiple stakeholder perspectives and develop a new construct termed ‘Mental Models of Integrated Care’ (MMIC), which consists of three types of models; namely integration-task, system-role and integration-belief.
The MMIC construct provides a comprehensive framework of psychological factors that may help or hinder inter-organisational and inter-professional relations. MMIC emphasises the convergence and divergence of stakeholders’ knowledge and beliefs and how these cognitions influence interactions across the continuum of care.
The authors suggest that shared MMICs among health system stakeholders may help create a collaborative environment conducive to the delivery of more integrated care (ie. a way of getting diverse stakeholders to work towards the same objectives by having a shared understanding of who does what and why).
The models therefore can provide a beneficial framework in terms of explaining what differentiates effective from ineffective initiatives, determining system readiness to integrate, diagnosing integration problems and developing interventions for enhancing integration.
• Amanda Carne is Research Associate at PHC RIS
Jenna M. Evans, G. Ross Baker, (2012) “Shared mental models of integrated care: aligning multiple stakeholder perspectives”, Journal of Health Organization and Management, Vol. 26 Iss: 6, pp.713 – 736
(A copy is available on request to Croakey).
This article, which can be accessed at http://www.emeraldinsight.com/journals.htm?issn=1477-7266&volume=26&issue=6&articleid=17062834&show=html, features in the 17th January 2013 edition of PHC RIS eBulletin, available at http://www.phcris.org.au/publications/ebulletin/index.php.
The eBulletin is designed to inform readers of recently published articles and reports, news items, media releases, upcoming conferences and courses, research grants, scholarships and fellowships, PHC RIS products and services and relevant websites in the primary health care field. Those interested in receiving the weekly eBulletin are invited to subscribe to the free service at http://www.phcris.org.au/mailinglists/index.php.
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Previous PHC RIS columns at Croakey
• From nurse prescribing to an Australian experiment
• How best to improve management of childhood obesity and related health problems
• Sustaining small rural primary health care services
• What is the evidence on knowledge translation strategies?
• Should your doctor be asking after your pet too?
• Nurses add value to chronic disease management
• Some useful tips for finding health policy information on the web
• Pros and cons of telehealth for people in rural areas
• What helps GPs provide better mental healthcare (and what doesn’t)
• Improving collaboration in diabetes care
• Improving dementia management in general practice
• Pets and what they do for our health
• Improving the diagnosis of ovarian cancer
• Chronic health problems and depression
• Helping older patients with chronic diseases to navigate the health system
• Tackling overuse of antibiotics
• When doctors prescribe exercise, does it make any difference?
• Caring for country is also good for Aboriginal people
• The perils of surrogate markers
• Are Australians willing to pay more for better oral health?
• What helps encourage self-care for those with chronic illness?
• More effort needed to strengthen shared care for people with serious mental illness
