Legal requirements can also hamper the information exchange (e.g. They were run for matches with synonyms for “inter-organisational” to exclude, for instance, research on neuronal networks (for an overview of the search terms and their applications, see Table 1 in the appendix). Based on this review, several areas for further research can be identified: first, our knowledge regarding barriers to the integration of care in inter-organisational settings would benefit from more systematic attention to existing organisation and network theories that address such barriers, even if only implicitly. DOI: https://doi.org/10.1111/cch.12322, Dinesen, B, Seeman, J and Gustafsson, J. The reviewed literature provides insights on the relationships between barriers as well as their causes. Discussion and conclusion: The compilation of these results allows for a better understanding of the characteristics and reasons for the occurrence of barriers that impede collaboration aiming for the integration of care, not only for researchers but also for practitioners. “Behavioral health services often require multiple sessions and extensive follow-up, which differs markedly from the way physical health needs are handled. 1, 2018, p. 5. The emerging types of barriers were then assigned to six categories representing analytical themes, derived from the domains regarded important for the integration of care as proposed by Kodner and Spreeuwenberg [1]. Attitudinal barriers are the most basic and contribute to other barriers. Some authors argue that the terms “barrier” and “facilitator” describe two sides of the same coin; e.g. Girard, A. Reader’s block: A systematic review of barriers to adoption, access and use in e-book user studies. This discussion paper focuses on some particularly challenging aspects of bridging primary care and oral health care for low health literacy populations. More often than not, several healthcare providers are involved in the care of the patient, from general practitioners and nurse practitioners to various specialists (for example eye specialists or podiatrists for managing diabetes complications), hospitals, home care services and, of course, pharmacies. DOI: https://doi.org/10.1177/0149206314563399. Differing organisational interests become more controversial if participants of inter-organisational collaboration are part of a “quasi-market”-relationship including the enactment of competition [56]. DOI: https://doi.org/10.1177/0149206307302554, Whiteford, H, McKeon, G, Harris, M, Diminic, S, Siskind, D and Scheurer, R. System-level intersectoral linkages between the mental health and non-clinical support sectors: A qualitative systematic review. Australian & New Zealand Journal of Psychiatry, 2014; 48(10): 895–906. Lack of information exchange: Closely related and sometimes caused by confidentiality concerns, a lack of information exchange can hinder joint working across organisations. Another is that behavioral health and primary care are entirely different care models. Secondly, the organisations involved stay formally independent and autonomous [32], but are obligated to their partners. For instance, Loisel et al. its specific governance mechanisms such as, e.g. leading to a lack of shared information about particular patients [26]. This helps to explain why some inter-organisational collaborations that aim for the integration of care make slow or no progress. International Journal of Integrated Care, 2016; 16(1): 1–19. On the other hand, barriers can also emerge more passively behind the back of actors, e.g. on inter-professional collaboration, but not with a focus across organisational boundaries), and articles not addressing the study question in other ways (e.g. International Journal of Integrated Care, 2010; 10(3): 1–9. Copenhagen: WHO; 2012. Another major barrier was that the electronic databases used by GPs, practice nurses, care chain partners and hospitals were still not integrated with each other. DOI: http://doi.org/10.5334/ijic.3068, Auschra, Carolin. Studies were screened for their fit with the theoretical conceptualisation of inter-organisational collaboration and integrated care as presented in the theory section. This problem becomes even more significant if you also include social care services, Payment models in healthcare often do not encourage coordinated efforts, since most healthcare professionals are reimbursed separately for the service they provide, not for the final result in terms of health for the patient, Health IT systems are often fragmented, making it difficult to follow the patient’s journey between different healthcare providers, and to collect all the necessary health data in one place. Confidentiality issues: Previous studies have reported that confidentiality issues can impede inter-organisational collaboration, e.g. Further attention is called for to barriers to the integration of care in inter-organisational settings, as there is a significant gap between what “could” be possible in collaborative practice and what actually is achieved within most inter-organisational relationships. In care organisations all over Europe, and the world, great work is being done in experimenting with new, innovative models that can solve these issues. Following these assumptions, each type of barrier can cause and/or influence all other types of barriers, as barriers also influence each other on and across levels of analysis (dimension 1 in Figure 3) and independently of their roots in structure or agency (dimension 2 in Figure 3, see also section 6.1). Methods for the thematic synthesis of qualitative research in systematic reviews. Beneficial practices of inter-organisational collaboration that help to integrate care include, for instance, the mutual exchange and transfer of information and knowledge, enhanced trust between providers, and the creation of synergy effects [13, 14]. The author has no competing interests to declare. Population Health Management, 2017; 20(3): 239–48. During coding, the author was sensitive to potential sources of barriers, which could be rooted both in structure and in agency [37]. More often than not, the integration of care faces barriers [8–11] caused by contextual, institutional and professional factors in different domains of integrated care [1]. More often than not, the integration of care faces barriers [8–11] caused by contextual, institutional and professional factors in different domains of integrated care [1]. Contacts and contracts: Cross-level network dynamics in the development of an aircraft material. Integrating health and mental health services: Historical obstacles and opportunities. They describe these domains as ranging from the macro to the micro level of analysis: the domains of administration, funding, organisation, service delivery and clinical practice [1]. Los Angeles, CA: Sage; 2014. International Journal of Integrated Care, 18(1), 5. Organisational goals do not need to overlap with collective goals [28]. International Journal of Integrated Care, 2002; 2(4): 1–6. The author thanks the two anonymous reviewers of IJIC, Joerg Sydow, two anonymous reviewers and participants of the AOM 2016 meeting (5th–9th August 2016 in Anaheim), as well as participants of the EGOS 2016 sub-theme 52 (7th–9th July 2016 in Naples) for their very helpful comments on earlier versions of this paper. An individualistic working culture in one partner organisation is an example of how cultural distance can impede inter-organisational collaboration [18]. A fourth domain, service delivery, includes and is affected by factors such as staff training, inter-personal relationships between professionals and the distribution of responsibilities and tasks. International Journal of Integrated Care, vol. For instance, the dependence of one organisation on another can work as a barrier if the more powerful organisation does not provide the necessary input [59]. Hueske, A-K and Guenther, E. What hampers innovation? The existence of different IT-systems typically complicates data exchange [10] and can act as a barrier to inter-organisational collaboration. This review focuses on academic peer-reviewed articles in English-language journals that were retrieved from the databases PubMed (https://www.ncbi.nlm.nih.gov/pubmed); Cochrane Library (http://www.cochranelibrary.com/); Web of Science (https://apps.webofknowledge.com); and via the resource hoster EBSCOhost (https://www.ebscohost.com/) Business Source Premier, Communication Source, EconLit, ERIC, MEDLINE, PsycARTICLES, PsycCRITICS, SocINDEX, and Academic Search Ultimate. This could be an indicator that many reasons for the slow progress or even failure of the delivery of integrated care across organisational boundaries can be found in the last domain. Their systematic literature search identified a variety of barriers, falling into several key categories: a focus on vulnerable populations (for example, mental health is a secondary concern when treating children with HIV), patient and family factors (for example, lack of culturally competent mental health care providers to treat ethnic minorities), comorbidities (for example, providing adequate care … DOI: https://doi.org/10.1016/S0168-8510(99)00037-8, https://doi.org/10.1016/S0168-8510(02)00205-1, https://doi.org/10.1097/00004010-199502010-00007, https://doi.org/10.1007/978-1-137-37003-7, https://doi.org/10.1097/00004010-200201000-00003, https://doi.org/10.1007/s10926-010-9281-1, https://doi.org/10.1097/HMR.0b013e31822aa443, https://doi.org/10.1080/13561820500081745, https://doi.org/10.1093/oxfordhb/9780199282944.001.0001, https://doi.org/10.1111/j.1540-6210.2007.00866.x, https://doi.org/10.1007/s11301-014-0109-5, https://doi.org/10.1016/B978-008044198-6/50038-3, https://doi.org/10.1016/j.jclinepi.2009.06.005, https://doi.org/10.1007/s11414-014-9448-1, https://doi.org/10.1080/13561820902921811, https://doi.org/10.1016/j.socscimed.2006.07.031, https://doi.org/10.1108/14777261011047354, https://doi.org/10.1111/j.1447-0748.2005.00198.x, https://doi.org/10.1016/S0306-4603(00)00127-1, https://doi.org/10.1080/1356182021000044166, https://doi.org/10.1111/j.1467-9299.2011.01917.x, https://doi.org/10.1186/s12913-017-2018-5, https://doi.org/10.1111/j.1540-6210.2012.02595.x, https://doi.org/10.1007/s10926-009-9205-0, https://doi.org/10.1007/s10926-005-8036-x, https://doi.org/10.1186/s12884-017-1381-x, https://doi.org/10.5465/AMR.2009.44885978, https://doi.org/10.1177/003803857200600101. External stakeholders, the organization, groups and individuals: A systematic review of empirical barrier research. International Journal of Integrated Care, 2014; 14(2): 1–12. In primary healthcare, a key barrier to effective and timely care was the lack of availability of general practice-based spirometry together with appropriate use of spirometry by general practitioners (GPs) and practice nurses to both diagnose and manage a patient with COPD: These differing backgrounds of healthcare employees can hamper inter-organisational collaboration [27, 66]. Stereotyping: People sometimes stereotype those with disabilities, assuming their quality of life is poor or that they are unhealthy because of th… Clinical guidelines are often established for major chronic diseases, but the guidelines can vary between regions and countries, and they are not always implemented in the same way (or at all). Public Money & Management, 1997; 17(4): 25–30. DOI: http://doi.org/10.5334/ijic.3068, Auschra, C. (2018). Collaboration between organisations belonging to regions with a long history of the fragmentation of care, e.g. That can be the case also when more planning takes place than implementation [56], which can lead to “overprocessing” [57] without any output on the level of care. A study of coordination of Swedish stakeholders in return-to-work. May 2015, Vol 46, No. Theory and methods: This systematic literature review of forty studies summarises and categorises the barriers to integrated care in inter-organisational settings as reported in previous studies. Others point to regulative constraints that many actors have already experienced while experimenting with collaboration [21]. Duplicates in the identified records were removed; 729 articles then remained. The figures show clearly why increased effectiveness in preventing, managing and treating chronic diseases is a matter of the highest priority for most health policy makers – and finance ministers. Historical developments: Historical developments and critical junctures, often on the macro level, influence the behaviour of organisational and individual actors. The research design of the empirical studies was mostly qualitative; only two used a quantitative approach and one a mixed-method design. DOI: https://doi.org/10.1186/s12884-017-1381-x. These initial keywords were chosen to cover as many relevant articles as possible. One can argue that the most extensive domain affecting the integration of care is administration, also including regulations, on a very macro or environmental level of analysis. due to certain institutionalized structures [cf. The end goal is to provide higher quality care, resulting in better health outcomes for the patient, and a better patient experience of the care journey, often at the same or even lower cost. “Barriers to the Integration of Care in Inter-organisational Settings: A Literature Review”. DOI: https://doi.org/10.1111/j.1540-6210.2007.00866.x, Berends, H, van Burg, E and van Raaij, EM. Strategic Management Journal, 1996; 17(S1): 55–83. reciprocity between autonomous organisations. DOI: https://doi.org/10.1007/s10926-009-9205-0, Loisel, P, Durand, MJ, Baril, R, Gervais, J and Falardeau, M. Interorganizational collaboration in occupational rehabilitation: Perceptions of an interdisciplinary rehabilitation team. Auschra C. Barriers to the Integration of Care in Inter-Organisational Settings: A Literature Review. Some studies addressing barriers to inter-organisational collaboration use no theoretical conceptualization at all [e.g. DOI: https://doi.org/10.1177/0004867414541683, Cooper, M, Evans, Y and Pybis, J. Interagency collaboration in children and young people’s mental health: A systematic review of outcomes, facilitating factors and inhibiting factors. By Dr. Katherine C. Nordal, executive director for professional practice. A lack of information exchange can, in turn, increase the risk of errors and mistakes and, in certain areas such as that of mental health care, jeopardise the job security of employees [69]. Academy of Management Executive, 2001; 15(2): 71–9. Especially before the formation of an inter-organisational collaboration, one facet of this barrier is the lack of knowledge about potential partner organisations. At the same time, by limiting the application of some of the search terms to titles and abstracts, the screening of ten-thousands of mostly irrelevant articles was avoided. In a third step, all the remaining articles were read in depth in order to determine whether they were suited to explain the occurrence of barriers that impede the integration of care in inter-organisational settings. Leading institutions, practitioners and researchers have reached a consensus that health service delivery profits from integration [1, 2, 3, 4] “across time, place and discipline” [5, p. 1]. Additionally, accountable care organisations which can be found in the U.S., but also in countries like Germany, involve inter-organisational collaboration [16, 17]. Lack of technological standards: Especially inter-organisational collaboration that requires the use of common IT-infrastructure faces formidable challenges with regard to lacking interoperability. DOI: https://doi.org/10.1111/1467-9302.00088, Johnson, P, Wistow, G, Schulz, R and Hardy, B. Interagency and interprofessional collaboration in community care: The interdependence of structures and values. The care groups negotiate the content and price of a comprehensive package of diabetes care, which makes it possible for the health insurer to buy care as one, single service, even though it will be delivered by different groups of healthcare professionals in different settings. by hindering common meetings due to different working arrangements [27]. More often than not, the integration of care faces barriers [8, 9, 10, 11] caused by contextual, institutional and professional factors in different domains of integrated care [1]. 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