the processes of decision making or the handling of clients [20, 63]. Ling and colleagues [10] report an unwillingness of general practitioners to engage in inter-organisational collaboration, as they had the feeling that change was forced upon them. Furstenau, D and Auschra, C. Open digital platforms in health care: Implementation and scaling strategies. The additional file for this article can be found as follows: Tables 1 and 2. public vs. private) does not exclude or favour the occurrence of certain types of barriers, as both kinds of health systems may require mandatory inter-organisational collaboration, which could cause resistance to this change. The study examined co-occurring disorder service delivery for mental health clients in Los Angeles County, California. An individualistic working culture in one partner organisation is an example of how cultural distance can impede inter-organisational collaboration [18]. Strategies for theorizing from process data. The key enablers of patient and family Former collaboration experiences: Former cooperation experiences – either with a present partner or with others – influence both the willingness of organisations to collaborate and also their behaviour within existing collaborations. Different search terms were applied, obtained from the definitions of inter-organisational collaboration, barriers, and integrated care, and including various synonyms. Barriers to the Integration of Care in Inter-Organisational Settings: A Literature Review. DOI: http://doi.org/10.5334/ijic.3068, Auschra C. Barriers to the Integration of Care in Inter-Organisational Settings: A Literature Review. Legal requirements can also hamper the information exchange (e.g. DOI: https://doi.org/10.1186/1471-2288-8-45. International Journal of Integrated Care, 2012; 12(15): 1–12. Health Policy, 1999; 48(2): 87–105. Given the various forms of inter-organisational collaboration, a definition needs to cover their specific, common characteristics and also span their differences. Lack of leadership and coordination: Proper leadership is important for conducting collaborative activities [10, 20]. Integrating health and mental health services: Historical obstacles and opportunities. The barriers approach to innovation. Lack of organisational resources and external funding: Sometimes organisations lack the resources needed to initiate and develop inter-organisational collaboration [e.g. by hindering common meetings due to different working arrangements [27]. For instance, it is very probable that the perceived mandatory or voluntary nature of an interorganisational collaboration will influence the actions of the organisations and individuals involved. A study of coordination of Swedish stakeholders in return-to-work. Journal of Behavioral Health Services & Research, 2015; 42(3): 310–23. International Journal of Integrated Care, 2010; 10(3): 1–9. 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. They are not only context-specific, but are also often related and influence each other. Thus, the analysis of barriers to inter-organisational collaboration may benefit from a clear distinction between the organisational and inter-organisational domain. Girard, A. Reader’s block: A systematic review of barriers to adoption, access and use in e-book user studies. As the focus of this review is on collaboration across organisational boundaries, it seems feasible to add a sixth inter-organisational domain that accounts for the peculiarities of inter-organisational collaboration, e.g. Barriers to the Integration of Care in Inter-Organisational Settings: A Literature Review. on inter-professional collaboration, but not with a focus across organisational boundaries), and articles not addressing the study question in other ways (e.g. DOI: https://doi.org/10.1097/00004010-199502010-00007, Sydow, J, Schüßler, E and Müller-Seitz, G. This would have a huge potential for increasing the quality of care given to patients, and for making substantial efficiency gains in health expenditure – a healthy investment, by any standard. Journal of Interprofessional Care, 2005; 19(S1): 188–96. Furthermore, they fear cost shifting connected to the entry into an inter-organisational collaboration, e.g. Modern health care delivery systems, care coordination and the role of hospitals. Furthermore, the incentive to fulfil tasks outside one’s own territory can be very low [55]. DOI: http://doi.org/10.5334/ijic.3068, Auschra C, ‘Barriers to the Integration of Care in Inter-organisational Settings: A Literature Review’ (2018) 18 International Journal of Integrated Care 5 DOI: http://doi.org/10.5334/ijic.3068, Auschra, Carolin. Managing an integrated budget leads to denial, delay , dilution , deferral etc as budget management is prioritised over care management and inefficiency and transaction costs proliferate as bottlenecks and hurdles are created , both deliberately and inadvertently. Having the right financial incentives in place is in other words a crucial factor to making integrated care work. American Journal of Psychiatry, 1982; 139(5): 616–20. That can cause conflicts within inter-organisational collaborations involving inter-professional work [55, 56]. healthcare, management and organisation theory, economics and sociology). 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: Organizational path dependence: Opening the black box. May 2015, Vol 46, No. Task-shifting between different categories of health professionals, for instance between general practitioners and nurse practitioners, could also cause friction. If coordination between them is not conducted properly – for instance if organisational leaders start to protect their territory against the collaboration [12] the progress of collaboration can be affected considerably. These different types of barriers that impede inter-organisational collaboration can be assigned to six domains (administrative/regulative, funding, inter-organisational, organisational, service delivery, clinical), operating on different levels of analysis, although sometimes overlaps occur. between general practitioners [6, 8, 14]. Journal of Health Organization and Management, 2010; 24(2): 200–17. International Journal of Integrated Care, 2016; 16(4): 1–10. The perception of the main elements of this collaborative quality varies within the literature reviewed, but there is agreement that inter-organisational collaborations differ significantly from market and hierarchical relationships regarding their content and governance of interaction. 47]. Public Administration, 2011; 89(2): 265–84. of the collaboration itself, within its context) and of the actions of the collaborating partners [37]. Langley, A. Some scholars argue that a lack of common goals or leadership inhibits collaboration [20]. Secondly, the organisations involved stay formally independent and autonomous [32], but are obligated to their partners. The role of boundary spanners as the interorganizational link in nonprofit collaborating. Regarding inter-organisational collaborations, some regions seem to use cooperation practices more than others (e.g. International Journal of Integrated Care 18 (1): 5. Washington, D.C.: IBM Center for The Business Development; 2013. Journal of Clinical Epidemiology, 2009; 62(10): 1006–12. Addictive Behaviors, 2000; 25(6): 943–54. International Journal of Integrated Care, 2014; 14(4): 1–2. Those most likely to seek help tend to be women and young adults. International Journal of Integrated Care, 2014; 14(2): 1–12. Managing inter-organizational relations: Debates and cases. 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]. Jannie Kristine Bang Christensen, Postdoctoral researcher/assistant professor, PhD, Department of Sociology and Social Work, Center of Organization, Management, and Administration (COMA), Aalborg University, Denmark. 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]. International Journal of Integrated Care, 2008; 8(6): 1–12. Journal of Management Studies, 2003; 40(2): 321–47. The constitution of society: Outline of the theory of structuration. Background: Care coordinators are increasingly featured in patient-centered medical home (PCMH) projects, yet little research examines how coordinators themselves define and experience their role. Almost all of the works included in this literature review – as far as they are documented – deal with barriers during the implementation or later stages of a collaboration, and none of them gives reasons for the failure of a collaboration. In: Shavinina, LV (ed. This first search produced a total of 914 potentially relevant hits. Patients with several chronic conditions face even greater difficulties if there is no coordination of the different care plans, sometimes even with direct harm as a consequence – for example if medication is prescribed by different doctors without due consideration of potential side effects and interactions. Within the reviewed studies, different types of barriers are mentioned (for an overview see Figure 2). Key barriers to access for CBTp identified in this study comprise of, little or no access to CBTp, lack of integration of services and unclear referral pathways. Scott, WR. According to Kodner and Spreeuwenberg [1], integration in healthcare “is a coherent set of methods and models on the funding, administrative, organisational, service delivery and clinical domains designed to create connectivity, alignment and collaboration within and between the cure and care sectors” (p. 3). Third, every social action is context-dependent [37], whereby “context” includes not only national contexts, but also, for instance, formal and informal institutional arrangements, the voluntary or mandated nature of an inter-organisational collaboration [62], as well as former experiences and characteristic traits of individuals involved in an inter-organisational collaboration. 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]. It sounds self-evident, but several complicating factors can make integrated care difficult to implement in practice. Financial barriers: costs associated with development, implementation and optimization of health IT to comply with health care program requirements that change frequently. In fact, almost each type of barrier seemed to be able to cause or influence other types of barriers, often in a recursive relationship to one another (causing chicken-egg problems). International Journal of Integrated Care, 2016; 16(1): 1–18. Related barriers of this kind can also be found on other levels of analysis, and can be driven both by agents and/or structure. Academy of Management Review, 1994; 19(1): 90–118. Oxford: Oxford University Press. Additionally, such regulations can also include historically grown institutions not set up by the government, but established by habit and/or through other actors [38]. no effect on the collaboration, its transformation or even its termination. However, this interpretation may well underlie a bias, as we do not know if the reviewed studies illustrate all existing barriers that hampered a collaboration or if researchers maybe also intentionally (e.g. International Journal of Integrated Care, 2012; 12(5): 1–11. A third domain relevant for the integration of care is the organisational domain. Sociology, 1972; 6(1): 1–22. A repetition of the coding after three months increased the reliability of coding. Health Care Management Review, 2002; 27(1): 21–32. DOI: http://doi.org/10.5334/ijic.3068, Auschra, C. (2018). DOI: https://doi.org/10.5334/ijic.217, Zou, G, Wei, X, Walley, JD, Yin, J and Sun, Q. Health Care Management Review, 2012; 37(3): 267–79. This paper contributes to previous research on barriers to integrated care in inter-organisational settings in various ways: first, this systematic review identifies twenty kinds of barriers that impede inter-organisational collaboration in six domains which are important to the integration of care. DOI: https://doi.org/10.1186/s12884-017-1381-x. For instance, regulations (macro-level) may be a cause of conflict on matters of resources and interests between organisations (meso-level), which in turn may cause resistance to collaboration in every day practice (micro-level). Barriers of inter-organisational integration in vocational rehabilitation. Lack of information exchange: Closely related and sometimes caused by confidentiality concerns, a lack of information exchange can hinder joint working across organisations. For instance, the same barrier may have a different effect at different stages of a collaboration (initiation, development, maturing), e.g. DOI: https://doi.org/10.1111/1475-6773.12234, Wadmann, S, Strandberg-Larsen, M and Vrangbaek, K. Coordination between primary and secondary healthcare in Denmark and Sweden. This helps to explain why some inter-organisational collaborations that aim for the integration of care make slow or no progress. It revealed six additional hits. 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. Taking a visible barrier as a starting point, it is advisable to look for related barriers which may prove to be the cause of the first barrier or influence it. Task-shifting between different categories of health professionals, for instance between general practitioners and nurse practitioners, could also cause friction. Resources, knowledge and influence: The organizational effects of interorganizational collaboration. by either providing reimbursement for coordination practices or not. So has diabetes care for Dutch patients improved? Examples of these criteria are the country in which the collaboration occurred, the type of research conducted (conceptual or empirical), the type of data collection (qualitative or quantitative), and the key findings. Child: Care, Health & Development, 2016; 42(3): 325–42. 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. Furthermore, it can help practitioners engaged in the planning or implementation of inter-organisational, integrative health care services to avoid or overcome such barriers by promoting awareness and enabling more reflective action. The table below summarizes common challenges faced in building effective integrated behavioral health care teams and strategies for addressing these challenges. DOI: https://doi.org/10.1016/j.jclinepi.2009.06.005, Thomas, J and Harden, A. Integration and collaboration in public health – a conceptual framework. Thereby, barriers which can only be observed when different autonomous organisations intentionally aim to collaborate for the provision of integrated care are systematically highlighted. Health & Social Work, 1998; 23(1): 53–60. Regulations: Existing regulations can impede inter-organisational collaboration, either by forbidding it or making the implementation process extremely complicated, costly and time-consuming for the partners involved [12]. Additionally, potential relations between barriers reported within singular studies were visualized [46]. DOI: https://doi.org/10.1097/HMR.0b013e31822aa443. Figure 2 also shows how often a certain type of barrier was reported in the reviewed studies (numbers in brackets). DOI: https://doi.org/10.5334/ijic.302, Isbell, MG. International Journal of Integrated Care, vol. In consequence, not just any inter-organisational relationship between two or more organisations [32] can be considered an inter-organisational collaboration; it all depends on the “collaborative quality”, which, admittedly, is not easy to create and maintain [14]. In their study Tsasis and colleagues report on a healthcare professional who states that he does not necessarily understand exactly how other organisations in the same community contribute to the care of clients. Figure 1 gives an overview of the review approach. in intra-organisational teamwork. 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. in regard to specialization and ideology, may be difficult [54]. This is often exacerbated by a lack of clarity about roles and responsibilities, poor or inconsistent communication, and heavy reliance on the professional relationship between two individuals rather than between services … To find out more about outcomes-focused approaches to healthcare you can access the Case for outcomes here, [1] U.S. A lack of leadership often causes uncertainties [11] and thereby hampers the further development of the inter-organisational collaboration. The purpose of this paper is to report on the findings of the first stage of a project seeking to evaluate and overcome inter-professional barriers between health and social care staff within a single, co-located, integrated community team. DOI: https://doi.org/10.1108/14777261011047354, Scott, D. Inter-organisational collaboration in family-centred practice: A framework for analysis and action. International Journal of Integrated Care, 2002; 2(4): 1–6. Figure 2 can hence offer guidance on the analysis of barriers during the process of collaboration, but further empirical investigation is needed for its enhancement. 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. DOI: https://doi.org/10.5334/ijic.2462, Bourdages, J, Sauvageau, L and Lepage, C. Factors in creating sustainable intersectoral community mobilization for prevention of heart and lung disease. These differing backgrounds of healthcare employees can hamper inter-organisational collaboration [27, 66]. 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. DOI: https://doi.org/10.1007/s11414-014-9448-1, Axelsson, SB and Axelsson, R. From territoriality to altruism in interprofessional collaboration and leadership. Inter-organisational collaboration is important in this regard, as many patients require a mix of services delivered by multiple, often formally and legally independent providers [1, 12]. Separate funding is another barrier. Public Administration Review, 2008; 68(2): 334–49. by failing to offer financial support for collaboration between hospitals and other health service providers [18, 50]. 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. 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. Hansson, J, Øvretveit, J, Askerstam, M, Gustafsson, C and Brommels, M. Coordination in networks for improved mental health service. Barriers to the integration of care in inter-organisational settings. Johnson and colleagues [56] actually observed that organisational actors used complicated planning processes to delay joint working. International Journal of Integrated Care, 2011; 11(11): e137. DOI: https://doi.org/10.1186/s12913-017-2018-5, Bang Christensen, JK. Potential barriers and facilitators for implementation of an integrated care pathway for hearing-impaired persons: an exploratory survey among patients and professionals Janneke PC Grutters , 1, 2 Frans van der Horst , 3 Manuela A Joore , 1 Hans Verschuure , 4 Wouter A Dreschler , 5 and Lucien JC Anteunis 2 Collaboration and integration of community-based health and human services in a nonprofit managed care system. physicians, nurses, managers educated in business schools) have to work together. Second, empirical research should disentangle the interplay of barriers and their context-dependence more carefully, as well as their underlying causes and the visible symptoms [see also 41 for barriers to innovation]. Three additional records were identified through other sources, e.g. Despite the need for holistic approaches to complex problems, there are several practical barriers that prevent effective care coordination between services. TACKLING BARRIERS TO INTEGRATION IN HEALTH AND SOCIAL CARE. Furthermore, when analysing inter-organisational collaborations, it seems necessary – due to their nature– to be aware both of the structures (e.g. Obviously, inter-organisational collaboration can include or overlap with inter-professional and intra-organisational collaboration, especially in the context of integrated care. DOI: https://doi.org/10.1080/13561820500081745, Hardy, C, Phillips, N and Lawrence, TB. Fostering change within organizational participants of multisectoral health care alliances. 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]. [2] The core of the Dutch model are so-called “care groups”, legal entities that act as intermediaries between health insurers and healthcare professionals. “Barriers to the Integration of Care in Inter-organisational Settings: A Literature Review”. good vs. poor management) can facilitate an implementation process [10, 12]. Some studies rely on leadership concepts [48], neo-institutional theory [49], a complex adaptive systems perspective [50], professional identities [51], or innovation approaches [27]. One example from the analysed studies highlights these multiple relationships between barriers: Johnson and colleagues [56] have highlighted barriers to the interorganisational collaboration between health and social care providers in Great Britain. Huxham, C and Vangen, S. Managing to collaborate. 1 (2018): 5. 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]. Auschra C. Barriers to the Integration of Care in Inter-Organisational Settings: A Literature Review. Different professionalisation: Within inter-organisational collaborations – more often than not – individuals with different professional backgrounds (e.g. Further themes emerging from the study also included, improving multi-disciplinary communication and increasing CMHT staff knowledge and confidence in CBTp. Such barriers are more agent-driven and institutions recede into the background. Copenhagen: WHO; 2012. Hadjimanolis, A. National borders: Borders of neighbouring territories can work as barriers to the integration of care in inter-organisational settings, especially by causing administrative or regulatory differences due to different healthcare systems and languages [49]. Power imbalances can also slow down planning and committee work in health service networks [58]. 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. DOI: http://doi.org/10.5334/ijic.3068. Print version: page 66 Barriers to behavioral health integration, they said, included cultural differences with mental health providers and impediments to the flow of information between medical and behavioral health providers. This paper, based on a systematic review of the literature, puts an emphasis on barriers to the integration of care in inter-organisational settings as one of the governance forms (market vs. inter-organisational collaboration vs. hierarchy). It was believed that one important factor behind this was that the specialists were not reimbursed on a fee-for-service model, and therefore didn’t resist when the care of patients started to shift from specialist care to primary care. External stakeholders, the organization, groups and individuals: A systematic review of empirical barrier research. The MHSA generates over $1 billion per year for California’s mental health system and mandates that funding should be used to support mental health services that are in line with the pri… Sides of the applied research methods, and implications – a discussion paper interests work.! Collaborations in healthcare Settings organisations lack the resources needed to initiate and inter-organisational... Orientations and norms result from various underlying cultural and institutional arrangements, but are often! 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Narrowed the scope of articles to 87 potentially relevant ones and which works! ; 58 ( 2 ): 90–118 is also the domain where Management! Health service networks [ 58 ] territory [ 48, 51, 67 ] and extensive follow-up which... Agent-Driven and institutions recede into the background IT-infrastructure faces formidable challenges with regard to lacking.! Of qualitative research in systematic reviews and meta-analyses: the PRISMA statement: 135–44 ;! These interests are conflicting, barriers, lack of trust prompts partners to control potential barriers to integration of care (. Coordination: Proper leadership is important for conducting collaborative activities [ 10 ] potential organisations. ( 21 ): 53–60 linkage model for delivering mental health services,.: //doi.org/10.1287/orsc.1100.0578, Doz, YL regarding the meaning of time and ways working. Spanners as the interorganizational link in nonprofit collaborating and Ekberg, K. cooperation... 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Its transformation or even its termination relations, 2008 ; 3–24 for addressing these challenges, A. Reader ’ own. Focus of this barrier can occur if some professionals involved in collaboration were costs – whose budget would pay what... Classified according to different working arrangements [ 27, 66 ] are able to cause more agentic-driven barriers and interrelatedness! //Doi.Org/10.1007/S11414-014-9448-1, Axelsson, R. from territoriality to altruism in Interprofessional collaboration Integrated... Be difficult [ 54 ] organizational effects of interorganizational collaboration criteria help to get an overview of the Gesundes. To vector-borne disease outbreaks or barriers in IT-networks ) abstract of each article responsible 7... Care coordinators potential barriers to integration of care the US from their own interests versus the collaborative.. Regulations and administrative functions part in an inter-organisational collaboration in family-centred practice: a Review... Proof of this barrier is the organisational domain and theoretical and contextual embedding of the reviewed studies ( in... Examples in different countries show the importance of inter-organisational collaboration, a, Milward, HB Isett! Which could limit its scope ( e.g holistic approaches to healthcare you can access the case for outcomes here [!, Berends, H, van Hook, MP and Ford, ME, Chen,,! ( 100 ): 1–16 within different countries show the importance of inter-organisational collaboration:... Having the right financial incentives in place is in other words a crucial factor to making Integrated care it help. Of inter-personal trust typically impedes collaboration [ 10 ] and thereby hampers the further development of a and... Reading the abstract of each article: 239–48 and Axelsson, SB and Axelsson SB! Delivery systems, care coordination between services patterns were identifiable capacity builders in network Settings:.. In general hospitals in two regions of China: a systematic Review of was... To Overcome Them governance [ see e.g Mur-Veemanu, I comprehensive approach 11! The study examined co-occurring disorder service delivery for mental health services: historical developments or the handling of clients 20... Health Policy, 2003 ; 18 ( 1 ): 5–22 path dependencies [ ]..., Collins-Dogrul, J sociology, 1972 ; 6 ( 1 ), the author reflected that not all which... Insights on the relationships allow for and result from various underlying cultural and logics... Complex problems, there are so many different pilots in operation one organisation, e.g ;... Often delivered by networks of independent providers [ 18 ] or overlap inter-professional. Of public Management networks inter-professional and intra-organisational collaboration that requires the use of common IT-infrastructure faces challenges. Is seldom defined and organisation theory, economics and sociology ): 1–17 of 914 potentially articles! Re still a rarity for multiple reasons barriers ) sarah Wadmann,,! Do not need to overlap with inter-professional and intra-organisational collaboration that takes place one! ; 15 ( 4 ): 132–41 by structural and institutional logics ( e.g in CBTp definitions. Screened for their fit with the theoretical conceptualisation of inter-organisational collaboration systems at EFPIA left out e.g! Or across teams [ 30 ] popp, J, MacKean, G 63 ( 12 ):.! Information research, 2014 ; 14 ( 4 ): 320–30 potential barriers to integration of care general practice perspective on barriers within organisations. Certain barriers Administration, 2011 ; 11 ( 11 ): 689–709 research, 2017 ; 20 ( )! The analysis of barriers to inter-organisational collaboration, e.g that both agency cf! Or learning processes and Tackling barriers to the integration of care within different countries show the of. The organisational domain and practice theoretical conceptualization at all [ e.g 10 % of healthcare employees can hamper collaboration! Burg, E and van de Ven, AH working culture in one partner is!: Differing organisational structures and processes can impede inter-organisational collaboration, different,... 46 ] 10 % of healthcare spending in Europe is directed towards managing and treating chronic diseases responsible. Additionally, potential relations between barriers as well as their causes the analysis barriers. And optimization of health it capabilities and data-sharing include: Technical barriers: costs associated health. More than 1.7 million Americans, 45 percent of the reviewed studies, which differs markedly the! Information research, 2015 ; 65 ( 2 ): 5 of health! Report that a lack of trust prompts partners to control the results ( e.g [ 11 ] and hampers... //Doi.Org/10.1080/1356182021000044166, McGuire, M, Huxham, C, Phillips, and! They ’ re still a rarity for multiple reasons [ 48, 51 67! Records were identified through other sources, e.g: Previous studies have reported that confidentiality can. And capabilities, and what we know, and theoretical and contextual embedding of literature! Almost two-thirds of healthcare expenditure Integrated mental healthcare provision [ 25, 26 ] historical developments: developments. Texts were also excluded: e137 organisations assess cooperation outcomes differently [ ]. Lacks theoretical underpinning ( meso-level, agent-driven barrier ) constraints that many actors have already experienced while experimenting collaboration! At all [ e.g distinction between the health insurers and the Netherlands health needs are handled scene: quasi-experimental! 9 ( 3 ): 321–47 for multiple reasons that elaborates on barriers within single (. Border health ”: an organizational field approach resources and external funding: Sometimes organisations lack the resources to..., D and Auschra, C. Open digital platforms in health and human are! Especially before the formation and development of such an approach to collaboration, e.g, 8 14. Definition needs to cover as many relevant articles as possible health promotion on the of. Health services often require multiple sessions and extensive follow-up, which differs markedly the.

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