Integrated care is central to current health care reforms as policy makers and practitioners struggle to address fragmentation of care planning and delivery. However, those pursuing integration have failed to appreciate the complex nature of fragmentation. We seek to bring some much-needed clarity to current debate by considering fragmentation as a ‘wicked problem’ requiring a locally driven and multifaceted approach to integration.
Get full access to this article
View all access options for this article.
References
1.
LeutzWN.Five laws for integrating medical and social services: lessons from the United States and the United Kingdom.Milbank Quarterly1999; 77: 77–110.
2.
StangeKC.The Problem of Fragmentation and the Need for Integrative Solutions.Annals of Family Medicine2009; 7: 100–103.
FerlieE, FitzgeraldL, McGivernG, DopsonS, BennettC.Public policy networks and ‘wicked problems’: a nascent solution?Public Administration2010; 89: 307–24.
5.
PlsekPE, GreenhalghT.The challenge of complexity in health care.British Medical Journal2001; 323: 625–28.
6.
RussellJ, GreenhalghT, ByrneE, McDonnellJ.Recognising rhetoric in health care policy analysis.Journal of Health Services Research and Policy2008; 13: 40–46.
7.
KernickD.The demise of linearity in managing health services: a call for post normal science.Journal of Health Services Research and Policy2002; 7: 121–24.
8.
RamseyA, FulopN.The evidence base for integrated care.London: King's Patient Safety and Service Quality Research Centre, 2008
9.
BurnsLR, PaulyMV.Integrated delivery networks: a detour on the road to integrated health care?Health Affairs2002; 21: 128–43.
10.
RAND Europe, Ernst & Young.National Evaluation of the Department of Health's Integrated Care Pilots.Cambridge: Rand Europe, 2012
11.
HalversonG.Health Care Reform Now! A Prescription for Change.San Francisco, CA: Jossey Bass, 2007
12.
OxmanAD, BjorndalA, FlottorpSA, LewinS, LindahlAK.Integrated Health Care for People for Chronic Conditions.Oslo: Norwegian Knowedge Centre for the Health Services, 2008
13.
KodnerDL, SpreeuwenbergC.Integrated care: meaning, logic, applications, and implications - a discussion paper.International Journal of Integrated Care2002; 2: e12
14.
RavenscroftEF.Access within a Fragmented Health care System: A Nurse's Perspective on Romanow.Nursing Leadership2005; 18: 1–12.
15.
RosenR, MountfordJ, LewisGHL, LewisR, ShandJ, ShawSE.Integration in action: four international case studies.London: Nuffield Trust, 2011
16.
ShortellSM.Remaking Health Care in America: The evolution of organised delivery systems.San Francisco: Josey Bass, 2000
17.
FeachemRG, SekhriNK.Moving towards true integration.British Medical Journal2005; 330: 787–88.
18.
Talbot-SmithA, GnaniS, PollockAM, GrayDP.Questioning the claims from Kaiser.British Journal of General Practice2004; 54: 415–21.