Results: Within these studies, twenty types of barriers have been identified and then categorised in six groups (barriers related to administration and regulation, barriers related to funding, barriers related to the inter-organisational domain, barriers related to the organisational domain, barriers related to service delivery, and barriers related to clinical practices). International Journal of Health Planning and Management, 2006; 21(1): 75–88. Development of a program for tele-rehabilitation of COPD patients across sectors: Co-innovation in a network. Hardy, B, Mur-Veemanu, I, Steenbergen, M and Wistow, G. Inter-agency services in England and The Netherlands. ), The Oxford handbook of inter-organizational relations, 2008; 3–24. “Behavioral health services often require multiple sessions and extensive follow-up, which differs markedly from the way physical health needs are handled. Understanding barriers that impede the development of collaborative inter-organisational relationships can promote the successful implementation of integrated care in such settings. Journal of Interprofessional Care, 2009; 23(4): 320–30. Population Health Management, 2017; 20(3): 239–48. 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]. Introducing inter-organizational relations. Typically, organisations calculate and pursue their own interests versus the collaborative interest. Taking part in an inter-organisational collaboration also implies a loss of organisational autonomy, e.g. 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]. Organizational path dependence: Opening the black box. Further reasons to exclude studies were if a study solely reported on barriers within single organisations (e.g. 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. Winters, S, Magalhaes, L, Anne Kinsella, E and Kothari, A. Cross-sector service provision in health and social care: An umbrella review. As a way to overcome these difficulties, the concept of “integrated care” has become more and more important over the last few years. Information Research, 2014; 19(2): 1–17. International Journal of Integrated Care. 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. 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. Surprisingly, although often used, the term “barrier” is seldom defined. Around 75% of healthcare spending in Europe is directed towards managing and treating chronic diseases. Such barriers are more agent-driven and institutions recede into the background. Despite their various potential benefits, many inter-organisational collaborations fail [according to 19 around 50–70%], and the implementation of collaboration proves to be a managerial challenge. This helps to explain why some inter-organisational collaborations that aim for the integration of care make slow or no progress. DOI: https://doi.org/10.1097/00004010-199502010-00007, Sydow, J, Schüßler, E and Müller-Seitz, G. Looking at different patient groups, around 10% of patients account for almost two-thirds of healthcare expenditure. Financial barriers: costs associated with development, implementation and optimization of health IT to comply with health care program requirements that change frequently. The aim of this paper is therefore to develop deeper insights on barriers that impede integrated care delivery in inter-organisational settings by reviewing previous research on barriers to inter-organisational collaboration in healthcare. Furthermore, in some cases, the surrounding context traditionally sets no incentive to inter-organisational collaboration – e.g. 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. Barriers of inter-organisational integration in vocational rehabilitation. When inter-organisational collaboration stretches over a wider geographical distance, “differences in the meaning and use of relevant concepts between countries and regions” [53, p. 950] may also occur. Examples of attitudinal barriers include: 1. This discussion paper expands on three of the recommendations from a paper commissione… 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). Second, this systematic literature review can guide further empirical research on the occurrence of barriers and their causes. 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. However, for the following reasons, it is difficult to make generalizations about these relationships from the present sample of studies without developing a somewhat deterministic, contingent, and thereby non-realistic view [cf. 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. The examination of such an approach to collaboration, however, requires diving deeply into specific cases. Duplicates in the identified records were removed; 729 articles then remained. The authors of the study make the point that integrated care models are difficult to evaluate due to the “lack of comparable outcome measures as well as in-depth, qualitative data”. 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. The reviewed literature provides insights on the relationships between barriers as well as their causes. Not all of these barriers emerge passively, some are set up intentionally. DOI: https://doi.org/10.1007/s10926-010-9281-1, Majchrzak, A, Jarvenpaa, SL and Bagherzadeh, M. A review of interorganizational collaboration dynamics. Because the literature search was focused mainly on peer-reviewed journals, some works meeting the inclusion criteria may have been left out (e.g. Evaluating the impact of an accountable care organization on population health: The quasi-experimental design of the German Gesundes Kinzigtal. 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. External stakeholders, the organization, groups and individuals: A systematic review of empirical barrier research. Kodner, DL and Spreeuwenberg, C. Integrated care: Meaning, logic, applications, and implications – a discussion paper. Public Administration Review, 2008; 68(2): 334–49. Task-shifting between different categories of health professionals, for instance between general practitioners and nurse practitioners, could also cause friction. 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. Integrated care in its various forms can produce benefits such as quality enhancement, increased system efficiency and cost reduction, higher client satisfaction, and better access to care [1, 6]. Huxham, C and Vangen, S. Managing to collaborate. Values and principles of integrated care. The management of chronic diseases poses specific challenges to healthcare systems. Washington, D.C.: IBM Center for The Business Development; 2013. 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. DOI: http://doi.org/10.5334/ijic.3068, Auschra, Carolin. Journal of Clinical Epidemiology, 2009; 62(10): 1006–12. 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. A comparative study of integrated care development and delivery. The author has no competing interests to declare. Objectives: The goal of this study was to assess pediatric oncology providers' perceptions of palliative care in order to validate previously identified barriers and facilitators to early integration of a pediatric palliative care team (PCT) in the care of children with cancer. This represents the barrier “lack of organisational resources and funding” (meso-level, agent-driven barrier). 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