In 2009 Australia’s National Health and Hospitals Reform Commission Report first recommended significant governance change as an important element in increasing the effectiveness and efficiency of health care delivery. In turn, regional service integration was one of the five key building blocks in Australia’s First National Primary Health Care Strategy. Federal government reforms in 2011 created meso-level organisations - Medicare Locals and Local Hospital Networks (LHNs) (in some jurisdictions Local Hospital Districts) For the goals of health reform to be realised these organisations must work together to achieve co-ordinated and integrated primary healthcare services. There is however a paucity of research evidence around successful strategies to deliver this objective.
The study will utilise the approach to effective regional health governance described following a review of regional governance arrangements internationally. This approach documents nine essential elements required for optimal regional health approach between meso-level organisations – population focus, shared care priorities, planning, measurement, innovation, change management, professional development, integrated information communication technology (ICT), and incentives.
Why integrated care?
The aim of integrated care is to improve outcomes, particularly for complex chronic problems, by overcoming issues of fragmentation through co-ordination and linkage of services along the continuum by moving from episodic treatment of acute illness to coordinated care supporting those with chronic conditions. Whilst the evidence on effectiveness on different forms of integration remains variable Ovretveit (2011) concluded clinical integration can improve quality and save money but this depends on the approach used , how well it is implemented and the environment it was introduced in.
Integration in healthcare as taken different approaches internationally and its ability to deliver benefits varied. For the purpose of this paper the breadth of integration is vertical integration bringing together different levels of care - primary care and secondary care.
The degree of integration has been described by authors as a continuum from linkage (identifying new needs and ways to work together within existing system and resources e.g. information sharing), co-ordination (explicit structures/ individuals are installed to coordinate benefits and care across systems) and full integration (control of resources to define new benefits and services that it controls directly e.g. multidisciplinary teams, pooled budgets). Full integration is most appropriate for users with high level needs.
Within different models of integration are different integration processes defined as, structural integration (alignment of tasks, functions and activities of organisations and healthcare professionals); cultural integration (convergence of values, norms, working methods and approaches); and, social integration (role of social relationships between various actors). This paper focuses on structural integration processes.