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Available from: Cristina Hernandez-Quevedo, May 13, 2014
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    ABSTRACT: Background The visions of more integrated care have created new roles and accountabilities for organizations and professionals. Thus, professionals are increasingly expected to engage in boundary spanning activities in order to facilitate inter-organizational and inter-sectoral collaboration. However, this task can be difficult for individual actors and it is important to investigate the work and challenges of boundary spanners in various settings. This study explores the challenges related to a new boundary spanning role for general practitioners employed to facilitate collaboration between the municipalities and general practice. Methods The study is based on semi-structured interviews with ten general practitioners acting as municipal practice consultants in the Capital Region of Denmark. The transcribed interviews were analyzed in several steps organizing the material into a set of coherent and distinct categories covering the different types of challenges experienced by the informants. Results The main challenges of the general practitioners acting as boundary spanners were: 1) defining and negotiating the role in terms of tasks and competencies; 2) representing and mobilizing colleagues in general practice; 3) navigating in an unfamiliar organizational context. Conclusions The results support previous studies in emphasizing the difficult and multifaceted character of the boundary spanning role. While some of these challenges are not easily dealt with due to their structural causes, organizations employing boundary spanners should take note of these challenges and support their boundary spanners with matching resources and competencies.
    BMC Family Practice 02/2015; 16(1). DOI:10.1186/s12875-015-0231-z · 1.74 Impact Factor
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    ABSTRACT: To examine the evolution of health care integration strategies and associated conceptualization and practice through a review and synthesis of over 25 years of international academic research and literature. A search of the health sciences literature was conducted using PubMed and EMBASE. A total of 114 articles were identified for inclusion and thematically analyzed using a strategy content model for systems-level integration. Six major, inter-related shifts in integration strategies were identified: (1) from a focus on horizontal integration to an emphasis on vertical integration; (2) from acute care and institution-centered models of integration to a broader focus on community-based health and social services; (3) from economic arguments for integration to an emphasis on improving quality of care and creating value; (4) from evaluations of integration using an organizational perspective to an emerging interest in patient-centered measures; (5) from a focus on modifying organizational and environmental structures to an emphasis on changing ways of working and influencing underlying cultural attitudes and norms; and (6) from integration for all patients within defined regions to a strategic focus on integrating care for specific populations. We propose that underlying many of these shifts is a growing recognition of the value of understanding health care delivery and integration as processes situated in Complex-Adaptive Systems (CAS). This review builds a descriptive framework against which to assess, compare, and track integration strategies over time.
    Advances in Health Care Management 11/2013; 15(1):125-61. DOI:10.1108/S1474-8231(2013)0000015011
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    ABSTRACT: The objectives of this report are to: ƒ analyse and map out the future development of BMI towards ultimate clinical utility such that it fulfils stakeholder needs (researchers, clinicians, health system providers, patients, industry and regulatory authorities), while paying attention to the ethical and security considerations, ƒ present BMI approaches that can help the ‘translation’ of biomedical research results into clinical practice, ƒ present methods of integration and extraction of data from biomedical research and healthcare practice in novel ways.