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Social Dimensions of Care Integration
... Actors with a proself motivation, who focus on their own interests, may arguably be unlikely to participate in integrated care endeavours in the first place [60], unless these endeavours enable them to pursue their personal goals. Actors may not always be completely prosocially motivated either and, thus, willing to listen to the input that is shared by others. ...
... All in all, person-based and situational antecedents affect the extent to which effective collaboration can be realized [28]. Prior research, however, suggests that the latter tends to be more influential than the former [60,68]. This is an important insight, as it is often more feasible to change the situational conditions than it is to alter group composition. ...
... Although scholars and practitioners in the field of integrated care increasingly acknowledge the "human dimension" of care integration [1,4,15,21], having the right reward structure in place remains an important requirement for collaborative efforts, precisely because reward structures have been shown to influence social motivation, with individual incentives promoting proself, and collective incentives promoting prosocial motivation [28]. This implies that even if managers emphasize collaboration, this is unlikely to have a strong effect if the reward structure in their organization continues to incentivize individual interests, values, and outcomes [60]. It is therefore important to develop a reward structure that is in line with the joint goal that is being pursued. ...
Introduction
At all levels, effective collaboration between actors with different backgrounds lies at the heart of integrated care. Much attention has been given to the structural features underlying integrated care, but even under structurally similar circumstances, the effectiveness of collaboration varies largely.
Theory and methods
Social and organizational psychological research shows that the extent to which collaboration is effective depends on actors’ behaviours. We leverage insights from these two research fields and build a conceptual framework that helps untangle the behavioural processes underlying effective collaboration.
Results
We delineate that effective collaboration can be realized when actors (1) speak up about their interests, values, and perspectives (voice behaviour), (2) listen to the information that is shared by others, and (3) thoroughly process this information. We describe these behaviours and explain the motivations and conditions driving these. In doing so, we offer a conceptual framework that can be used to explain what makes actors collaborate effectively and how collaboration can be enhanced.
Discussion and conclusion
Fostering effective collaboration takes time and adequate conditions, fitting the particular context. As this context continuously changes, the processes and conditions require continuous attention. Integrated care, therefore, actually requires a carefully designed process of integrating care.
... The latter means that voice is motivated by a desire to bring about a constructive change for the organization, or for one or more stakeholders, such as peers in one's occupational group (Burris, Rockmann and Kimmons 2017). As such, we define voice behavior as the different ways and means through which employees speak up, attempt to have a say in, and potentially influence issues that affect their work or lives (Kee et al. 2021). In line with this, voice behavior has three inherent characteristics. ...
... Hierarchy, status, and voice behavior in care settings One setting in which employees may be hesitant to speak up, and lower level employees in particular, is in the field of health care (Kee et al. 2021). Healthcare organizations are typically characterized by a well-entrenched hierarchy as well as status differences between members of different occupational groups (Apker and Eggly 2004). ...
Members of frontline low-status occupational groups often have access to a vast pool of knowledge, expertise, and experience that may be valuable for organizations. However, previous research has shown that members of these occupational groups are often reluctant to exhibit voice behavior due to their low position in the organizational hierarchy and perceived status differences. Drawing on in-depth interviews with auxiliary nurses (ANs) who participated in a development trajectory, as well as with their colleagues and supervisors, we demonstrate how members of this low-status occupational group develop voice behavior. Our findings show how acquiring three different types of knowledge and acting on this knowledge can lead to forming new and different types of relationships with members of higher status occupational groups in the organization. Subsequently, these relational changes enhanced voice behavior, as the ANs under study became more skillful in navigating the organization and felt better equipped to share their ideas, concerns, and perspective. We contribute to the literature on voice behavior by members of low-status occupational groups by moving beyond the findings of previous studies that have shown that low-status employees are unlikely to exhibit voice behavior. We detail how the development of knowledge, as well as relationships between different occupational groups, is crucial for the enhancement of voice behavior that transcends hierarchical levels. Moreover, we add to the literature on upward influence of subordinates by showing how such voice allows subordinates to exert upward influence in their organizations and initiate change that benefits their own occupational group.
Objective
Existing studies on shared decision-making (SDM) have hardly taken into consideration that patients could have independently developed expectations prior to their consultation with a healthcare provider, nor have studies explored how such expectations affect SDM. Therefore, we explore how pre-consultation expectations affect SDM in patients with low back pain.
Methods
We performed a qualitative study through telephone interviews with 10 patients and seven care professionals (physicians, nurse, physician assistants) and 63 in-person observations of patient-physician consultations in an outpatient clinic in the Netherlands. Transcripts were analyzed through an open coding process.
Results
A discrepancy existed between what patients expected and what care professionals could offer. Professionals perceived they had to undertake additional efforts to address patients' ‘unrealistic’ expectations while attempting SDM. Patients, in turn, were often dissatisfied with the outcomes of the SDM encounter, as they believed their own expectations were not reflected in the final decision.
Conclusion
Unaddressed pre-consultation expectations form a barrier to constructive SDM encounters.
Practical implications
Patients’ pre-consultation expectations need to be explored during the SDM encounter. To achieve decisions that are truly shared by care professionals and patients, patients’ pre-consultation expectations should be better incorporated into SDM models and education.
Introduction:
In the Netherlands multiple single, cross sector and cross governance level policy reforms were introduced to improve health and social care and decrease fragmentation. In addition to legislative and funding measures, the governmental strategy was to set up long-lasting improvement programs and supported by applied research.
Description:
Five national improvement programs on chronic disease management, maternity care, youth care, care for older people and dementia care were analysed. The Laws of integration of Leutz were used as an analytical framework. The programs demonstrated a mixture of employing policy, quality and financial measures to stimulate coherence and integration.
Discussion:
The Laws that Leutz formulated are to a large extent applicable in the Dutch context. However, the characteristics of the system of governance being corporatist in its structure and its culture imply that it is hard to distinguish single actors being in the lead. Integration is a more complex process and requires more dynamics, than the law 'keep it simple, stupid' suggests.
Conclusions:
In the Dutch context integration implies a permanent pursuit of aligning mechanisms for integration. Sustainable integration requires long-standing efforts of all relevant stakeholders and cannot be achieved quickly. It may take a decade of consistently applying a mix of policy instruments.
When employees voluntarily communicate suggestions, concerns, information about problems, or work-related opinions to someone in a higher organizational position, they are engaging in upward voice. When they withhold such input, they are displaying silence and depriving their organization of potentially useful information. In this article, I review the current state of knowledge about the factors and motivational processes that affect whether employees engage in upward voice or remain silent when they have concerns or relevant information to share. I also review the research findings on the organizational and individual effects of employee voice and silence. After presenting an integrated model of antecedents and outcomes, I offer some potentially fruitful questions for future research.
Ethnic diversity may impede groups' use of distributed information in decision making. This is not so much because diversity interferes with groups' ability to reach agreement, but because ethnic diversity may disrupt the elaboration (exchange and integration) of distributed information. The authors find evidence for this proposition in an experiment (N = 63 groups) in which ethnically diverse groups are shown to benefit more from instructions emphasizing information integration than ethnically homogeneous groups when dealing with distributed information, whereas neither ethnic diversity nor information integration instruction affected decision making performance in groups with fully shared information. These effects were mediated by a behavioral measure of group information elaboration. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
This article expands the view of groups as information processors into a motivated information processing in groups (MIP-G) model by emphasizing, first, the mixed-motive structure of many group tasks and, second, the idea that individuals engage in more or less deliberate information search and processing. The MIP-G model postulates that social motivation drives the kind of information group members attend to, encode, and retrieve and that epistemic motivation drives the degree to which new information is sought and attended to, encoded, and retrieved. Social motivation and epistemic motivation are expected to influence, alone and in combination, generating problem solutions, disseminating information, and negotiating joint decisions. The MIP-G model integrates the influence of many individual and situational differences and combines insight on human thinking with group-level interaction process and decision making.