Although the term integration is widely used in many areas as health care and many other systems, there is no specific definition of policy direction put together to define it. Canadian health association (2006), advises that, “if a clear vision is lost in what is vital (in integration), there is always a lost opportunity for success” (p.1). Integration is always a challenging task because of its dynamic nature presented when individual companies with varied challenges and visions have to harmonize their operations (Gray, 1989).
Integration is also about creating needs-based and client based operation (Lurie, 2009). The best example is horizontal integration that merges many functional units into a single centrally managed unit while vertical integration brings all production departments under one roof or organization (Hernandez, 2000).
In the health care institution, collaboration will ensure consistency of services and effective coordination of services and as a result the overall performance is greatly improved. The streamlined and coordinated delivery comes in hardy in this improvement. On the side of the clients, they have better continued care at their disposal. Such integration mounts its weight on better service provision, effective coordination of information and increasing opportunities within the system to make information easily shared.
Integration will also trigger efficiency in two main ways: information technology support and human resource. This means systems borrow and learn from one another. We will start by looking at how Mental health and addictions departments can come together to form an integration.
The first major consideration is the type of integration to be assumed in this collaboration. In this case study they addressed the aim of the integration. The question was whether to integrate the services of the departments or all services in the whole system.
Mental health and addictions departments share in the requirement of appropriate housing and social support. Integration of mental health and addiction services would take place at various levels. The first level would be the policy level where eligibility level, workforce requirement and financial incentives support the other integration forms awaiting implementation (Lurie, 2009). When fully done, the integration will enable service providers to meet their client’s needs in a cost-effective and accessible way.
The best example of this integration benefit is presented by the case of Ontario. In support for people with substance use problem, the experts of mental health supportive housing was of paramount assistance in Ontario (Burns & Pauly, 2002). The initiative was a success in bringing unity between mental health and addictions service providers across Ontario.
This proves a great effectiveness in exchanging treatment between the two departments that are related. For example, appropriate housing and social support provision are prerequisites for addiction and mental health problems (Burns & Pauly, 2002).
However, one setback of this integration is that it gets overwhelmed by the wide range of health and social services. To accomplish all these needs effectively under one system may therefore prove impossible.
The integration also seems to reduce need for re-hospitalization and therefore save cost but the savings cannot cover the service gaps and the greater capacity created in the system. Support can also be implemented when collaboration happens at the policy level. Integration further enables service providers to satisfy their clients in a way that reduces cost because the services are made readily available and accessible.
Finally there is an array of factors that inspires mental health and addictions to integrate. These factors are mostly cultural, sociological and clinical. The both areas are anchored in a combination of genetics, biology and general life experiences. Therefore most approaches used in their treatment are similar. In addition there is need to offer regular care in both mental care and addictions in order to improve the clients health.
On another case study, mental healthcare and general healthcare was integrated in what can be called vertical integration in a service provision. The integration was inspired by a need to improved organization and service integration in health and mental health care circles. There was a vision to improve clinical outcomes out of change of structure. The aim of the integration would be to create a patient centered rather than hospital centered service provision (Lurie, 2009).
A major challenge under this case could be the fragmentation of health care when different streams are separately funded for example hospitals, physician and drugs among others while the greatest achievement would be the unified community health service administrative structures that are able to transfer funds across service delivery sectors. There is also success in the planning on system basis.
However there is a challenge of system complexity. The resultant system is too complex to warrant effective service delivery. Further due to diversity of the individual departments there is a likelihood of competing visions and professional ideological differences thus difficult to achieve consensus.
The case contended with other challenges which were noted prior to its implementation. One fact was that collaboration has proved not to be so easy in this sector. For instance, while private sector integration is a leading economic contributor, few of them have proved success.
Secondly to achieve the goal of organization change re-structuring does not succeed because the fact was health care issues are too sensitive to be changed on the basis of trends. Moreover, research claims had proved that less than one management structure in clinical health care collaboration brings little or no change. This is because there is an over concentration of structure that limits the effectiveness of reforms.
However, the case is given impetus by the fact that this integration leads to organizational alignment thus healthy competition that improves health care provision. Moreover, such factors as, flexibility, Autonomy and free contacts with clients were noted to be drivers of the integration to its success (Church et al., 1995).
It was also noted that when a multidisciplinary departments are merged they save on operation cost while giving effective services to their clients than stand alone models. Interestingly the study discovered that the organization of health providers in the collaboration are remunerated and even deployed widely determine the effectiveness of their service delivery.
This kind of integration can be termed as service integration as it involves services across complex care providers. One of the considerations all these integrating departments must make is to do financial integration for without this, true integration can never take place. Secondly it is doomed to fail if they implement reforms that are not fully evaluated. That is why integration must take time to be actualized.
Moreover, the human resource must be given the first priority in policy making for community based care (Church et al., 1995) because this will achieve the aim of handing over health human resources to the community based care where there is more of client participation. That can never be achieved if when organizational plans are made, these considerations are pigeonholed.
In another case a survey was carried for cancer service integration in horizontal and vertical health care integration (Hernandez, 2000). A systematic approach in survey development was adopted and a decision making was decentralized. The surveyors developed an integrated service network. In this case study a number of integration techniques were used for example the functional integration.
The local cancer system leaders were deployed in coming up with effective aspects of existing health service integration measures for cancer (Hernandez, 2000). In addition, clinical program leaders from Ontario’s cancer system were deployed. The aim was to have each interviewee state main challenges to this integration. The main task on council members was to identify which integration would succeed and which one would fail and give further recommendations. This way the study proves to be comprehensive and promising.
They also had physician system integration in which physicians were linked financially to a central pool where they sourced facilities and services. This way there was unified involvement in the running of the system hence patients care units were coordinated across operating units of a system (Burns & Pauly, 2002).
For the success of this kind of integration, functional integration is always the most suitable for financial management and operating policies among other useful operations (Shortell et al., 2000).
One major limitation of the study was that the case study did not include family doctors and therefore the study lost fundamental information from family physicians who contribute greatly in the care of cancer patients. This integration also puts physicians under pressure to minimize cost and shifts focus from individual to population levels of clinical integration.
Another limitation evident was presented by the fact that there is usually low participation rate for clinician in the Cancer service integration survey thus, this could be a challenge when these results and findings are inductively used to a larger population of cancer care providers in Ontario and beyond (Schoenman et al., 2003).
Integration is always essential in business as it enables two companies with a common vision to supplement each other’s strengths as exemplified by PacifiCare and Maxicare firms. The two companies provide run high quality health institutions with very efficient service provision (Wampler et al., 1996). Maxicare for instance contracts with high profiled health institutions while PacifiCare are consisted in target marked analysis.
PacifiCare also boasts of professional management style and skills while Maxicare majors on growth and entrepreneurs.
However, the Maxicare Company experienced resource shortage as a result of high investment. PacifiCare on the other hand did not face many changes apart from minor restructuring in financial management during the merging exercise. Their merger therefore would solve most of the challenges for according to their development score both scored zero in their culture level.
In conclusion, these integrations were vital in closing up a gap in individual operations. However, for any integration to succeed partners must exercise ideological restraint. There must be well laid down procedures for reaching consensus and resolving conflicts that may arise in the course of restructuring and structuring of the departments to share common goals.
Integration must also leave almost all gaps sealed. That means member departments must find it easier to achieve its goals and effectively deliver services in the integration than it would have done without it.
The overall vision of any integration must be driven by clear knowledge of pivotal contributors to success in areas such as leadership, community involvement and structure, purpose of the integration, the human resource skills, facilitation and other extraneous factors as political opinions. It is these factors that determine the success or failure of any integration.
Integration is a dynamic undertaking which in some cases it can never be objectively determined. In line with this research findings demonstrate that there is no objective way for managing integrations and therefore what works with one particular integration may not do so with another one (Church et al., 1995).
Most researches on collaborations do not see the light of the day simply because their initial research concentrate on reducing cost rather than the means to effective service delivery (Church et al., 1995). Against this trend it is therefore wise for integration research to focus on clients as the end but not cost reduction.
This has rendered the integration act to be not a business as usual. What must be taken into consideration when departments are integrating is that every other integration will be so unique that its success or failure will depend on factors specific to such particular parties. To achieve success it is important to make the most exhaustive study and analysis of the targeted goals with all parties in mind. It is also significant to get views from the community who are target beneficiaries.
References
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Church, J., Pong, R., Sanders, D., Wanke, M., & Cappon, P. (1995). Health Human
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Gray, B. (1989). Collaboration: The constructive management of differences.
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Lurie, S. (2009). Getting to Integration: Command and Control or Emergent Process. The Innovation Journal: The Public Sector Innovation Journal, 14(1), 4.
Schoenman, J.A., Berk, M.L., Feldman, J.J., & Singer, A. (2003). Impact of Differential Response Rates on the Quality of Data Collected in the CTS Physician Survey. Evaluation and the Health Professions, 26(1), 23-42.
Shortell, S.M., Gillies, R.R., Anderson, D.A., Erickson, K.M., & Mitchell, J.B. (2000). Remaking Health Care in America: The Evolution of Organized Delivery Systems. San Francisco: Jossey-Bass.
Wampler, J., Frank, D., & Fogel, K. (1996). Strategic Alliances: An Integrated Health System Alternative. Frontiers of Health Services Management, 13(1), 543-56.