Overcoming Political Fragmentation: The Potential of Meso-Level Mechanisms; Comment on “Integration or Fragmentation of Health Care? Examining Policies and Politics in a Belgian Case Study”

Document Type : Commentary

Author

1 Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, ON, Canada

2 Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada

Abstract

Martens and colleagues’ paper “Integration or Fragmentation of Health Care? Examining Policies and Politics in a Belgian Case Study,” offers an in-depth examination of integrated care policy efforts in Belgium. A key finding in this case study was that political fragmentation proved too great an obstacle for integration efforts. In this commentary, I draw on the organizational behaviour and integrated care literatures to suggest how meso-level mechanisms related to sensemaking, distributive leadership, and evaluation could help overcome policy (or macro) level challenges like those experienced in Belgium. The commentary also suggests we need to consider and address both the process and normative challenges in these transformation efforts.

Keywords


  • epublished Author Accepted Version: March 5, 2022
  • epublished Final Version: March 12, 2022
  1. Martens M, Danhieux K, Van Belle S, et al. Integration or fragmentation of health care? Examining policies and politics in a Belgian case study. Int J Health Policy Manag. 2021. doi:34172/ijhpm.2021.58
  2. Filliettaz SS, Berchtold P, Koch U, Peytremann-Bridevaux I. Integrated care in Switzerland: strengths and weaknesses of a federal system. Int J Integr Care. 2021;21(4):10. doi:5334/ijic.5668
  3. Tenbensel T, Miller F, Breton M, et al. How do policy and institutional settings shape opportunities for community-based primary health care? A comparison of Ontario, Québec and New Zealand. Int J Integr Care. 2017;17(2):13. doi:5334/ijic.2514
  4. Looman W, Struckmann V, Köppen J, et al. Drivers of successful implementation of integrated care for multi-morbidity: mechanisms identified in 17 case studies from 8 European countries. Soc Sci Med. 2021;277:113728. doi:1016/j.socscimed.2021.113728
  5. Zimmerman B, Lindberg C, Plsek P. Edgeware: Insights from Complexity Science for Health Care Leaders. Irving, TX: VHA; 1998.
  6. The Health Foundation. Evidence Scan: Complex Adaptive Systems. London, UK: The Health Foundation; 2010.
  7. Jordan ME, Lanham HJ, Crabtree BF, et al. The role of conversation in health care interventions: enabling sensemaking and learning. Implement Sci. 2009;4:15. doi:1186/1748-5908-4-15
  8. Denis JL, Lamothe L, Langley A, et al. The reciprocal dynamics of organizing and sense-making in the implementation of major public-sector reforms. Can Public Adm. 2009;52(2):225-248. doi:1111/j.1754-7121.2009.00073.x
  9. Heimans J, Timms H. New Power: Why Outsiders are Winning, Institutions are Failing, and How the Rest of Us Can Keep Up in the Age of Mass Participation. New York, USA: Macmillan; 2018.
  10. Bevan H. Enabling Change and Change Leaders. United Kingdom: NHS Horizons; 2019.
  11. Fooks C, Goldhar J, Wodchis WP, Baker GR, Coutts J. New Voices, New Power, New Ways of Working: Bringing integrated care to the National Health Service in England. Healthc Q. 2019;21(4):32-36. doi:12927/hcq.2019.25743
  12. Menear M, Blanchette MA, Demers-Payette O, Roy D. A framework for value-creating learning health systems. Health Res Policy Syst. 2019;17(1):79. doi:1186/s12961-019-0477-3
  13. Sheikh K, Abimbola S. Learning Health Systems: Pathways to Progress: Flagship Report of the Alliance for Health Policy and Systems Research. Geneva: World Health Organization; 2021.
  14. Morain SR, Kass NE, Grossmann C. What allows a health care system to become a learning health care system: results from interviews with health system leaders. Learn Health Syst. 2017;1(1):e10015. doi:1002/lrh2.10015
  15. Steele Gray C, Grudniewicz A, Armas A, Mold J, Im J, Boeckxstaens P. Goal-oriented care: a catalyst for person-centred system integration. Int J Integr Care. 2020;20(4):8. doi:5334/ijic.5520
  16. Steele Gray C, Gagnon D, Guldemond N, Kenealy T. Digital health systems in integrated care. In: Amelung V, Stein V, Suter E, Goodwin N, Nolte E, Balicer R, eds. Handbook Integrated Care. 2nd ed. Cham: Springer; 2021:479-496. doi:1007/978-3-030-69262-9_28
  17. Lanham HJ, Leykum LK, Taylor BS, McCannon CJ, Lindberg C, Lester RT. How complexity science can inform scale-up and spread in health care: understanding the role of self-organization in variation across local contexts. Soc Sci Med. 2013;93:194-202. doi:1016/j.socscimed.2012.05.040