The Scaling Up of Integrated Care: The Importance of Context

During the 17th International Conference on Integrated Care (ICIC), held in Dublin last week, people from different countries presented strategies on the development, evaluation and/or implementation of integrated care. Although many strategies showed overlap in approaches and face the same challenges, other strategies revealed significant differences between countries. For example, where home care is self-evident to residents in the Netherlands, the Swiss Red Cross is supporting countries in Eastern Europe to develop home care. In Israel, the community was engaged during the development of a new hospital, to be opened this June, focussing on bridging health and social care. In contrast, in a suburb of Sydney, it was specifically chosen not to build a new hospital, but to involve the community, local providers and partners in the development of a community based health and wellbeing service integrating primary care, specialist services, community health and government and non-government agencies. This illustrates that the journey towards integrated care is not often the same for different countries and regions.

Context, context and context
When talking about health care, social care, public health, community and integrated care the definition of these terms seem to differ tremendously between countries and even between regions in the same country. The environment plays an important role in the development, piloting, and implementation of integrated care initiatives. What successfully works regarding integrated care delivery in one country or region, may not work in another setting. Plenty of knowledge on important elements of integrated care delivery in a single context is available, however how these elements play out in different contexts is less clear. Awareness and sensitivity to the role of contextual factors is a critical condition during knowledge sharing to ensure the right track of achieving progress in integrated care.

Measuring ‘maturity of integrated care’
During the session on measurements that support decision-making in integrated care, I presented the very first findings of our study related to the testing of the content validity of an instrument measuring maturity of integrated care: the Maturity Model. The rationale behind the Maturity Model is that ’maturity of integrated care’ can represent the phases of the development and implementation of integrated care. This information should help stakeholders to overcome mistakes and/or to speed up the progress towards more mature integrated care. Data about maturity of integrated care can be helpful if, for example, region A wants to learn from region B, assuming that B is more mature than A and A wants to progress towards the level achieved by B.

Our effort to test the validity of measuring the maturity of integrated is part of the SCIROCCO project. This EU subsidized project aims to develop the Maturity Model into a validated and tested self-assessment tool which supports the matching of regions grounded on the differences in maturity in integrated care delivery. In the maturity model, specific attention is paid to the different contexts between the different regions which should enable discussions and exchange of knowledge and experiences to ultimately make a faster progress towards maturity of integrated care. Taking part in the evaluation activities of the SCIROCCO project gives me a priority seat to explore the sharing and learning processes between different regions while they evolve in their journeys towards obtaining accessible, quality, effective and sustainable health care. I look forward sharing more insights with you in due time.

by Liset Grooten,
affiliate junior researcher at Panaxea and PhD candidate at Vrije Universiteit Brussel
For more information about the Maturity model or the SCIROCCO project please feel free to contact me @