Background: Cross-sector integrated care is increasingly seen as the route to improving health, advancing health equity, and reducing care fragmentation. While considerable literature has examined characteristics of successful integrated care initiatives, less is known about how sectoral, organizational, and professional boundaries may be overcome to support care unification. The field of health services research has much to learn from the rapid collaborative response that ensued during COVID-19.
The purpose of this study was to explore and describe the impact of cross-sector integration utilized during COVID-19 at the individual and organizational level, through the Capability, Opportunity, and Motivation to change behaviour model.
Approach: An exploratory case study was conducted with an inter-sectoral working group who engaged with and provided vaccines to a community of high COVID-19 incidence from April – September 2021 in Toronto, Canada. This study used three sources of data: key informant interviews (n= 10), key stakeholder interviews (n=4), organizational participants (n=2) and a review of relevant documents. Participants included front-line workers, managers, directors and executive directors from hospitals, community health centres, social care, government, and faith organizations. Data were inductively analyzed using Braun and Clark’s (2006) theoretical thematic analysis.
Results: Findings suggest that the success of this community centred initiative rested on the remarkable capability and collective efficacy of the inter-sectoral working group. Participants’ professional identity served as a key intrinsic motivator to support the achievement of normative integration during this rapid collaborative response. The fluid interplay of social processes known to facilitate cross-sector collaboration, namely distributive leadership, and informal organizing were central features to this initiative, where community knowledge was considered an essential resource by working group members and system leaders. While participants were proud of their accomplishments, many were disappointed with limited system learnings to advance integrated care, with communities, beyond COVID-19.
Implications: Recommendations include a call for health system leaders to increasingly draw on opportunities for collective sectoral organizing grounded in complexity thinking, where sentinel focus areas are addressed through population health approaches. Through these collaborative acts, there is opportunity to bridge divides, drawing on internal motivations and collective governance to generate learning inclusive of community, addressing value for the system as a whole.

Background: Healthcare is duplicated and lacks integration when health professionals possess overlapping clinical skills and deliver services that are designed around their professional expertise.

Approach: At the Mater Hospital Brisbane (Australia), consumers would undergo lengthy assessments with duplicated questions when occupational therapists, physiotherapists, and speech pathologists complete separate, profession-specific stroke assessments. A “transdisciplinary” approach was used to redesign stroke assessment around consumer needs and eliminate unnecessary duplication. “Transdisciplinary” approaches involve sharing clinical skills/roles and training professionals to work beyond their usual scope of practice. Healthcare professionals met fortnightly to co-design and monitor implementation of a transdisciplinary stroke assessment, replacing profession-specific assessments of occupational therapy, physiotherapy, and speech pathology. To compare usual and transdisciplinary assessment methods, a pre-/post-implementation clinical study was conducted over 22 months. Patient and public involvement occurred in two ways: 1) patients with stroke were surveyed after completing the usual/transdisciplinary stroke assessment, and 2) people with stroke/their carers watched a pre-recorded transdisciplinary assessment and were asked for feedback via an online survey. Data was also collected via timed assessments and medical record audits. Inductive content analysis was used to understand consumer needs and experiences. Multivariable linear regression estimated assessment time differences. Cost minimization and sensitivity analyses estimated organizational cost savings.

Results: Compared to profession-specific stroke assessments (N=63), when the transdisciplinary assessment was used (N=116), patients spent 37.6 minutes less undergoing stroke assessment (95% CI −47.5, −27.7; p<0.001). Patients also required 3 fewer occasions of service from allied health professionals (p=0.011) before discharge to their usual residence or rehabilitation. Due to time savings, the estimated cost saving was $379.45 per patient (probabilistic 95% CI −487.15, −271.48). Patient safety (e.g., hospital readmission and fall rates) and patient outcomes (e.g., quality of life at 3 months) were not different. Patients who received profession-specific assessments reported they would “waste a lot of time repeating some activities and questions.” Whereas patients who received the transdisciplinary stroke assessment did not experience assessment duplication. People with stroke emphasized the importance of integrating multiple professions into one transdisciplinary assessment and suggested a greater focus on assessing cognition and mental health. The project's impact was three-fold, 1) improved efficiency for a more sustainable stroke service, 2) improved patient experience related to reduced duplication and intensity of stroke assessment, and 3) consumer-generated improvements for the transdisciplinary stroke assessment.

Implications: Using transdisciplinary stroke assessment was a successful strategy to integrate the expertise of multiple allied health professionals, redesign stroke services around consumer needs, reduce assessment duplication, and improve consumer experience. Next, the consumer-generated improvements should be applied to the transdisciplinary stroke assessment. The co-designed transdisciplinary approach can be translated to other services to leverage the impact of integrated care for a sustainable future.

Background: One of the key early clinical deliverables of these Ontario Health Teams is the creation of Integrated Clinical Pathways (ICP), specifically targeting Chronic Obstructive Pulmonary Disease (COPD) and Congestive Heart Failure (CHF). The primary objective of the ICP project is to enhance the quality of life for individuals living with chronic diseases and their caregivers by simplifying management pathways and improving overall care experiences. The Couchiching Ontario Health Team (COHT) leveraged partnerships for the ICP project to establish a regional Chronic Disease Program.

Approach: Planning and implementation of the COHT Chronic Disease program required an integrated care approach. To engage people as partners, co-create a shared vision, and address unique local needs, a planning day was conducted in collaboration with the COHT Patient Family Caregiver Network (PFCN) to identify care gaps and design a future state pathway for chronic disease management. The involvement of community partners and PFCN members was crucial in program co-design to ensure care and services were people-centered and that they meet the needs of users. As planning progressed, the team identified the need to engage additional partners to ensure pathway work adequately captured and supported the needs of more complex patients within the program. Taking an innovative approach to the province’s ICP project, COHT partnered with Waypoint Centre for Mental Health Care and the region’s North Simcoe Muskoka Specialized Geriatric Services program to better incorporate mental health needs and the needs of older adults and their caregivers into the pathways.

Results: Through the planning day and collaboration with the PFCN, a "Chronic Disease Hub" is now in place that empowers patients to be active participants in their care. An interdisciplinary team-based approach is employed that prioritizes the needs of both patients and their care partners, with regular check-ins to assess well-being. The pathways emphasize culturally safe care and address social determinants of health, including poverty, language barriers, and facilitating referrals to essential community services. With engagement of a specialized mental health partner and a specialized geriatric service program leader, screening tools are incorporated into pathways, new referral processes have been embedded and programming is being developed to build the self-management capacity of patients and their caregivers and to build the clinical capacity of the team. To ensure our ongoing commitment to co-design and continued quality improvement, the PFCN remains an active and engaged partner.

Implications: The integrated approach demonstrated by the COHT, in collaboration with our PFCN and community partners, underscores the significance of comprehensive care pathways in enhancing health outcomes and enriching patient experiences. This project serves as a model for fostering holistic chronic disease management through community engagement and support. In this presentation, we will share our approach and results to date. We will highlight lessons learned in our co-design journey and will provide insight into potential opportunities to expand, collaborate and consider further scale and spread.

Background:
Patient and Public engagement (PPI) is acknowledged to serve as a key driver in improving the healthcare system. This applies across the spectrum of care, health policies, research, and education.

Approach:
In the French-speaking part of Switzerland, patients’ expertise is mobilised in a postgraduate education curriculum targeting care coordination and attended by professionals in nursing, physiotherapy, nutrition, and social work.
Patients’ expertise is mobilised following the various degrees of patient-as-partner’s involvement. This includes co-design of the curriculum, co-assessment of students’ assignments, independent teaching as well as co-teaching, contributions to high-fidelity simulation sessions, and co-evaluation of the curriculum.
In our presentation, we will focus on the evaluation of a pilot pedagogical sequence, which targets skills such as the ability to partner with professionals and people involved, and to mobilize shared decision-making methods and tools.
The aim of our research was to explore a) the feasibility and acceptability of this pedagogical sequence, b) the preliminary benefits of this sequence for professionals, and c) the implications of a collaboration with a patient-as-partner.
Mixed methods were used for this exploratory study conducted in 2023. Data collection included pre- and post-sequence questionnaires and assessing attitudes towards shared decision-making and individual reflective written essays in which students reflected upon new learnings.

Results
Findings show that the sequence was delivered as intended and included various degrees of patient-as-partner’s involvement, and that including these degrees in the curriculum fosters skill transfer by students. The questionnaires reflected positive changes in the students’ postures towards partnership before and after the sequence. Students engaged in the sequence showed a better understanding of what partnership and shared decision-making is and isn’t. They displayed reflexive thinking about one’s own and others’ postures and practices. Students showed increased awareness of communication methods and tools enabling shared decision making and partnership practices.

Implications:
The audience will learn about the following aspects:
•The contents of a shared-decision-making curriculum targeting shared decision-making care built and delivered by patients and professionals.
•The methods that were used to evaluate this curriculum.
•The preliminary impacts of this sequence from the students’ perspectives.
•The challenges linked to the sustainability of patient involvement in postgraduate education.
Next steps include:
•The adjustment of the pedagogical sequence following the pilot.
•The reinforcement of PP’s involvement in the curriculum.
•Research opportunities about the transfer of shared decision-making practices and partnership into students’ professional practice.

Background: In the UK, individuals from ethnic minority backgrounds faced disproportionate impacts during and after the COVID-19 pandemic. Luton, the first designated Marmot Town in England, stands as one of the most super-diverse and socially deprived regions, significantly affected by the pandemic. To address these disparities, Luton Borough Council and the Bedfordshire & Luton Community Foundation funded the Voluntary, Community, and Social Enterprise (VCSE) organisations to implement a collaborative service model inspired by the Luton Fairness Taskforce. Commissioned under the ‘Covid Recovery Collaboration Fund’, this initiative aimed to reduce health and wellbeing inequalities among Luton's diverse population.

Approach: The Institute for Health Research at the University of Bedfordshire conducted a multi-mixed-method evaluation of this model, assessing its effectiveness, sustainability, challenges, and enabling factors. Data were collected from impact reports, end-of-grant documents, focus groups, interviews, and case studies. Qualitative data were analysed thematically using NVivo, and quantitative data were analysed using SPSS. Overall findings from all the sources were triangulated to provide comprehensive insights.

Results: The project served 7,177 individuals, with 52% of them being White and 48% of service users from other ethnic background, reflecting the ethnic diversity of Luton. A collaborative model among VCSE organisations with diverse skill sets enhanced performance by minimising duplication, fostering innovation and creativity, and expanding the scope of services. This approach facilitated the achievement of sustainable outcomes. Successful implementation required strong community trust that facilitated engagement, regular meetings, training, and lead oversight. However, challenges such as data-sharing agreements, funders’ expectations, and resource constraints affected delivery.

Implications: While collaboration offers enhanced service delivery and innovation, addressing resource limitations, governance issues, and local authority support is crucial to fully harness its potential benefits and sustainability.

Background: Integrated care research and practice often emphasizes integration, the process of bringing together people, organisations, and processes. While this focus may not be surprising, given the term ‘integrated care,’ we argue that differentiation—the division of labour within networks and partnerships—is equally crucial. Drawing on the work of organisational theorists such as Lawrence and Lorsch (1967) and Puranam (2018), this study examines how both differentiation (task division) and integration (bringing together) function as dual pillars of effective care networks. We extend this concept by introducing "value differentiation," focusing not only on the tasks actors perform but also on the diverse values and they bring. While much literature addresses shared values in integrated care and governance (e.g., Valentijn, 2015; Ansell and Gash, 2008), the specific impact of value diversity and alignment on integrated care and network collaboration in general remains underexplored. We aim to identify combinations of differentiation and integration that correlate with network effectiveness, challenging the assumption that shared values are a prerequisite for successful collaboration.

Approach: This study employs Crisp-Set Qualitative Comparative Analysis (csQCA) to analyse data from 24 integrated care networks in the Netherlands, gathered through surveys, interviews with integrated care leaders, and document reviews. We assessed how functional differentiation and integration, alongside network brokerage, value differentiation and integration, interact to produce effective care networks.

Results: Our findings highlight two configurations of effective integrated care networks. First, networks require a balance of functional differentiation (task division) and integration (unifying processes) to achieve goals. Initiatives prioritising integration without adequate task diversity fall short, as complementary roles are necessary to address complex needs. Similarly, networks with high task differentiation struggle without strong integration mechanisms to align efforts. Second, networks with high value diversity among actors become effective when collective values are agreed upon (value integration) and a network broker facilitates coordination, bridging diverse perspectives to foster collaboration.

Implications: This study builds on existing models of integrated care, such as the Rainbow Model, to demonstrate that both differentiation and integration are fundamental to network success. It offers fresh insights into how diverse values impact network effectiveness, contributing to governance frameworks and highlighting the broader significance of values in collaboration and partnership across integrated care settings. Beyond theoretical contributions, this study offers practical recommendations for integrated care leaders: prioritizing the differentiation aspects within integrated care can significantly enhance effectiveness. Leaders should engage deeply with the composition of their networks and partnerships, recognising the diverse tasks, functions, and values of each actor. This means carefully identifying the roles and contributions required from each actor and considering how these align with the objectives of the partnerships. Furthermore, we recommend that integrated care leaders proactively address values, embedding the promotion of shared network values within their strategies to support network cohesion. By actively cultivating an environment where diverse values are acknowledged and collective values are fostered, integrated care leaders can ultimately improve network performance.

Background: External fixation is widely used in treating complex fractures and limb reconstruction. Pin site infections remain a significant complication, impacting on patients’ physical and psychosocial wellbeing. This clinical improvement project at a University Hospital in Southern Denmark aimed to enhance pin site care by involving
patients and caregivers throughout the treatment pathway. Pin site care is crucial for preventing serious infections/osteomyelitis and involves collaboration between hospital and municipal caregivers. Traditional pin site care in our unit was complex and timeconsuming, causing patient anxiety and frequent unplanned clinic visits.
Approach: Inspired by the Participatory Design research methodology, a quality improvement project was conducted in three phases:
(1) identifying users’ needs, through field observations, interviews with nurses (from the hospital and the community), and patients combined with a review of existing international litterature
(2) developing solutions collaboratively through workshops with representaives from the hospital and the community, cognitive reflexions with patients and conducting a 'mini' Health Technological Assessment,
and (3) testing/evaluating the created solutions through surveys, interviews and field observations. Iterative cycles of planning, acting, observing, and reflecting were employed, facilitating mutual learning among all participants. Interviews with patients, families and healthcare professionals and field observations both at the hospital and in the municipality/community were conducted.
Results: Phase 1 identified the need for improved education of both patients and carers about infection recognition and the need for an assessment tool for pin site infection. Similarly, a less painful and time-consuming dressing method was warrented by both patients and cross-sectional carers. Phase 2 involved extensive user input to develop and implement a new dressing procedure using PolyMem™ along with an assessment tool.
Phase 3 evaluated the new methods, revealing reduced patient pain, fewer clinic visits, and stable infection rates as well as less time-consuming pin site care.
Conclusion: The project enhanced pin site care, involving users in developing a new care process, thus improving patient satisfaction and care efficiency. Information material (a leaflet) for both patients and staff at the hospital and the municipality/community staff. This material also aimed to educate HCPs about patients’ psychosocial concerns identified in phase one, and to empower patients and their families by involving them in the care process and supporting them in identifying signs of infection. The information material for the municipality also featured a QR code directing care staff to a video demonstrating the new dressing process. All the information was made available at “Mit Sygehus” (“My Hospital”), a free app for communicating health information in the Region of Southern Denmark.
Implications for future practice: Incorporating patient perspectives and collaborative methods can significantly improve clinical care pathways. There is general interest in finding new ways to use technology in healthcare. We found that an app accessible via a QR-code can support written information with video and other ways of presenting knowledge of importance to both healthcare professionals and patients/ families. The results have implications for how care can be organized with the involvement of patient perspectives and in creating new ways of communicating healthcare knowledge.