Integrating services for older people: a resource book for managers
International Journal of Integrated Care, 20 June 2005 - ISSN 1568-4156
Book review
Integrating services for older people: a resource book for managers
Edited by Henk Nies and Philip C. Berman
European Health Management Association (EHMA), Dublin, Ireland: 2004, pp 234,
ISBN 90 5957 283 1 also available from: URL: http://www.ehma.org/carmen/index.html
Michel Tousignant, PhD, Researcher, Research Center on Aging, 1036, rue Belvedere sud, Sherbrooke, QC, Canada J1H 4C4
General comments regarding the evaluation of this book

This book about the implementation of integrated network contains the full range of information useful for managers with a new interest in the implementation of an integrated network. The structure of this book is particularly interesting with regard to its pedagogical aspect where the rigor of the different chapter sections is repeated from chapter to chapter and where the importance of knowledge required by managers in order to efficiently implement an integrated network is clearly demonstrated.

From a general point of view, this book covered a large spectrum of key points related to implementation of integrated network such as concepts of integrated care networks where a very interesting section looks at the constraints on service integration with the different parameters likely to influence the success or failure of service integration being exhaustively described. From different models of integration strategies within the structure of service integration, this book describes the organisational structures of service integration. Moreover, three perspectives to be considered in service integration are presented, namely the user needs, client requests and referrals, and the availability of services through the integrated network. The models of case management are presented with a very interesting description. A distinction is made between the advantages and disadvantages of the five case management models. Some others key points of the integrated network are discussed like cultural changes related to any major change within an organisation, strategic planning, which concerns primarily the decision-makers within the community and private sectors who must work together towards the goal of redefining health services, management of information and quality management models.

Even though the tone of this book is largely theoretical, a careful reading by a manager would result in a concrete idea of the steps involved in the implementation process of an integrated network. The chapters deal exhaustively with the different models contained within. Although interesting, this exhaustive presentation does not allow readers to make a choice about the ideal type to promote according to the characteristics of a given milieu.

Budgetary and financial aspects are not addressed in a convincing manner, creating a barrier to the implementation of integrated networks. An additional chapter looking at financing models to allow integration would be an asset.

Even though the target reader is a manager, any one interested in the implementation of an integrated network would benefit from reading this document. The reader's interest could be captured by specific chapters, thus acquiring various conceptual notions useful for a reflection on changes in the health care system towards integrated networks.

In the light of these comments, my evaluation is that it would be pertinent to proceed with the publication of such a book in the context of the flourishing of integrated networks throughout the world. Based on the extent of reading that I have done on integrated networks, I firmly recommend this book to every health professional who might be interested in the implementation of an integrated network. I reiterate the fact that this book is a good theoretical tool that could permit a practical and concrete adaptation.

Specific comments of the book chapters

The objective of Chapter 1 is to present the concepts of integrated care networks. This chapter is very well constructed, addressing successively the different points of interest for managers, the goals of the integration of services, the different levels of integration and the dimensions of continuity of care. The role of users as well as non-professional care providers is also addressed. As well ethical aspects. This very interesting section looks at the constraints on service integration with the different parameters likely to influence the success or failure of service integration being exhaustively described.

Chapter 2 is related to the organisational structures of service integration. It addresses service integration in terms of organisational aspects at the network level and the health system level. Different models of integration strategies within the structure of service integration are presented. The different stakeholders of the integrated service network are also described, beginning with the users, through the level of managers, the professionals, proprietors or operational managers of quality control agencies, financial agencies to the political level. The relative influence of entrepreneurs, stakeholders and health-care professionals is discussed in terms of their roles of influence.

Chapter 3 deals with the notions of involvement, empowerment and advocacies. Operational definitions are given for these terms. The content of this chapter is largely theoretical. Although interesting, this chapter is not the highlight of the book.

Evaluation of user needs is described in Chapter 4. Three perspectives to be considered in service integration are presented, namely the user needs, client requests and referrals, and the availability of services through the integrated network. The importance of a multi-disciplinary needs evaluation is mentioned. The different types of needs are described, such as health, mental health, environmental, psychological, spiritual and economic, as well as patient preferences.

The care trajectory (Chapter 5) is defined as an integration strategy that offers a better integration between clinicians, community services and other health and social services. Practical clinical guides are used as examples of the care trajectory. The importance of conclusive data in the use of different services is noted.

The objective of Chapter 6 is to present case management. A clear definition is presented and the process of case management is well presented. The models of case management are presented with a very interesting description. A distinction is made between the advantages and disadvantages of the five case management models, among other details. The implementation process for case management is described according to the five-stage sequence.

Chapter 7 addresses integrated teams, which are defined as multidisciplinary and interorganisational groups of health professionals who work together to provide services in order to support the different needs of the individual who is in a position of dependence on the health-care system. An interesting aspect of this chapter is an assessment that combines an evaluation of the clinical efficacy as well as the economic factors while taking into account the satisfaction of the user. This assessment model is entirely pertinent and coherent with the implementation of integrated networks.

Overall picture of the human resources that contribute to the provision of care is landed in Chapter 8. More horizontal mobility of staff is highlighted as part of important outcomes. Indeed, integration of services often implies that boundaries between provider organisations become increasingly blurred. Relative importance between training, supervision, legal safeguards and planning are identifies as a key of success.

Chapter 9 deals with cultural changes related to any major change within an organisation. Two models known to facilitate cultural change, namely ‘learning approach’ and ‘client call first approach’ are presented. The description is interesting but the choice of one or other of the two models remains obscure after reading the chapter.

Leadership required in the development of integrated networks is addressed in Chapter 10. The definition and models of leadership are described. The different qualities of leadership are also clearly presented. Barriers to effective leadership are also described as an explainable source of barriers to the implementation of integrated networks.

Chapter 11 looks at strategic planning, which concerns primarily the decision-makers within the community and private sectors who must work together towards the goal of redefining health services.

Chapter 12 addresses the management of information. It is noted that the authors' preference is towards a computerized management system choice.

Three quality management models are presented in Chapter 13, namely ‘total quality management’, ‘continual quality improvement’ and ‘quality awards’, mentioning the different actors likely to interact in the evaluation of the quality of the integrated network.