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Reading: The only constant is change – Exploring the evolvement of health and social care integration


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The only constant is change – Exploring the evolvement of health and social care integration


Charlotte Klinga

Karolinska Institutet, SE
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This research (cover story from a thesis) addresses the challenge of how to establish and maintain long-lasting integration of health and social care services in mental health care and aims to explore the dynamics of organisational change and sustainability.


A qualitative research approach was used in a longitudinal case study, ranging from 1995-2015. Data were collected from individual and group interviews and from steering committee minutes. The Dynamic Sustainable Framework (DSF) was used to analyse the data and identify themes that helped explain the dynamics of organisational change and sustainability.


Four themes are used to summarize the findings.

Shared structure and ongoing refinement: The integrated services were co-located under co-leadership management. A shared mission on the value of integrated health and social care was essential for establishing a culture of shared values and for sustaining the required long-term collaboration and cooperation.

Continuous learning:

Continuous exchange of competencies and experiences was prioritized and forums were established for various stakeholders to exchange information for learning and service improvement. Staff was encouraged to help find solutions to the problems encountered when providing equal health and social care.

Cooperation as a guiding principle:

The integration of health and social care services, which was based on the principle of cooperation, encouraged informal caregivers and other parties such as service user associations and service user representatives to take part in the cooperation.  

Service user centeredness:

The central role of the service user was formalized by an agreement that specified the individual care and rehabilitation plans. Attention was paid to service users’ holistic needs and to their abilities and strengths in the focus on finding best-possible solutions to their needs.


Three main factors were identified as key in achieving long-term integration of health and social care services. First, partnerships between the health and social care services, as well as with service users and service user associations, enabled the sharing of responsibility for the integrated services and long-term decision-making. The formulation of an overall agreement, a shared mission, and the involvement of all stakeholders in the steering committee also exemplified this. Second, person-centeredness was central in the provision of the integrated services, but also in contacts with service users. Co-location of services, co-leadership, and inter-professional teams were other strategies used to meet the service users’ needs. Third, organisational learning was used as a strategy to continually adapt and align services to the changing needs of the service users.

Lessons learned:

The development of long-lasting integration of health and social care services also built capacity to manage differences and changes by relying on partnership, person-centeredness, and continuous learning.


Additional interviews with professionals in the integrated services, politicians, and civil servants could have broadened the study scope and strengthened this research.

Suggestions for future research:

Prioritised areas of future research include longitudinal studies on the impact of different factors on sustainability but also on the inter-relatedness of factors impacting sustainable change.

(Financial support: European Commission GA, 305821 - INTEGRATE, Swedish research council and Forte)

How to Cite: Klinga C. The only constant is change – Exploring the evolvement of health and social care integration. International Journal of Integrated Care. 2021;21(S1):282. DOI:
Published on 01 Sep 2021.


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