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Shared situation awareness as a contributor to high reliability performance in railroad operations. The variable success of integrated care initiatives has led experts to recommend tailoring their design and implementation to the local context [ 2 , 3 , 4 ]. However, relatively little is known about what contextual factors are associated with successful integrated care delivery [ 5 , 6 ]. In addition to the broader social, political, economic and cultural environment [ 7 ], factors in the organizational context also influence integrated care efforts.

However, organizational contexts are rarely described, understood, or measured with sufficient depth and breadth in empirical studies or in practice. The focus of research and evaluation tends to be on measuring the mechanisms of the intervention itself, the extent to which care is integrated, and outcomes. We thus lack knowledge of which organizational factors matter, and when and how they matter. This definition encompasses both internal organizational factors as well as collective inter-organizational factors needed to leverage and combine resources from multiple organizations in the delivery of integrated care.

Comparative case study research provides useful methods for understanding context and explaining why some integrated care initiatives work effectively in some contexts, but not in others [ 10 , 11 ]. Case study research involves the collection of qualitative, and often quantitative, data from various sources to explore the characteristics of one or more organizations, or parts of organizations [ 12 ]. To conduct comparative case studies, researchers need standardized tools for collecting comparable data on organizational factors across care providers, settings, and studies.

However, we are unaware of any measurement systems that have been developed with the aim of rigorously characterizing and comparing a wide range of organizational capabilities, spanning structural, process and socio-cultural elements, and involving both qualitative and quantitative methods. In this paper, we describe the development and content of a conceptual framework and research toolkit for conducting standardized, comparable case studies of the organizational context for integrating care.

The toolkit provides methods and tools for assessing key organizational and inter-organizational characteristics that affect the implementation and success of integrated care initiatives. A multi-method approach consisting of five stages informed the development of the toolkit: 1 development and validation of the Context and Capabilities for Integrating Care Framework, 2 development of document review guidelines, 3 identification, assessment and selection of survey instruments, 4 , development of interview resources, and 5 pilot testing of the document review guidelines, consolidated survey and interview guide.

Some studies of integrated care initiatives examine selected and limited organizational factors, but there is no comprehensive framework to guide research. The CCIC Framework was developed through a literature review of system-level integrated care strategies using papers identified through a previous review [ 14 ]. We extracted organizational factors from included papers and grouped them together under preliminary categories. The framework was revised and validated through semi-structured interviews with 53 managers and care providers engaged in the implementation and operation of 38 integrated care networks in Ontario, Canada.

A combination of purposeful and snowball sampling was used to identify networks and participants. Interviews consisted of open-ended questions to identify important organizational factors followed by graphic elicitation to obtain views on the framework. Codes were also generated inductively for factors mentioned by participants and not already reflected in the CCIC Framework.

Because the framework is specific to integrated care, certain elements of prior frameworks take on more importance and are more detailed e. Detailed methods on how the framework was developed are reported in a separate publication [ 15 ]. Below we describe the development of the data collection instruments in the research toolkit.

We aimed to capture in the toolkit all factors identified by the CCIC Framework with minimal respondent burden and to enable triangulation of results. We therefore began by developing document and website review procedures as they represent the least intrusive method of data collection, followed by the identification and consolidation of high quality survey instruments and the development of interview guides to address any remaining factors not covered by the previous methods. We developed a list of potential sources e. Using the factors outlined in the CCIC Framework as a guide, we identified key information to look for and record during document and website review.

The lists of sources and of key information were identified, expanded, and modified through group discussion among research team members.

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The guidelines outlined in the toolkit were informed by a seminal publication on the use of document analysis as a qualitative research method [ 16 ]. We conducted a rigorous search for validated surveys that measure the constructs in the CCIC Framework. The database searches were supplemented by an expert consultation involving investigators with the Health System Performance Research Network www. A total of 40 experts responded and collectively identified 30 tools.

Identified instruments were assessed based on their psychometric properties, respondent burden, and applicability to integrated care efforts in terms of prior use and language i. All three criteria were considered equally in the assessment of instruments. In instances where instruments covered similar content and were comparably strong across the above criteria, the authors discussed the merits of each instrument until consensus was reached on the most appropriate instrument.

While some of the surveys could be applied to other initiatives beyond integrated care e. Detailed methods and results on the review of survey instruments are reported in a separate publication [ 13 ]. We developed a semi-structured interview guide to elicit views on which organizational factors have been most and least influential in shaping implementation and performance in a given integrated care initiative. We also developed a repository of interview questions that measure content areas not covered, or inadequately covered, by the survey instruments.

The interview guide and repository were developed iteratively by the team through discussion and pilot testing. The consolidated survey instrument and the semi-structured interview guide were piloted with four managers and three care providers working in four integrated care networks in Ontario.

The provider survey was piloted with two care providers, the manager survey was piloted with two managers, and the interview guide was piloted with two managers and one provider. Survey pilot participants filled out either a paper-based or online version of the survey and participated in a 30 minute debriefing interview to provide feedback. Interview pilot participants were engaged in a cognitive interviews [ 17 ] in which they were asked to consider the structure and content of the interview questions rather than answering questions outright.

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Pilot testing of the consolidated surveys resulted in minor changes to wording in the introduction and instructions, and to one survey item. Overall, pilot test participants completed the survey in approximately 40 minutes and found the instructions and questions easy to understand and complete.

Minor changes were also made to the wording of instructions in the interview guide, and to the questions themselves, to improve clarity and to improve the flow of questions. These factors can be examined within organizations and across partnering organizations in a network. The document and website review procedures focus on publicly available information and readily accessible information from internal organizational documents. Examples of organizational data recommended for collection as part of the document review include: organization age and size Physical Features of the Organization , staff mix and financial standing Resources , organization affiliations and the degree of hierarchy and centralization Organizational Design , and board composition and involvement in quality of care Governance.

We identified 83 survey instruments meeting our inclusion criteria. Based on the assessment criteria and team discussion, six surveys were selected for inclusion in whole or in part :. Measure of Network Integration [ 19 ]. Survey of Organizational Attributes for Primary Care [ 22 , 23 ]. Organizational Culture Inventory [ 24 ]. Two versions of the survey were created, aimed at managers and care providers respectively. The interview guide consists of two sections. In the first section, there are three open-ended questions and eight prompts aimed at characterizing the integrated care initiative in terms of successes, challenges, and the nature of relationships.

The interview question repository provides questions on organizational factors not well covered by the surveys, such as Information Technology, Leadership Approach, Clinician Engagement and Leadership, Patient-Centeredness and Engagement, Commitment to Learning, and Delivering Care. However, the interview questions target different aspects of these topics than their corresponding surveys items.

A total of 20 questions are provided, not including prompts, and are organized by respondent group managers, clinical and administrative staff, and clinical staff. Together, the interview guide and repository provide the opportunity to understand and probe qualitatively what is measured quantitatively by the survey instruments. The research toolkit was designed to yield standardized comparable data on organizational and inter-organizational factors that influence the implementation and success of integrated care initiatives.

Below we offer guidance and considerations for the optimal use of the toolkit. The toolkit may be used by both researchers and managers interested in understanding the influence of organizational context on integrated care initiatives.

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When used in research, the toolkit can help characterize and compare organizational context across multiple cases and enable comparison of results across studies. This knowledge can help explain why some integrated care initiatives succeed and some fail, and can be used to generalize findings and best practices across integrated care settings. We also encourage the use of the toolkit by leaders and managers engaged in planning, implementing or evaluating integrated care initiatives. Application of the toolkit can provide information and support to managers in identifying appropriate partner organizations and change management strategies.

The toolkit is intended for application within and across the organizations involved in a given integrated care initiative. This may include primary care practices, community care organizations, hospitals, long-term care facilities, allied health organizations, and social services agencies, among others. In order to examine the organizational and inter-organizational factors within and across these organizations, appropriate respondents include senior management, middle management, and clinical staff. Administrative staff may also be included. Sampling approaches will vary based on the network, organization or team size.

In a small organization, or in a small integrated care network or team, no sampling will be necessary. Rather, all involved staff may be invited to participate in the surveys, and potentially the interviews depending on available resources. Prior to transitioning to the private sector, he was founding manager of the Centre for Business Process Outsourcing, a Scottish research centre co-funded by the University of Strathclyde and Highland and Island Enterprise regional development agency for the North of Scotland. Besides his role at Carisma RCT, he still maintains a series of academic roles at various Universities in the United Kingdom, Vietnam, and China; he serves on the editorial boards of several academic journals, and he is a member of a number of scientific committees.

His work and views on management and operations regularly appear in prominent publications including The Times and various international journals, books, and trade magazines. Marco can be contacted via e-mail at m.

Doing Research that Matters: Shaping the Future of Management

Scientific research, and particularly management research, is in dire straits, accused of lack of relevance and impact and an unhealthy preoccupation with theoretical and methodological rigor. Listen the reading of the article: Your browser does not support the audio element.

The book was officially launched on August 10th, at an event organised by Emerald Group Publishing at the Academy of Management Conference. After a brief introduction by the Juliet Harrison Emerald , Marco Busi presented the book to the audience, touching on three key points of his journey:. The event continued with a round of questions from the several participants which led to an interesting discussion. That was then followed up by an informal drink reception and book signing session. Feedback collected from those who attended was extremely positive and encouraging.

Synopsis Table of contents Foreword About me Press review Book launch Synopsis If you believe the impact of management research and education is in decline, this book will help. Contents Prologue — My declaration of intent Personal introduction to the futureers Chapter 1. Shaping the future of management by reinventing management research Chapter 2. Destination paradise: understanding what to aim for Chapter 3. The thrill of discovery Chapter 4.

The big or small q: finding romantic problems worth studying romantic problems worth investigating Chapter 5. Enjoy the ride Chapter 6. Travelling solo, or in groups?