Editorial

Citation

Kaehne, A. (2022), "Editorial", Journal of Integrated Care, Vol. 30 No. 1, pp. 1-2. https://doi.org/10.1108/JICA-02-2022-086

As the variants of the SARS-COV-2 are refusing to go away, health systems across the world are trying to move from pandemic to epidemic mode. The implications for integrated care are immense and our authors, just like all frontline practitioners, have tried to grapple with the consequences of rapid transformations and change. Integration that was once an issue of bringing together various macro- and meso-systems, predominantly dealing with professional and organisational divides, has now morphed into a challenge affecting the entire health system. It may be helpful to outline a few of the new dimensions of integrated care to grasp the magnitude of change for clinical and non-clinical health practice.

As COVID hit, hospital capacity, in particular intensive care unit beds, needed to be increased speedily which presented hospital managers with tests of their collaborative and leadership abilities as they transferred patients from acute treatment centres to community facilities or care homes. Those care homes themselves struggled to implement and maintain effective infection control measures in the face of ever changing guidance and uncertainties about the virus. Whilst the cooperation between hospitals and community care facilities landed in, what one may call, traditional integration territory, testing existing relationships between providers and requiring them to build new ones a completely novel terrain opened up: a public health emergency and how to keep the wider public safe.

A brief examination of the contributions to this journal over the last ten years showed that emergency public health measures feature little in integration studies. Similarly, key public health interventions that were put in place during the pandemic such as roll outs of mass vaccination programmes, contact tracing or self-isolation support measures were simply not on the radar of scholars working in the field of integration. They are now!

The pandemic revealed a significant blind spot of integration research: public health and health behaviour during emergency public health responses. If we, as a community of researchers and practitioners, thought this outside the remit of our field, we learnt to think otherwise. The profound changes in hospital management occurred parallel to enormous changes to how our primary and secondary care services are being planned, designed and delivered. During the pandemic, public health often took precedence over elective surgeries in many countries creating a backlog of planned hospital activities. Regular health checks for some patient groups were also at times suspended which increased the chances of undetected health problems, which is now producing an avalanche of urgent health needs hitting exhausted staff and stretched health systems.

The second significant transformation is digital. As infection control became an issue, primary care facilities, such as general practitioners, often shut their doors moving their care delivery to digital platforms. This only accelerated a shift that has gotten under way already in several countries. In fact, private health care providers had long offered remote consultations to their patients where appropriate. Whilst there are concerns about the impact of socially distant care delivery on the patient doctor relationship, these new ways of working are likely to stay for reasons of efficiency, if not for offering a decreased risk of infection. The irony is that remote consultation may transform the care relationship especially for those patients who may have benefitted most from personal touch in a face to face environment. The role of empathy and compassion in listening and caring for elderly and frail patients or those with chronic diseases or mental health issues has become a prominent theme of concern as digitalisation is taking root.

So what is the role of integration in all these changes? A look at the rainbow model of integration reveals the limitations of our current approach to integrated care. The model limits our understanding to the conventional divides that separate organisations, professions and teams. Integration is perceived as an emergent practice that overcomes or transcends those divides, providing better care for patients.

What is not captured in the model is the current wave of transformations exacerbated by public health and infection control measures, digitalisation and health system emergency responses to the pandemic. In fact, emergency response measures were often introduced in many countries by suspending existing established collaborative arrangements, creating new governance structures on the go. The research on integration will have to reckon with these ad hoc structures that have appeared in our health systems. Yet, benchmarking them against the parameters of the rainbow model will not capture the novel conditions of delivering remote socially distanced care or the importance of public health as a touchstone of health system resilience. Integrated care research thus faces a profound challenge of its own. It will need to move away from the organisational boundary investigations to a more comprehensive understanding of care integration around standards of safety, risks and health system resilience. At present, we can only see the rough outlines of this new integration research; yet, there is no doubt that if we disregard the warning signs, the field will lose its relevance in the face of new challenges.