Figure 1
B3-Maturity Model [22].
Figure 2
Planning for a Maturity Assessment Process [32].
Table 1
Distribution of responses.
| DISTRIBUTION OF RESPONSES | DEFINITION |
|---|---|
| Agreement | Less than four ratings outside a 3-point region containing the median |
| Split | At least four ratings outside the 3-point region containing the median |
Table 2
Operational definitions of levels of maturity.
| MEDIAN | DISTRIBUTION OF RESPONSES | MATURITY LEVEL |
|---|---|---|
| 0–2 | Agreement | Initial |
| 3–4 | Agreement | Progressing |
| 5 | Agreement | Optimising |
| Any | Split | Uncertain |
Table 3
Participant Characteristics.
| Total number of participants (n) | 12 |
| Background of participants (n, %) | |
| Healthcare Administrators | 5 (42) |
| Healthcare Professionals | 4 (33) |
| Social Service Administrators/Professionals | 3 (25) |
| Years of experience (n, %) | |
| 5–9 | 2 (17) |
| 10–14 | 2 (17) |
| 15 and above | 8 (66) |
Figure 3
Maturity of Integrated Care based on Overall Median.
Table 4
Results of Delphi study based on SCIROCCO tool.
| DIMENSIONS | ROUND 1 | ROUND 2 | ROUND 3 | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| MEDIAN | % AT MEDIAN | % IN AGREEMENT | DISTRIBUTION OF RESPONSES | MATURITY LEVEL | MEDIAN | % AT MEDIAN | % IN AGREEMENT | DISTRIBUTION OF RESPONSES | MATURITY LEVEL | MEDIAN | % AT MEDIAN | % IN AGREEMENT | DISTRIBUTION OF RESPONSES | MATURITY LEVEL | |
| 1 Readiness to change | 3.0 | 66.7 | 91.7 | Agreement | Progressing | 3 | 66.7 | 100.0 | Agreement | Progressing | 3 | 66.7 | 100.0 | Agreement | Progressing |
| 2 Structure & Governance | 2.5 | 37.5 | 75.0 | Agreement | Progressing | 2 | 58.3 | 91.7 | Agreement | Initialising | 2 | 75 | 91.7 | Agreement | Initialising |
| 3 Digital Infrastructure | 2.5 | 20.8 | 41.7 | Split | Uncertain | 3 | 50 | 83.3 | Agreement | Progressing | 3 | 83.3 | 91.7 | Agreement | Progressing |
| 4 Process Coordination | 2.5 | 33.3 | 66.7 | Split | Uncertain | 2 | 58.3 | 83.3 | Agreement | Initialising | 2 | 66.7 | 91.7 | Agreement | Initialising |
| 5 Funding | 1.0 | 58.3 | 66.7 | Split | Uncertain | 1 | 83.3 | 91.7 | Agreement | Initialising | 1 | 91.7 | 91.7 | Agreement | Initialising |
| 6 Removal of Inhibitors | 1.0 | 58.3 | 66.7 | Split | Uncertain | 1 | 75 | 75.0 | Agreement | Initialising | 1 | 83.3 | 83.3 | Agreement | Initialising |
| 7 Population Approach | 3.0 | 50 | 100.0 | Agreement | Progressing | 3 | 83.3 | 100.0 | Agreement | Progressing | 3 | 91.7 | 100.0 | Agreement | Progressing |
| 8 Citizen Empowerment | 2.5 | 33.3 | 66.7 | Split | Uncertain | 2.5 | 37.5 | 75.0 | Agreement | Progressing | 3 | 58.3 | 75.0 | Agreement | Progressing |
| 9 Evaluation Methods | 2.5 | 33.3 | 66.7 | Split | Uncertain | 2.5 | 41.7 | 83.3 | Agreement | Progressing | 3 | 58.3 | 91.7 | Agreement | Progressing |
| 10 Breadth of Ambition | 3.0 | 33.3 | 66.7 | Split | Uncertain | 3.5 | 29.2 | 58.3 | Split | Uncertain | 3.5 | 29.2 | 58.3 | Split | Uncertain |
| 11 Innovation Management | 2.0 | 33.3 | 83.3 | Agreement | Initialising | 2 | 58.3 | 91.7 | Agreement | Initialising | 2 | 66.7 | 100.0 | Agreement | Initialising |
| 12 Capacity Building | 3.0 | 41.7 | 58.3 | Split | Uncertain | 3 | 50 | 50.0 | Split | Uncertain | 3 | 50 | 50.0 | Split | Uncertain |
[i] Agreement: Within a 3-point region containing the median.
Table 5
Categorisation of dimensions into maturity levels.
| MATURITY LEVELS | DIMENSIONS OF SCIROCCO TOOL |
|---|---|
| Initial | Structure & Governance, Process Coordination, Funding, Removal of Inhibitors, Innovation Management |
| Progressing | Readiness to Change, Digital Infrastructure, Population Approach, Citizen Empowerment, Evaluation Methods |
| Optimising | - |
| Uncertain | Breadth of Ambition, Capacity Building |
Table 6
Justifications by participants on ratings of dimensions.
| THEMES | SUBTHEMES | DIMENSIONS OF SCIROCCO TOOL | NO. OF DIMENSIONS | CODES (N) | CODES (% OF TOTAL) |
|---|---|---|---|---|---|
| Progress in integrated care | Citizen’s engagement | Citizen Empowerment | 1 | 4 | 1.8 |
| Clear vision or plan with emerging leaders | Readiness to change, Process Coordination | 2 | 7 | 3.1 | |
| Funding for integrated care initiatives | Readiness to change, Structure and Governance, Funding | 3 | 6 | 2.7 | |
| Improved coordination in care processes | Readiness to change, Structure and Governance, Process Coordination, Evaluation Methods, Breadth of Ambition, Capacity Building | 6 | 16 | 7.1 | |
| Innovations captured and mechanisms for knowledge transfer | Innovation Management, Capacity Building | 2 | 10 | 4.5 | |
| Ongoing dialogue and planning | Readiness to change, Structure and Governance, Removal of Inhibitors, Capacity Building | 4 | 4 | 1.8 | |
| Risk stratification for specific groups | Population Approach | 1 | 11 | 4.9 | |
| Structures that enable integrated care | Readiness to Change, Structure and Governance, Digital Infrastructure, Process Coordination, Removal of Inhibitors, Evaluation Methods, Breadth of Ambition, Capacity Building | 8 | 21 | 9.4 | |
| Gaps in integrated care | Absence of systematic approach | All dimensions | 12 | 34 | 15.2 |
| Limited by technical processes | Digital Infrastructure | 1 | 6 | 2.7 | |
| Limited coordination and involvement of stakeholders | Readiness to change, Structure and Governance, Digital Infrastructure, Process Coordination, Funding, Removal of Inhibitors, Population Approach, Breadth of Ambition, Innovation Management, Capacity Building | 10 | 63 | 28.1 | |
| Limited public awareness and engagement | Readiness to change, Removal of Inhibitors, Citizen Empowerment | 3 | 14 | 6.3 | |
| Limited resources and expertise | Digital Infrastructure, Funding, Removal of Inhibitors, Population Approach, Evaluation Methods, Capacity Building | 6 | 21 | 9.4 | |
| Policy reform necessary | Removal of Inhibitors, Structure and Governance, Funding, Removal of Inhibitors, Breadth of Ambition | 5 | 7 | 3.1 |
Table 7
Integration of quantitative and qualitative findings.
| DIMENSIONS | OVERALL MEDIAN | CONSENSUS | MATURITY LEVEL | PROGRESS IN CARE INTEGRATION | GAPS IN CARE INTEGRATION |
|---|---|---|---|---|---|
| 1 Readiness to change | 3 | Consensus | Progressing | Clear vision or plan with emerging leaders, Funding for integrated care initiatives, Improved coordination in care processes, Ongoing dialogue and planning, Structures that enable integrated care | Absence of systematic approach, Limited coordination and involvement of stakeholders, Limited public awareness and engagement |
| 2 Structure & Governance | 2 | Consensus | Initial | Funding for integrated care initiatives, Improved coordination in care processes, Ongoing dialogue and planning, Structures that enable integrated care | Absence of systematic approach, Limited coordination and involvement of stakeholders, Policy reform necessary |
| 3 Digital Infrastructure | 3 | Consensus | Progressing | Structures that enable integrated care | Absence of systematic approach, Limited by technical processes, Limited coordination and involvement of stakeholders, Limited resources and expertise |
| 4 Process Coordination | 2 | Consensus | Initial | Clear vision or plan with emerging leaders, Improved coordination in care processes, Structures that enable integrated care | Absence of systematic approach, Limited coordination and involvement of stakeholders |
| 5 Funding | 1 | Consensus | Initial | Funding for integrated care initiatives | Absence of systematic approach, Limited coordination and involvement of stakeholders, Limited resources and expertise, Policy reform necessary |
| 6 Removal of Inhibitors | 1 | Consensus | Initial | Ongoing dialogue and planning, Structures that enable integrated care | Absence of systematic approach, Limited coordination and involvement of stakeholders, Limited public awareness and engagement, Limited resources and expertise, Policy reform necessary |
| 7 Population Approach | 3 | Consensus | Progressing | Risk stratification for specific groups | Absence of systematic approach, Limited coordination and involvement of stakeholders, Limited resources and expertise |
| 8 Citizen Empowerment | 3 | Consensus | Progressing | Citizen’s engagement | Absence of systematic approach, Limited public awareness and engagement |
| 9 Evaluation Methods | 3 | Consensus | Progressing | Improved coordination in care processes, Structures that enable integrated care | Absence of systematic approach, Limited resources and expertise |
| 10 Breadth of Ambition | 3.5 | Split | Uncertain | Improved coordination in care processes, Structures that enable integrated care | Absence of systematic approach, Limited coordination and involvement of stakeholders, Policy reform necessary |
| 11 Innovation Management | 2 | Consensus | Initial | Innovations captured and mechanisms for knowledge transfer | Absence of systematic approach, Limited coordination and involvement of stakeholders |
| 12 Capacity Building | 3 | Split | Uncertain | Improved coordination in care processes, Innovations captured and mechanisms for knowledge transfer, Ongoing dialogue and planning, Structures that enable integrated care | Absence of systematic approach, Limited coordination and involvement of stakeholders, Limited resources and expertise |
Appendix 1
Descriptions for group rating of 12 dimensions of SCIROCCO tool.
| DIMENSION | GROUP MEDIAN | MATURITY LEVEL | DESCRIPTION FOR RATING |
|---|---|---|---|
| Readiness to Change | 3 | Progressing | Vision or plan embedded in policy; leaders and champions emerging |
| Structure and Governance | 2 | Initial | Formation of task forces, alliances and other informal ways of collaborating |
| Digital Infrastructure | 3 | Progressing | Digital infrastructure to support integrated care are piloted but there is not yet region-wide coverage |
| Process Coordination | 2 | Initial | Some standardised coordinated care processes are underway; guidelines are used, some initiatives and pathways are formally described, but no systematic approach is planned |
| Funding | 1 | Initial | Funding is available but mainly for the pilot projects and testing |
| Removal of Inhibitors | 1 | Initial | Awareness of inhibitors but no systematic approach to their management is in place |
| Population Approach | 3 | Progressing | Risk stratification used for specific groups, i.e., those who are at risk of becoming frequent service users |
| Citizen Empowerment | 3 | Progressing | Citizens are consulted on integrated care services and have access to health information and health data |
| Evaluation Methods | 3 | Progressing | Some integrated care initiatives and services are evaluated as part of a systematic approach |
| Breadth of Ambition | 1 (5) | Initial | The citizen of their family may need to act as the integrator of service in an unpredictable way |
| 3 (1) | Progressing | Integration between care levels (e.g., between primary and secondary care) is achieved | |
| 4 (6) | Progressing | Improved coordination of social care service and health care service needs is introduced | |
| Innovation Management | 2 | Initial | Innovations are captured and there are some mechanisms in place to encourage knowledge transfer |
| Capacity Building | 1 (5) | Initial | Some approaches to capacity building for integrated care services are in place |
| 3 (6) | Progressing | Learning about integrated care and change management is in place but not widely implemented | |
| 5 (1) | Progressing | A ‘person-centred learning healthcare system’ involving reflection and continuous improvement is in place |
Appendix 2
Overall responses of self-assessment tool over time.
Appendix 3
Responses of SCIROCCO tool by stakeholder groups over time.
Appendix 4
Comparison of SCIROCCO Exchange outcomes across regions.