Abstract
Governance has become a popular term in our integrated care discussions, with people using various terms to name this: integrated governance; joint governance; collaborative governance; network governance; shared responsibility . But it’s a term more used than defined: there hasn´t been many efforts to conceptualise governance. Minkman (2017) and Minkman et al (2021) define it as “the total package of leadership, accountability and supervision in the local setting in an area or region”.
In the integrated care movement, integrated care governance (ICG) is perceived as something new and different from the traditional governing approach. Traditional governance has been designed to apply vertically within organisations, rather than to steer and oversee the coordination of care between organisations. Traditional governance is ill-prepared to promote horizontal accountabilities between services and organisations or to the service users and the public.
In contrast, integrated care governance is theorised to be horizontal and non-hierarchical and should be based on trust and collaboration as a basic values, rather than on hierarchal dependencies. Accountability to the society and the public is the fundamental reason and goal, while the focus of supervision should be on the service user´s journey and how the service user perceives and experiences care. If this is how the literature depicts ICG, how much have we truly advanced internationally in achieving this ideal type?
This research provides an empirical investigation on to what extent governance has changed in those organisations or systems that have made progress on their integrated care journey and are widely recognised as international leaders. The research investigates 5 international case studies: the integrated care organisation OSI Bidasoa (OSI is the Spanish acronym) in the Basque Country, Spain; One Gloucestershire Integrated Care System (ICS) in England; the East Ayrshire health and social care partnership in Scotland (the East Ayrshire Integration Joint Board); the South Karelia Wellbeing Services County in Finland; and the Gold Cost Integrated care system in Australia.
Through documentary review and semi-structured interviews with key informants (3 interviewees per case- including the CEO, other senior managers and members of the Board of Governors or similar), the research maps current governance structures (the roles and composition of governing bodies; service users participation and effective involvement) as well as accountability relationships (vertical, diagonal, horizontal; whether there is effective accountability to the public; etc.). The analysis to be presented at ICIC24 will show to what extent the whole package of governance - and in particular accountability- in those leading organisations is substantially different to traditional governance of health and care organisations.