Integration? It’s Differentiation! Leveraging Diversity for Effective Integrated Care Networks and Partnerships: A Configurational Approach

Background: Integrated care research and practice often emphasizes integration, the process of bringing together people, organisations, and processes. While this focus may not be surprising, given the term ‘integrated care,’ we argue that differentiation—the division of labour within networks and partnerships—is equally crucial. Drawing on the work of organisational theorists such as Lawrence and Lorsch (1967) and Puranam (2018), this study examines how both differentiation (task division) and integration (bringing together) function as dual pillars of effective care networks. We extend this concept by introducing "value differentiation," focusing not only on the tasks actors perform but also on the diverse values and  they bring. While much literature addresses shared values in integrated care and governance (e.g., Valentijn, 2015; Ansell and Gash, 2008), the specific impact of value diversity and alignment on integrated care and network collaboration in general remains underexplored. We aim to identify combinations of differentiation and integration that correlate with network effectiveness, challenging the assumption that shared values are a prerequisite for successful collaboration.

Approach: This study employs Crisp-Set Qualitative Comparative Analysis (csQCA) to analyse data from 24 integrated care networks in the Netherlands, gathered through surveys, interviews with integrated care leaders, and document reviews. We assessed how functional differentiation and integration, alongside network brokerage, value differentiation and integration, interact to produce effective care networks.

Results: Our findings highlight two configurations of effective integrated care networks. First, networks require a balance of functional differentiation (task division) and integration (unifying processes) to achieve goals. Initiatives prioritising integration without adequate task diversity fall short, as complementary roles are necessary to address complex needs. Similarly, networks with high task differentiation struggle without strong integration mechanisms to align efforts. Second, networks with high value diversity among actors become effective when collective values are agreed upon (value integration) and a network broker facilitates coordination, bridging diverse perspectives to foster collaboration.

Implications: This study builds on existing models of integrated care, such as the Rainbow Model, to demonstrate that both differentiation and integration are fundamental to network success. It offers fresh insights into how diverse values impact network effectiveness, contributing to governance frameworks and highlighting the broader significance of values in collaboration and partnership across integrated care settings. Beyond theoretical contributions, this study offers practical recommendations for integrated care leaders: prioritizing the differentiation aspects within integrated care can significantly enhance effectiveness. Leaders should engage deeply with the composition of their networks and partnerships, recognising the diverse tasks, functions, and values of each actor. This means carefully identifying the roles and contributions required from each actor and considering how these align with the objectives of the partnerships. Furthermore, we recommend that integrated care leaders proactively address values, embedding the promotion of shared network values within their strategies to support network cohesion. By actively cultivating an environment where diverse values are acknowledged and collective values are fostered, integrated care leaders can ultimately improve network performance.