Doing Meso-Level Integration: The cultural, relational, and communications practices that draw primary care closer to the broader system.
Notice bibliographique
Résumé
Introduction: In alignment with the conference’s first theme, this paper draws on qualitative research to address issues of change management implementation at the meso-level in integration. It uses a case study of integration efforts as they played out during the first wave of the COVID-19 Omicron variant in Alberta, Canada to identify practical ways of doing organization-to-organization integration in Primary Care (PC). Background: While the existing literature describes three high-level approaches to enabling the integration of health and social systems in a range of contexts, it is unclear how stakeholders in PC and health system organizations might practically operationalize these approaches. How, specifically, should those stakeholders go about: enacting a pro-integration culture; doing the relationship work required for integration; and communicating to support integration? Put differently, what are the practical change management behaviours that give life to these three key approaches and make integration real? Approach: A subset of semi-structured interviews with key informant stakeholders was drawn from a larger study of policy and change management implementation under pandemic conditions in Alberta, Canada. Participants in these interviews were directly involved in efforts to integrate PC into the province’s health system response to COVID-19 generally, and specifically into the response to the Omicron wave. The 10 interviews averaged 65 minutes in length and included key informants from both independent PC and central health system organizations. The Interpretive Description technique was used to analyze the interview transcripts and so identify practical enactments of pro-integration culture, relationship work for integration, and integration-supportive communication. Results: Key ways of enacting a pro-integration culture included: sending signals with staffing choices; making personal expressions of commitment to the values of integration; and ensuring communal commitments to those same values. Doing integration relationships involved: following through on rhetorical commitments; and persevering at proving oneself in the eyes of counterparts from other organizations. Finally, communicating in ways that supported integration involved: bidirectional communication that included listening as well as talking; the elimination of intermediaries to close the social and knowledge distance between PC and health system stakeholders; and actuating a mix of formal and informal communication channels rather than relying on purely formal committee work or informal contacts. Conclusions: Practical steps towards achieving meso-level organization involve making high-level approaches to culture, relationships, and communication real in everyday behaviour. Efforts to integrate PC into a broader pandemic response in Alberta Canada provide a window on these specific change management implementation behaviours and so how to ‘do’ integration. Doing pro-integration culture involves sending signals through staffing choices, personal, and group commitments. Doing integration relationships involves following through on commitments and persevering. Doing integration communications involves listening as well as talking, closing the distance between stakeholders, and taking advantage of formal and informal channels. Stakeholders seeking to integrate at the meso-level may wish to consider these practical action
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,014 | 0,016 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,001 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,002 |
| Études des sciences et des technologies | 0,016 | 0,025 |
| Communication savante | 0,009 | 0,006 |
| Science ouverte | 0,002 | 0,016 |
| Intégrité de la recherche | 0,002 | 0,005 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,005 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».