Separate funding is another barrier. “Behavioral health services often require multiple sessions and extensive follow-up, which differs markedly from the way physical health needs are handled. For instance, if a (mandated) collaboration threatens the political and economic interests of an organisation involved, it can be very reluctant to collaborate [62]. For instance, Loisel et al. However, this interpretation may well underlie a bias, as we do not know if the reviewed studies illustrate all existing barriers that hampered a collaboration or if researchers maybe also intentionally (e.g. National borders: Borders of neighbouring territories can work as barriers to the integration of care in inter-organisational settings, especially by causing administrative or regulatory differences due to different healthcare systems and languages [ 49 ]. Leading institutions, practitioners and researchers have reached a consensus that health service delivery profits from integration [1, 2, 3, 4] “across time, place and discipline” [5, p. 1]. Actors who are willing to block collaboration deliberately can also strengthen these barriers on purpose. due to observation bias) focused on certain barriers. Stereotyping: People sometimes stereotype those with disabilities, assuming their quality of life is poor or that they are unhealthy because of th… Because the literature search was focused mainly on peer-reviewed journals, some works meeting the inclusion criteria may have been left out (e.g. Journal of Interprofessional Care, 2009; 23(4): 320–30. The case study concluded that although major progress had been made, there were still barriers to a fully-functioning, integrated care system. This narrowed the scope of articles to 87 potentially relevant ones. Kodner, DL and Spreeuwenberg, C. Integrated care: Meaning, logic, applications, and implications – a discussion paper. Inter-organisational collaboration can thus reduce fragmentation within healthcare systems and provide the potential to generate innovation in healthcare delivery (e.g. Chronic diseases are responsible for 7 of 10 deaths each year, killing more than 1.7 million Americans annually. Cultural distance between organisations: Organisations develop their own specific cultures, which can create barriers to inter-organisational collaborations if organisations are not capable of managing these differences. Furthermore, in some cases, the surrounding context traditionally sets no incentive to inter-organisational collaboration – e.g. Surprisingly, although often used, the term “barrier” is seldom defined. Popp, J, MacKean, G, Casebeer, A, Milward, HB and Lindstrom, R. Inter-organizational networks. Some were of a political and economic nature, particularly issues in the relationship between the health insurers and the care groups. Fourth, probably more barriers exist than those captured by the papers reviewed here. To stay in line with this focus, further studies were excluded, e.g. American Journal of Psychiatry, 1982; 139(5): 616–20. This is also the domain where the management of a collaboration can influence its outcomes [20]. This helps to explain why some inter-organisational collaborations that aim for the integration of care make slow or no progress. International Journal of Integrated Care, 2008; 8(6): 1–12. Cambridge: Polity Press; 1984. Such a focus is especially important, as some barriers occurring during inter-organisational collaboration are particular to this governance form due to the existence of the inter-organisational domain, where, for instance, formally autonomous and culturally different organisations collaborate. In fact, almost each type of barrier seemed to be able to cause or influence other types of barriers, often in a recursive relationship to one another (causing chicken-egg problems). Missing actors: The lack of important actors can be a barrier to successful collaboration in a certain nexus of health service delivery [12]. The barriers approach to innovation. BMC Medical Research Methodology, 2008; 8(45): 1–10. inter-professional collaboration within a single organisation such as a hospital) through collaborative inter-organisational relations [e.g. Barriers to Integrated Care and How to Overcome Them. book chapters, monographs), thereby also omitting further barriers. When organisations start to protect their interests very strongly within an inter-organisational collaboration, this can lead to the situation that nobody will take on responsibility for common issues [18]. To sum up, when analysing barriers (either for research purposes or in order to overcome them), it seems helpful to assume that a barrier which is visible could be caused by one or several other barriers that are not obvious at first glance [41]. The evolution of cooperation in strategic alliances: Initial conditions or learning processes? Related barriers of this kind can also be found on other levels of analysis, and can be driven both by agents and/or structure. They are not only context-specific, but are also often related and influence each other. 18, no. DOI:, Hearld, LR, Alexander, JA and Mittler, JN. Different orientations and norms result from various underlying cultural and institutional logics (e.g. Lack of Awareness. through decreased governmental support in the public sector [56]. More often than not, several healthcare providers are involved in the care of the patient, from general practitioners and nurse practitioners to various specialists (for example eye specialists or podiatrists for managing diabetes complications), hospitals, home care services and, of course, pharmacies. Different professionalisation: Within inter-organisational collaborations – more often than not – individuals with different professional backgrounds (e.g. Furstenau, D and Auschra, C. Open digital platforms in health care: Implementation and scaling strategies. Provan, KG, Fish, A and Sydow, J. Interorganizational networks at the network level: A review of the empirical literature on whole networks. Nevertheless, this analysis offers insights into the most important aspects of the academic discourse on barriers that impede the integration of care in inter-organisational settings. Such barriers are more agent-driven and institutions recede into the background. DOI:, Andersson, J, Bengt, A, Axelsson, SB, Eriksson, A and Axelsson, R. Organizational approaches to collaboration in vocational rehabilitation – An international literature review. patient data) delivered by the collaborating organisation by collecting them again [59]. Second, empirical research should disentangle the interplay of barriers and their context-dependence more carefully, as well as their underlying causes and the visible symptoms [see also 41 for barriers to innovation]. Third, the context-dependence of barriers and their interrelatedness are discussed. These include structural barriers, lack of clear communication and competition between traditionally separate services, all of which make collaboration difficult. between different professions, team members or across teams [30]. In their study Tsasis and colleagues report on a healthcare professional who states that he does not necessarily understand exactly how other organisations in the same community contribute to the care of clients.

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