Integration and the Performance of Large-scale Health Enterprises: Field Studies of Psychological Health Delivery Systems in the U.S. Military

Abstract

Large-scale health enterprises comprise multiple organizations that provide programs and services for patients. Despite the interconnectedness of these systems there is a lack of empirical research documenting how these organizations work collectively - or integrate - and how this integration impacts enterprise performance measured through quality, efficiency, and access. In the case of psychological healthcare, patients often require a number of services that span multiple departments and programs within an enterprise, increasing the complexity of maintaining a continuum of care for these patients. This paper, which is part of a larger effort to examine psychological healthcare in the U.S. Military Health System, presents a series of qualitative observations and analyses of the integration of psychological health-related organizations at two large health enterprises within the military. These qualitative inquiries take a multilevel approach for examining integration within these enterprises and address the following areas of interest: 1) the mechanisms for integration; 2) the objects of integration; 3) the dimensions of integration; 4) the contextual factors that influence integration; and 5) the impacts of integration on enterprise performance. Using semi-structured interviews, qualitative data was collected and then examined using content analysis to identify the most frequent themes for each area of interest. This data was used to validate and refine a comprehensive framework for integration that was developed to pull together multiple, distinct strands of the integration literature. This data was also used to demonstrate the relationship between different dimensions of enterprise performance and to identify areas where, in the process of optimizing enterprise performance, there is a trade-off between these dimensions. The preliminary, qualitative results of this research are intended to provide a conceptual foundation and framework for future analytic studies.