Commentary on “Using information communication technology in models of integrated community-based primary health care: learning from the iCOACH case studies”
“Using information communication technology in models of integrated community-based primary health care: learning from the iCOACH case studies” by Carolyn Steele Gray and her international group of colleagues epitomizes my love for research at the intersection of implementation and organization science. This comparative case study assesses information and communication technology (ICT) use to support delivery of integrated and coordinated primary health care in nine health systems across Ontario, Quebec and New Zealand. One part of the paper addresses a classic implementation question: What influences the implementation of an intervention (in this case ICT)? I applaud Steele Gray et al. for using a multilevel determinant framework to answer this question, explicitly acknowledging the potential influence of individuals within health systems, the environment within and outside the health systems, and the technology itself. The authors identified determinants that are unsurprising in the context of implementing a tool for care integration: difficulties with accessing information, limited interoperability across health systems, and inertia among included organizations and individuals. Still, their results identify important questions at the intersection of implementation and organization science, such as whether centralized or decentralized systems are more conducive to the implementation of an organization-level intervention, and how to strike optimal balance of efficiency and effectiveness in communication among providers.
As a scholar with a passion for research at the intersection of implementation and organization science, though, I find the second question that Steele Gray et al. seek to answer even more compelling: What role does ICT play in enabling health systems to integrate care? I find this question particularly compelling because, instead of positioning ICT as an intervention as they do in the previous question, in this question, Steele Gray et al. position ICT as a strategy to promote the implementation of another intervention–i.e., integrated and coordinated care. From my perspective, integrated and coordinated care represents a goal that is fundamental to the work that most of us do: Patients receive necessary care (and no unnecessary care) at the right time, from the right person. By shifting the conceptualization of ICT from intervention to implementation strategy, Steele Gray et al. get us closer to achieving our shared, fundamental goal.
Steele Gray et al. acknowledge that more work is needed to apply underlying theoretical foundations to understand their findings. From my perspective, organization theory offers the authors a host of readily available explanations for their findings. For example, despite marked differences across included health systems, Steele Gray et al. found “strikingly similar” uses of ICTs for care integration. Institutional theory would suggest that this is the result of isomorphism (i.e., health systems converge in their operations due to, for example, professional norms, even when doing so may not improve performance). Implementation science can leverage institutional theory to deconstruct this isomorphism and push health systems toward ICT uses that will improve care integration.
In sum, in “Using information communication technology in models of integrated community-based primary health care: learning from the iCOACH case studies,” Carolyn Steele Gray and her colleagues present a fascinating study that I hope represents a surge of interest at the critical intersection of implementation and organization science.
Read the full abstract.