Community Oriented Integrated Care Networks – advancing the cause of integration

Integration seems a laudable goal for health and social care. In this blog I explore two senses of the word “cause” – etiology and advocacy. Let us advance the agenda of integration by understanding its nature, which in turn can contribute to its enhancement.

I am a GP (UK) and Primary Care (US) advocate but am only qualified myself as a specialist neurologist with additional training in psychiatry, psychology and ethics. As a transdisciplinary, intergenerative healer I do consider myself a GP hybrid variant – Generalist Proactivist.  Our academia, health system and governments are siloed into departments with their own priorities and practices and so much of organisational life is limited by poor and distorted communication. It is time to celebrate and enliven the processes of engagement in organizational life and restrict our fascination with rigid structure. We need beautiful organisations that enhance not limit their individual members.

A key is integration, but how do you achieve the holistic orientation that this word signifies? Here are some suggestions:

  • Align purpose and mission – alienation in organisational life is often associated with a disconnect between the life goals of the individual (purpose and meaning) and the mission of the organization.
  • Shared vision – the individual and organization both need an aspirational vision of his/her/its future
  • Input from our “subject” of care – often organizational integration occurs by asking for deeper engagement with those served by those serving.
  • Focus of value – wholeness often comes from the heart not just the mind.
  • Transdisciplinary – siloes are problematic in academia, health systems and governments. Going beyond, albeit important, conversations between (“inter”) disciplines and professional to exploring the boundaries among them to find new sources of innovation can be key.
  • Interprofessional – professions need to go beyond their own often self-serving claims to power to be sure that the social contract is fulfilled together.
  • Intergenerational – the temporal imagination and relationship deepening of discourse and action with different types of experience associated with different ages can lead to intergenerative innovation.
  • Spirit of learning – lifelong and continual, experiential and service-based learning is the key to organisational effectiveness and integration.

Peter J. Whitehouse MD-PhD, Case Western Reserve University,


6 Replies to “Community Oriented Integrated Care Networks – advancing the cause of integration”

  1. Such a refreshing take on integration that is as much organic as mechanical. Too many people seem to think that integration means mechanical, linear connection that can be fixed from a distance, like connecting components in a car with nuts and bolts. Up to a point this mechanical idea has value. But more difficult to achieve, describe and evaluate is what Peter is describing – integration as networks of trusted relationships. Shared purpose, mission and vision; transdisciplinary, interprofessional alignment of hearts as well as minds. These are things of the human spirit. To get to this place people have to engage and co-develop in a spirit of continual, lifelong, experiential, service-based learning. The NHS has traditionally done this better than many other healthcare systems. Let;s make sure that the NHS Long-Term Plan keeps these human values at its heart.

    1. Well said. I am facilitating some discussions of spirit citizenship currently and it is deep into trust, connection and relationship .

  2. When the world ends there will be four living creatures left on Earth. Two will be cockroaches, and the others will be trying to integrate health and social care.Integration of care is obviously necessary but has proved hard to do.
    .Community Orientation gets plenty of lip-service but not so much action.
    That’s why a group of academics and practitioners from a wide range of backgrounds have formed a learning group called Community Oriented Integrated care Networks – COIN
    Health Matters welcomes COIN and will publish its debates, starting with this one from a prestigious American social and clinical scientist, Peter Whitehouse
    Watch out for regular blogs, and COIN’s prospectus

    1. Thanks Steve. I often ask whether the last two humans in your story are hugging or hitting each other over the head!
      PS it may be a gender issue!

  3. These are inspiring words.
    Do we have examples of ‘beautiful organisations’ and case-histories of how they crossed the canyon of Neolithic Rigidity?

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