McMaster University, Department of Psychiatry and Behavioral Neurosciences, McMaster Childrens' Hospital, Hamilton, Ontario, Canada.
Health Care Manage Rev. 2013 Jan-Mar;38(1):51-60. doi: 10.1097/HMR.0b013e31824b1c54.
The high overlap of mental health and substance use problems in the Canadian health care system and the subsequent demand for more effective services for clients with these high-risk issues have stimulated the debate on their integrated treatment. Although the idea of integration has been endorsed by decision makers at both programs and system levels, little attention has been paid to factors that have facilitated this process.
In this article, the processes by which organizational texts, language, metaphors, and symbols have facilitated institutionalization of integrated treatment are identified and discussed.
METHODOLOGY/APPROACH: Findings from a qualitative case study of 2 treatment programs that were part of a large, urban hospital in Ontario providing services for populations with concurrent disorders are presented. Data were collected using semistructured interviews with professionals and clients, analysis of policy and organizational documents, and nonparticipant observations.
Research evidence on comorbidity, government reports, and other organizational texts that were created and disseminated across the province has contributed to the dissemination of the concept of integration. Certain ideas might be successfully implemented when environments are conducive to change; such environmental catalysts include the status of professionals who support new discourse, the characteristics and importance of the problem being addressed, and the timing of implementation. The findings clearly demonstrate that the conditions of the wider institutional environment-the emergence of research evidence on comorbidity and the provincial health care reform, with its focus on rationalizing the existing health care system-supported the idea of integration.
The ability to understand how discursive activities of program planners, clinicians, and policy makers contribute to making new ideas deeply embedded in organizational structures can become an important mechanism of effective decision-making activities when health managers attempt to promote new plans and strategies.
在加拿大的医疗保健系统中，心理健康和物质使用问题高度重叠，因此需要为这些高风险问题的客户提供更有效的服务，这促使人们对其综合治疗进行了辩论。尽管决策者在项目和系统层面都支持整合的想法，但很少关注促进这一过程的因素。
本文旨在识别和讨论组织文本、语言、隐喻和符号促进综合治疗制度化的过程。
方法/方法：本文呈现了安大略省一家大型城市医院为同时患有多种疾病的人群提供服务的 2 个治疗项目的定性案例研究的结果。使用半结构化访谈、政策和组织文件分析以及非参与观察的方法收集专业人员和客户的数据。
全省范围内创建和传播的共病研究证据、政府报告和其他组织文本为整合概念的传播做出了贡献。当环境有利于变革时，某些想法可能会成功实施；这种环境催化剂包括支持新话语的专业人员的地位、正在解决的问题的特征和重要性，以及实施的时机。研究结果清楚地表明，更广泛的机构环境条件——共病研究证据的出现和省级医疗改革，重点是使现有医疗保健系统合理化——支持了整合的想法。
理解计划制定者、临床医生和政策制定者的话语活动如何有助于使新想法深深嵌入组织结构，可以成为医疗保健管理人员在尝试推广新计划和战略时进行有效决策活动的重要机制。
