title: Older persons' experiences of whole systems: the impact of health and social care organizational structures.
abstract: OBJECTIVE
  An in-depth case study of whole systems working.
  
  
  BACKGROUND
  This paper reports on the second part of a two-part study exploring whole systems working. Part 1 of the study focused on an in-depth review of the literature pertaining to continuity of care and service integration. The second part, reported here, focused on an in-depth case study of one whole system. Evaluation Informed by the findings of part 1 of the study, data collection methods included in-depth interviews, real-time tracking of 18 older people, focus groups and consensus conferencing. Different data sets were analysed individually and synthesized using matrices derived from the literature review findings.
  
  
  RESULTS
  Key themes from data synthesis include: (1) access to the most appropriate services; (2) service fragmentation; (3) continuity of care; and (4) routinized care.
  
  
  CONCLUSIONS
  The four themes of the case study reflect the need to address issues of demarcation of professional responsibilities, complicated channels of communication, information flows, assessment and reassessment in whole systems working.
  
  
  CONCLUSIONS
  The impact of disempowering relationships on actual continuity of care and perceptions of quality among service users and providers. Lessons need to be learnt from specialist services and applied to service delivery in general.
authors.affiliation: Institute of Nursing Research/School of Nursing, University of Ulster, UK. bg.mccormack@ulster.ac.uk
authors.forename: Brendan
authors.initials: B
authors.lastname: McCormack
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Mitchell
authors.forename: Glenda
authors.initials: G
authors.lastname: Cook
authors.forename: Jan
authors.initials: J
authors.lastname: Reed
authors.forename: Susan
authors.initials: S
authors.lastname: Childs
mesh_terms: D000368:Aged / Q000523:psychology*; D001294:Attitude to Health; D003266:Continuity of Patient Care / Q000458:organization & administration*; D005260:Female; D017144:Focus Groups; D005851:Geriatric Nursing / Q000458:organization & administration; D006297:Health Services Accessibility / Q000458:organization & administration; D006299:Health Services for the Aged / Q000458:organization & administration*; D006801:Humans; D008297:Male; D020380:Needs Assessment; D009660:Northern Ireland; D009718:Nurse Administrators / Q000458:organization & administration; D015404:Nursing Methodology Research; D011787:Quality of Health Care / Q000458:organization & administration*; D013222:State Medicine / Q000458:organization & administration; D011795:Surveys and Questionnaires; D013597:Systems Analysis