title: Capitalizing on synergies-a discourse analysis of the process of collaboration among providers of integrative health care.
abstract: BACKGROUND
  Integrative health care (IHC) combines therapies and providers from complementary and conventional health care. Previous studies on IHC have shown power relations between providers but few studies have explored how the interaction develops over time. The objective of this study was to explore the development of IHC collaboration and interaction among participating providers during a series of consensus case conferences for managing patients with back and neck pain.
  
  
  METHODS
  This qualitative study was conducted within a pragmatic randomized controlled clinical trial in primary care. Patients' treatment plans were developed based on IHC provider consensus conferences (n = 26) of which 15 (5 of the first, 5 in the middle, and 5 of the last in the clinical trial) were selected for analysis. Findings were derived by means of discourse analysis, focusing on the participants' use of subject positions during the conferences.
  
  
  RESULTS
  The IHC team in this study gradually formed a group identity, moving their subject positions from individual treating subjects to members of a team and were able to make consensus-based decisions about patients' individual treatment plans. In the discourse, the IHC team identified collaborative shortcomings and problematized the provision of IHC. They were able to capitalize on the synergies in their collaboration and developed a shared vision of IHC provision.
  
  
  CONCLUSIONS
  The process of IHC collaboration involved the gradual formation of an IHC team identity, which facilitated interdisciplinary, non-hierarchical consensus-based decision-making in the team. The discourse further suggests that a reform of some legal and organizational health sector barriers might be needed to realize sustainable implementation of IHC services in Sweden.
authors: Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Division of Nursing, 141 83, Huddinge, Sweden.
authors: Susanne
authors: S
authors: Andermo
authors: Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Division of Nursing, 141 83, Huddinge, Sweden; I C-The Integrative Care Science Centre, 153 91, Järna, Sweden.
authors: Tobias
authors: T
authors: Sundberg
authors: Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Division of Nursing, 141 83, Huddinge, Sweden.
authors: Christina
authors: C
authors: Forsberg
authors: Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Division of Nursing, 141 83, Huddinge, Sweden; I C-The Integrative Care Science Centre, 153 91, Järna, Sweden.
authors: Torkel
authors: T
authors: Falkenberg
mesh_terms: D000328:Adult; D003299:Cooperative Behavior; D003657:Decision Making; D005260:Female; D006282:Health Personnel; D006801:Humans; D055048:Integrative Medicine; D008297:Male; D008875:Middle Aged