title: How personal and standardized coordination impact implementation of integrated care.
abstract: BACKGROUND
  Integrating health care across specialized work units has the potential to lower costs and increase quality and access to mental health care. However, a key challenge for healthcare managers is how to develop policies, procedures, and practices that coordinate care across specialized units. The purpose of this study was to identify how organizational factors impacted coordination, and how to facilitate implementation of integrated care.
  
  
  METHODS
  Semi-structured interviews were conducted in August 2009 with 30 clinic leaders and 35 frontline staff who were recruited from a convenience sample of 16 primary care and mental health clinics across eight medical centers. Data were drawn from a management evaluation of primary care-mental health integration in the US Department of Veterans Affairs. To protect informant confidentiality, the institutional review board did not allow quotations.
  
  
  RESULTS
  Interviews identified antecedents of organizational coordination processes, and highlighted how these antecedents can impact the implementation of integrated care. Overall, implementing new workflow practices were reported to create conflicts with pre-existing standardized coordination processes. Personal coordination (i.e., interpersonal communication processes) between primary care leaders and staff was reported to be effective in overcoming these barriers both by working around standardized coordination barriers and modifying standardized procedures.
  
  
  CONCLUSIONS
  This study identifies challenges to integrated care that might be solved with attention to personal and standardized coordination. A key finding was that personal coordination both between primary care and mental health leaders and between frontline staff is important for resolving barriers related to integrated care implementation.
  
  
  CONCLUSIONS
  Integrated care interventions can involve both new standardized procedures and adjustments to existing procedures. Aligning and integrating procedures between primary care and specialty care requires personal coordination amongst leaders. Interpersonal relationships should be strengthened between staff when personal connections are important for coordinating patient care across clinical settings.
authors.affiliation: Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, 150 S. Huntington Ave (152-M), Boston, MA, 02130, USA. justin.benzer@va.gov.|Department of Health Policy and Management, Boston University School of Public Health, 715 Albany Street Talbot Building, T2W, Boston, MA, 02118, USA. justin.benzer@va.gov.|VISN 17 Center of Excellence for Research on Returning War Veterans, Waco, TX, USA. justin.benzer@va.gov.
authors.forename: Justin K
authors.initials: JK
authors.lastname: Benzer
authors.affiliation: Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, 150 S. Huntington Ave (152-M), Boston, MA, 02130, USA. irene.cramer21@gmail.com.|Department of Health Policy and Management, Boston University School of Public Health, 715 Albany Street Talbot Building, T2W, Boston, MA, 02118, USA. irene.cramer21@gmail.com.
authors.forename: Irene E
authors.initials: IE
authors.lastname: Cramer
authors.affiliation: Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, 150 S. Huntington Ave (152-M), Boston, MA, 02130, USA. james.burgess@va.gov.|Department of Health Policy and Management, Boston University School of Public Health, 715 Albany Street Talbot Building, T2W, Boston, MA, 02118, USA. james.burgess@va.gov.
authors.forename: James F
authors.initials: JF
authors.lastname: Burgess
authors.affiliation: Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, 150 S. Huntington Ave (152-M), Boston, MA, 02130, USA. david.mohr2@va.gov.|Department of Health Policy and Management, Boston University School of Public Health, 715 Albany Street Talbot Building, T2W, Boston, MA, 02118, USA. david.mohr2@va.gov.
authors.forename: David C
authors.initials: DC
authors.lastname: Mohr
authors.affiliation: Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, 150 S. Huntington Ave (152-M), Boston, MA, 02130, USA. Jennifer.sullivan@va.gov.|Department of Health Policy and Management, Boston University School of Public Health, 715 Albany Street Talbot Building, T2W, Boston, MA, 02118, USA. Jennifer.sullivan@va.gov.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Sullivan
authors.affiliation: Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, 150 S. Huntington Ave (152-M), Boston, MA, 02130, USA. martin.charns@va.gov.|Department of Health Policy and Management, Boston University School of Public Health, 715 Albany Street Talbot Building, T2W, Boston, MA, 02118, USA. martin.charns@va.gov.
authors.forename: Martin P
authors.initials: MP
authors.lastname: Charns
mesh_terms: D001291:Attitude of Health Personnel; D003156:Community Mental Health Services / Q000458:organization & administration* / Q000592:standards; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D005260:Female; D006297:Health Services Accessibility / Q000458:organization & administration*; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology / Q000628:therapy*; D011320:Primary Health Care / Q000458:organization & administration*; D016730:Program Development; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs / Q000458:organization & administration* / Q000592:standards