Whole System in the Room: Toward Systems Integration in Healthcare

ABSTRACT

How might systems integration be furthered in healthcare? The paper addresses this by exploring critically the potentials of appreciative inquiry for accelerating systems integration through a large group intervention. We analyze a one-day dialog workshop to get “the whole system in the room” to improve cancer care in a regional health authority in south west Sweden. Seeing systems integration as socialization and enhanced common understandings, we suggest that discourse may play a crucial role in bringing together the various stakeholders in the system. Our analysis of the group discussions of the event demonstrates however that the degree of shared understanding can vary considerably across the discussion themes of appreciative inquiry. We argue that the “patient,” as a linguistic artifact, can act as a boundary signifier that enables those present to interact in a meaningful and coherent way but that this stops short of systems integration.

Acknowledgments

We are eternally grateful to our colleagues at Chalmers University of Technology, Gothenburg, Sweden who helped us with the data collection from the dialog day. We would also like to thank our colleagues at RCC West for their cooperation and support.

Notes

¹ QALY is a generic measure of disease burden, including both the quality and the quantity of life lived.