Flexibility in rigid systems: a meta-synthesis of best practices for integrated care

BMC Primary Care Backåberg et al. BMC Primary Care (2025) 26:353 https://doi.org/10.1186/s12875-025-03062-y Open Access RESEARCH Flexibility in rigid systems: a meta-synthesis of best practices for integrated care Sofia Backåberg1† , Mirjam Ekstedt1*† , Elin-Sofie Forsgärde1† , Heidi Hagerman1† and Kristina Tryselius1† Abstract Introduction Integrated care has the potential to mitigate patient safety risks by enhancing collaboration and maintaining a patient-centred approach. However, best practices for successful implementation are lacking. This study aims to identify and describe key components of best practices for integrating health and social care to increase understanding of successful implementation. Methods A Collaborative Reflexive Deliberative Approach was used. The data comprised twenty-one published articles and five unpublished manuscripts from 2015 to 2023, along with the experiences of ten clinicians and researchers in integrated care, and the research team itself. Results Components identified as best practices for integrated care, each describing different aspects shaped by and for the patient, were: holistic co-creation in an ethical stance, trust through physical and relational proximity, flexible caring, learning and adaptable organizations and flexible information and communication. Discussion/conclusion The study emphasizes the importance of building trust through proximity and adaptable organizational learning, and the need for a holistic perspective, acknowledging both the limitations and potentials of health and social care integration. Embracing innovative thinking and recognizing that not everyone needs all services at all times can foster flexible, person-centred integrated care. Addressing these complexities is essential for successful integration efforts. Keywords Care transitions, Integrated care, Collaborative reflexive deliberate approach, Flexible caring, Learning organizations, Patient-centeredness, Patient safety † Sofia Backåberg, Mirjam Ekstedt, Elin-Sofie Forsgärde, Heidi Hagerman and Kristina Tryselius contributed equally to the manuscript and are considered the first authors of this manuscript. *Correspondence: Mirjam Ekstedt 1 ᵃDepartment of Health and Caring Sciences, Linnaeus University, Universitetsplatsen 1, 392 31 Kalmar and Växjö, Sweden Introduction Globally, the health and social care systems are structured into specialized areas of responsibility. Such specialization enables professionals to become experts in specific domains. However, it creates challenges in the form of fragmentation, which may potentially limit a comprehensive understanding of patients’ situations and health [1–3]. Patients with complex care needs are particularly vulnerable, as their care requirements often involve multiple professionals from different organizations. Fragmentation creates risks for patients, such as gaps in information and care during transitions from one setting to another [4]. © The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. Backåberg et al. BMC Primary Care (2025) 26:353 Integrated care addresses fragmentation by connecting and coordinating health and social care organizations [5]. Integrated care is a concept with multiple definitions and contents [6]. It is influenced by the different perspectives and expectations of users in the health system, making it difficult to define uniformly [7]. However, enhancing collaboration within and between different health and social care organizations, along with adopting a more integrated, people-centred approach to care delivery, has the potential to generate significant benefits for the patient [8]. Effective collaboration and communication among professionals are described as crucial for a comprehensive understanding of patient’s health and social care needs [2]. At times, health and social care successfully integrate care through shared intentions and agreements. However, such collaboration across organizations is underdeveloped in many countries [4, 9, 10]. The patient perspective is widely recognized as the foundational principle in integrated care, offering an alternative to organization-driven models [10]. From the patient perspective, integrated care is described as personalized and coordinated [11], fulfilling care needs within a reasonable time frame [12] and increasing satisfaction with and improving experiences of quality of care [13]. However, a lack of comprehensive synthesis describing the best practices of integrated care remains. There are several reasons for health and social care organizations to strive towards integrating care services, such as enhancing patient care, improving health population outcomes, and achieving organizational efficiency goals [11]. A meta-analysis identified an overall association between integrated care, lower costs, and improved outcomes compared with ordinary care [14]. However, research on the cost-effectiveness and outcome of integrated care shows differing results [13, 14] and evidence on the effectiveness of integrated care remains limited [4]. Nevertheless, as described above, integrated care holds promise for enhancing patient experiences, fostering collaboration, and mitigating fragmented care by addressing the needs that emerge during transitions of care across organizations [1, 4]. Continuity of care is described as a critical component to enable integrated care and appears to be advantageous for achieving a comprehensive understanding of patient health and social care needs [15–19]. Current literature shows that identifying fragmentation in the care for patients within and across organizations is crucial to increasing the quality and safety of care [4, 9, 10]. There are several national and international examples of efforts to address these challenges by striving to implement integrated care [10, 20, 21]. These efforts provide valuable insights into the potential for systemic change, yet significant barriers to the successful implementation Page 2 of 9 of integrated care remain, resulting in few successful examples [20–22]. This collaborative study addresses these challenges by synthesizing existing knowledg (...truncated)