Managing the care of health and the cure of disease–Part II: Integration. Health Care Manage Rev 2001; 26: 70–84

The development of appropriate levels of integration in the system of health care and disease cure will require stronger collective cultures and enhanced communication among the key actors. Part II of this paper uses this line of argument to reframe four major issues in this system: coordination of acute cure and of community care, and collaboration in institutions and in the system at large. © 2001 Aspen Publishers, Inc. Systems that are highly differentiated generally re-quire correspondingly high degrees of integration. We concluded in Part I that the system properly la-beled “health care and disease cure ” is characterized by an enormously high degree of differentiation yet rather low levels of integration. Either differentiation has to be reduced or integration increased. Since dif-ferentiation is not only the very essence of this system, but also a source of its great strength; it is the level of integration that shall have to be increased. STRENGTHENING THE MECHANISMS OF COORDINATION Six basic mechanisms exist to integrate, or coordi-nate, work in organizations.1 These are illustrated in Figure 1 and described below. Mutual adjustment is the most direct form of coordi-nation: Two or more people simply adapt to each other as their work progresses, usually by informal communication. This mechanism tends to be relied upon in the simplest of situations (such as two people canoeing through rapids) as well as in the most com-plex (as in teams designing a new aircraft). Direct supervision focuses responsibility for coordi-nating the work on someone who does not actually do it; a “supervisor, ” “boss, ” or “manager ” is named (and a “hierarchy of authority ” thus created) to issue directives to the different people doing the work. Key words: differentiation, integration, health care management, health care organization, health care syste