Decision-making dilemmas within integrated care service networks: A systematic literature review

Introduction: The diverse nature of people’s care needs requires collaboration between different organisations and sectors. One way of achieving such collaboration is through integrated care service networks. Decision-making is considered an important aspect of network governance and key to achieve further integration of care services. As integrated care scholars only implicitly seem to touch upon the issue of decision-making, we aimed to identify multiple decision-making dilemmas. Theory and Methods: A systematic literature review was conducted of eighteen empirical studies in which decision-making dilemmas in integrated care service networks were inductively identified. To frame and understand these dilemmas, we partly drew on Provan and Kenis’ governance models and their hypothesised decision-making dilemma for service networks. Results: Identified decision-making dilemmas included 1) autonomy versus inter-dependence, 2) diversity versus coherence, and 3) self-interest versus common goals. In line with Provan and Kenis’ hypothesis, we highlight a cross-cutting dilemma of inclusiveness (all viewpoints are considered hence widely supported decisions) vs. efficiency (reaching timely decisions). Discussion and conclusion: We believe that network-and ‘systemic’ stakeholders both need to reflect upon and learn from decision-making dilemmas to work towards widely supported and adequate decisions. This is important for achieving aligned and holistic care services that many people desire