Service delivery
September 23, 2014

Five trends shaping the integration of services

Governments around the world are integrating services as a means of improving the capacity and effectiveness of their social support systems. Canadian governments are among a number of leading innovators. You only have to look at recent budgets and throne speeches across Canada to see that service integration will only gain further momentum.

Alberta’s human services reforms, Ontario’s Community Homeless Prevention Initiative, and British Columbia’s Services to Adults with Developmental Disabilities project are just a few of the homegrown initiatives at the forefront of integration reforms.

Today’s service integration schemes are as diverse as they are ambitious. Support workers are now able to view client needs holistically thanks to centralized case records. Individuals are being given the power to put together their own care packages as a result of consolidated personal budgets. New online portals are offering service users an easier and more efficient means of applying for a broad range of programs and supports.

Some schemes represent second-generation initiatives, built on the back of earlier reforms. Others are entirely new enterprises spurred not only by budget constraints but also by developments in technology and more dynamic relations between governments, citizens, and service delivery organizations from the private and not-for-profit sectors. These initiatives span a diverse set of program areas: from child and family welfare to employment services and elder care.

So what do today’s integration schemes tell us about the trajectory of the integration agenda? The Mowat Centre at the University of Toronto, in partnership with KPMG’s Human and Social Services Global Centre of Excellence, recently released the results of a global survey of government leaders spearheading integration efforts in 22 jurisdictions – six of them Canadian.

We asked government leaders about the future direction of their own initiatives. What were the next milestones in the implementation process? What pilots and proposals were planned or in development? Five common trends emerged from their insights:

1. The creation of streamlined client pathways
We will see a growing move away from “one-size-fits-all” approaches to service provision. Clients will increasingly be streamed according to the level and nature of support they require.

This more effective use of resources will take a range of forms, including the use of tiered support models where clients are subject to a common assessment process and then channelled into an appropriate band of support (ranging from self-service to intensive support).

Governments are also leveraging developments in technology to create streamlined pathways through support systems. For instance, data encryption and the proliferation of internet-enabled mobile devices make it possible for citizens to self-serve through user-friendly, integrated online services. In the next few years we will see an increase in the functionality of these online platforms: instant messenger, document upload, and appointment scheduling functions are set to be added in a number of jurisdictions. We will also see service users being encouraged to create assistive mobile apps that can be shared with others.

At the same time, advances in electronic records-keeping, interoperable technologies, and sophisticated data analytics will increase the number of vulnerable citizens that can be identified and given intensive support. Provinces such as Alberta and British Columbia are already blazing a trail in this regard.

2. A focus on outcomes
With external pressures on services (from ageing populations to escalating public debt) showing no sign of abating, governments are more and more concerned with directing scarce program dollars to interventions that are demonstrably effective.

Increasing efforts are being made to ensure that a robust evidence base guides integration schemes. What is the best combination and sequence of interventions for different population groups? Are there circumstances where integration is not appropriate? Governments are turning to scientifically rigorous evaluation methods to understand whether new integrated delivery models perform better than existing service provision.

Likewise, the integration landscape will increasingly be shaped by new support infrastructure in the form of organizations that analyze and disseminate evidence on exactly what works. British Columbia’s newly established Centre for Employment Excellence (created as part of the province’s integration of employment services) is a shining example of such a body.

Equally, governments are recognizing that service delivery methods and payment models have been too prescriptive in the past. New outcomes-based payment systems are enabling service delivery organizations to innovate and focus on program objectives.

3. Inter-governmental integration
Most of today’s integration schemes are taking place at a single level of government (whether within one department or across many). But governments are beginning to apply a systems lens to service integration and explore ways of coordinating operations across different levels of government.

Experiments in the joint commissioning of services and integrated case management stand out as exciting developments that promise to facilitate seamless support for clients. So too do the emergence of new frameworks, tools, and technologies that enable IT systems to interact and exchange information across different levels of government.

4. Inter-sectoral integration
Governments are also building more coordinated and sustainable service delivery systems through stronger partnerships with providers from the non-profit and private sectors. Experiments in staff co-location, information sharing, and joint strategic planning are enabling the seamless referral of clients and coordinated support for individuals and families with complex needs. And – at a time when the non-profit sector has been hit hard by falling donations and cuts in grants – developments in streamlined procurement and multi-year (rather than annual) contracts will help stabilize service delivery organizations. Ontario’s Peel Region stands out as a leader in this regard.

5. Place-based integration
There is growing support for taking place-based approaches to the coordination of service design and delivery. One increasingly popular method is to reorganize human and social services departments along geographical lines. The rationale for this move is simple: if internal divisions have an area-based rather than a program-based mandate, they are more likely to adopt a holistic approach to service planning and provision.

An alternative place-based approach will see regional and national governments devolving greater control of finances and systems management to local authorities. Ontario’s Community Homeless Prevention Initiative, for instance, is a wonderful example of an innovative scheme that gives local service managers flexibility in designing services around the specific needs and capacities of their local areas.

With growing pressure on service delivery systems, service integration will remain at the forefront of the public sector reform agenda for the foreseeable future. But integrated services delivery takes time to implement. As policymakers and practitioners plan for the long term, it is essential that they understand where the integration agenda is heading and learn from the insights and innovative practices of early movers.

 
The Integration Imperative: Reshaping the delivery of human and social services, a joint report by KPMG International and the Mowat Centre, is available at http://mowatcentre.ca/pdfs/mowatResearch/92.pdf.

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