System-wide thinking to integrate and intervene

System-wide thinking to integrate and intervene


CEOs in the human services sector see early intervention and integration within human services and with the healthcare system as among the top opportunities for reform in the next 5 years. When seen from the perspective of the customer and through the lens of a single health and care system these two opportunities are deeply interlinked.


system-wide thinking to integrate and intervene

A system-wide perspective is critical to ensure that human services work effectively. For governments this may involve enabling data-sharing, managing the market or commissioning the right services at the right time. However, providers and non-government organizations can also think at a system level. Understanding the role of your organization in the ecosystem is critical to performing effectively. It enables an organization to manage demand for services, interact with related services to improve the quality of care and to ensure sustainability.

The need to intervene early is not an issue that organizations can manage on their own as it requires investment and commitment from across the health and care system. Few organizations provide the full spectrum of services from universal to specialist and across health and human services. Even fewer are the sole provider in their area so implementing change requires working with partner organizations.

Integration is not necessarily the result of this but it does solve part of the financial issue, one of the key barriers to committing to early intervention. Early intervention requires upfront investment in services that are designed to reduce the workload of more intensive and acute parts of the health and care system. These are not always the organizations that provide the initial investment which significantly weakens the business case to invest in early intervention. If health and human service organizations are integrated, the improved outcomes and financial benefits that accompany them will eventually flow back to pot from which the investment came. 

Full system integration is not usually a viable option as it encompasses a huge variety of not-for-profit organizations, community organization, caregivers and families, as well as governments and private providers. Instead, leaders in local systems should asses where organizational integration is needed and where the same benefits can be gained from dedicated formal liaison teams and pooled budgets. Closer working relationships are key but they also need to be supported by a degree of financial integration to ensure that budgets are big enough to invest and are able to generate meaningful improvements.

The key to any form of financial integration is a clear and fair mechanism for how the effects of the intervention will be measured and how rewards will be allocated. Small underspends or surpluses are quickly swallowed up by organizations under pressure and human services systems are not neatly linear to show the positive outcomes of prevention work. However, while the financial case is important, the clear aim of early intervention is to improve outcomes for people and so use of a proxy or an imperfect mechanism should not prevent leaders from acting to reform the system. Provided it is clear and agreed in advance, systems should act now.



The article “System-wide thinking to integrate and intervene” by Liz Forsyth, KPMG International, was taken from the publication entitled Listen, learn, lead: 2018 Human and Social Services Outlook.

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