CHAPTER 3: THEORETICAL FRAMEWORK
3.3 The Theory used in this Study
This study employs the integrated service delivery model as a framework for understanding the impact and functionality of OSS in the EThekwini Metropolitan Municipality. The term integrated services refers to joining-up of multiple public organizations to deliver services in an integrated way for the benefit of service users149. A more detailed definition can be drawn from the health literature which states that integration is a coherent set of methods and models on the funding, administrative, organisational, service delivery and clinical levels designed to create connectivity, alignment and collaboration within and between different sectors150. The model stresses that the integration of the government department in service delivery is likely to produce desired outcomes. Moreover, the integration encourages efficiency and effectiveness in both sectors but more especially on the public sector.
The definition of integration employed in the paper cited above covers three aspects: (a) collocation, (b) collaboration, and (c) cooperation. Each aspect defines integration at different levels. Collocation refers to having all stakeholders in one location such as, health services, housing services or social services and etc. The centralization of services leads to reduced travel and time costs associated with take-up for service users151 Collocation also makes for easier accessibility between agencies or departments that can help to promote collaboration among groups of service providers and professionals.
Collaboration entails a higher level of integration than collocation. It refers to stakeholders working together through information sharing and training as well as creating a network of agencies to improve service user experience. Collaboration is an essential step for reducing
148 Zulu, P (2012) The Research Design, Lecture Notes delivered on 07 December 2012
149Kraaijenbrink J (2002) Centralization Revisited? Problems on Implementing Integrated Service Delivery in The Netherlands, University of Twente
150 Kodner, D. L. and Spreeuwenberg, C. (2002) Integrated Care: Meaning, Logic, Applications, and Implications-a Discussion Paper, International Journal of Integrated Care
151 Sloper, P. (2004). Facilitators and Barriers for Co-ordinated Multi-Agency Services. Child: Care, Health & Development. (30)6, pp 571-580.
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the existing gaps in services for service users152. By sharing knowledge, agencies or departments and professionals can improve the referral process to other services offered by the centre.
The last and the highest degree of integration is achieved through cooperation. Cooperation is define as professionals communicating and working together on a service user’s case153. Richardson and Patana (2012) argue that effective cooperation is central to improving services for the benefit of end users. When professionals work well together, costs can be lowered, services are not duplicated, and the identification and response to service user’s needs occurs faster. This theory is relevant because it speaks to the integration of services and it provides a good basis for testing the functionality of OSS in the chosen research site.
Robinson et al (2008) identified a number of potential spoilers in integration and they can be grouped under three key areas: contextual barriers and political climate, organisational challenges, and cultural issues154.
a. Political Climate
Issues to do with the political climate include changes in political steer, financial uncertainty, agency re-organisation and the organisational change climate155. These issues are hindrance to integration and if unresolved have a potential to collapse the whole integration process. In South Africa, for example, there is a change of management in municipalities in every 5 year period when there are local elections. This change of management brings about uncertainty in structures or bodies that the outgoing committees were committed to, e.g. OSS. It is important that structures such as OSS have systems in place to manage change when it comes as the local councillors play a pivotal role in them.
Change management is a comprehensive, cyclic and structured approach for transitioning
152 Richardson, D and Patana P (2012) Integrated Services and Housing Consultation, Discussion paper for the Organization for Economic Co-Operation and Development (OECD)
153 Rosenheck, R. A., Resnick, S. G., and Morrissey, J. P. (2003). Closing Service System Gaps for Homeless Clients with Dual Diagnosis: Integrated Teams and Interagency Cooperation. The Journal of Mental Health Policy and Economics,
154 Robinson M, Atkinson M, and Downing D (2008) Supporting the Theory Building in Integrated Services Research, National Foundation for Educational Research, Slough
155 Richardson, D and Patana P (2012) Integrated Services and Housing Consultation, Discussion paper for the Organization for Economic Co-Operation and Development (OECD)
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individuals, groups and organizations from a current state to a future state with intended benefits156.
b. Contextual Barriers
Local needs can be at odds with meeting national priorities, and there can be issues of rurality generating challenges and costs for networks.
c. Organizational Challenges
A range of organisational challenges are associated with agencies having different policies, procedures and systems which do not blend. Where managers do not experience integrated working as part of their core work, integrated working can be vulnerable to changes in work priorities, and real ownership may not be embedded.
d. Cultural Issues
There are cultural and professional obstacles, for example, tendencies towards negative assessment and professional stereotyping, as well as different professional beliefs. There is still little evidence of far-reaching service user involvement in terms of integrated service development. Within service redesign, it is not yet accepted culture in practice to involve children and families, and individual services have arrangements for user involvement which do not fit together.
Robinson et al (2008) also mention the enablers157. According to Robinson et al (2008), the key enablers are associated with clarity of purpose/ recognised need, structural integration, commitment at all levels, strong leadership and management, relationships/ trust between partners, understanding and clarity of roles and responsibilities158.
156 Managing Change in Organization: A Practical Guide (2013), published by the Project Management Institute (PMI), Pennsylvania
157 Robinson M, Atkinson M, and Downing D (2008) Supporting the Theory Building in Integrated Services Research, National Foundation for Educational Research, Slough
158 Robinson M, Atkinson M, and Downing D (2008) Supporting the Theory Building in Integrated Services Research, National Foundation for Educational Research, Slough
57 a. Clarity of Purpose/ Recognised Need
Stakeholders must be clear about the basis of their involvement, and there must be a clear recognition of the need for partnership working.
b. Structural Integration
At the strategic level key enablers include: relating organisational structure to purposeful planning, leadership, a focus on outcomes. Impacts of structural integration occur at different levels. For service users they include greater attention to prevention, more accessible and acceptable services, empowerment and engagement in decision making. For professionals they include a greater sense of unification and equality
c. Commitment at all levels
The need for commitment from key strategic managers and budget holders was stressed within much of the literature. Explicit commitment to the partnership/integration is required and there is likely to be different levels of buy-in, so some agencies/individuals may require additional nurturing to engage them.
d. Strong Leadership
Strong leadership and management are also vital to success. Leadership must pave the way forward and avoid favouritism, bias and distrust of subordinates
e. Relationship and Trust between Partners
Models of new ways of working also highlight personal qualities of staff, for example, a joined-up attitude which involves trust and entails a self-reflective attitude and enthusiasm for collaborative working.
f. Understanding and Clarity of Roles and Responsibilities
Whilst some authors pointed to the need to put effective structures in place, there is a view that efforts with regard to integrated services are likely to flounder if they rely solely on restructuring. Robinson et al (2008) findings suggest that whilst professionals involved in conjoined partnerships gain clearer insights into the roles and responsibilities beyond their own sector, those involved in more fully integrated partnerships express feelings of
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unification and equality and recognise the potential of their partnership for the community.
For this model to assist in helping us understand the functionality of OSS it will be used together with the other model discussed below.