The organisation of healthcare services

This chapter describes that organised health systems have existed for less than a century and are in an urgent need to transform from the delivery of disease centred services to people centred, integrated health services. In doing so, different models and frameworks exist. Notwithstanding the growing number of integrated initiatives, it has been difficult to consistently demonstrate improved outcomes in research settings, and even harder to achieve larger scale implementation in practice. The reasons for this situation are multi-faceted. A promising approach for the evaluation of systems transforming toward the delivery of integrated health services is realist research. Applying the art and science of complexity may prove helpful to better understand the heterogeneity in effects for all stakeholders involved, including patients and healthcare providers.