Phenomenology of health and social care integration in Italy

This article analyses how governance and organisational dynamics produce different forms of health and social care integration. The ethnographic study, carried out in two different Italian organisations, highlighted two forms of integration, which the authors term mechanical and cultural. The first is characterised by the prevalence of codified and hierarchical forms of coordination and the substantial isolation of professional groups, with limited contact opportunities. Under these conditions, integration is mainly achieved in the final product through the independent and uncoordinated delivery of specific social and health services. In the second, codified tools occur alongside informal coordination activities, based on face-to-face interactions and the sharing of knowledge, values and goals. Integration takes place in daily formal and informal interactions and in the development of professional intimacy. The results of the study suggest that public policies need to be clear about the form of integration at which they aim. The mechanical form is appropriate for product integration, while cultural integration is the preferred form for process and professional integration. In the latter case, ICTs are undoubtedly useful but not sufficient. To stimulate informal coordination, mutual trust and professional reciprocity, analogic communicative patterns are needed to allow the symbolic dimension to be expressed.