Abstract : Introduction: The increasing number of people in chronic conditions requires not only a growing
number of diverse care and support services, but also a better articulation between the different
providers. To reduce the fragmentation of the health care system, policy makers, professionals,
and family and user-led organizations, are engaged in a permanent process of innovation and
cooperation. Because the improvement of integrated care relies entirely on that collective
dynamics, the latter has to be better understood.
Aims: Approach integrated care schemes through their life cycle, offer an interactive model
explaining the dynamics of innovation, and identify the success factors that facilitate integration
work in France.
Results: Comparing seven different integrated care schemes created in France over the past two
decades, both for vulnerable elderly and for adults with disabilities, shows that their development
follows a similar pattern – what we call the life cycle of integrated care schemes – made of three to
four phases: emergence, building up, routine, and eventually disappearance. All along the
process, local initiatives, usually conducted by pioneer physicians or family and user-led
organizations, face national public policy agenda. Interactions occur through four key processes
initiated by national-level policy makers: experimentation, assessment, conceptualization, and
generalization. More specifically, these processes are meta-processes because they are fuelling
schemes’ life cycles which are themselves organizational processes. Depending on the scheme
you consider, the four meta-processes occured neither in the same order nor at the same pace.
Hence the comparison helps us understand the factors that may restrict or facilitate the effective
implementation of integration work. Finally, the in-depth study we realized on an emergent scheme
devoted to the management of people with rare diseases’ care pathways, reveals the reciprocal
learning and prescription process between local political entrepreneurs and policy makers working
at multiple levels.
Conclusions: Innovation is neither the work of a few pioneers nor the one of national policy
makers, but a collective and interactive dynamics. The continuity of public funding is crucial in the
process, as well as the existence of a resource project team at the national level in order to ensure
equal treatment throughout the country.