Whole System in the Room: Toward Systems Integration in Healthcare

How might systems integration be furthered in healthcare? The paper addresses this by exploring critically the potentials of appreciative inquiry for accelerating systems integration through a large group intervention. We analyze a one-day dialog workshop to get "the whole system in the room" to improve cancer care in a regional health authority in south west Sweden. Seeing systems integration as socialization and enhanced common understandings, we suggest that discourse may play a crucial role in bringing together the various stakeholders in the system. Our analysis of the group discussions of the event demonstrates however that the degree of shared understanding can vary considerably across the discussion themes of appreciative inquiry. We argue that the "patient," as a linguistic artifact, can act as a boundary signifier that enables those present to interact in a meaningful and coherent way but that this stops short of systems integration.