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Analysis of where the individual studies were conducted could not be determined because many authors did not report this information. Service type provided in the included reviews spanned acute, primary and community care. The number of articles included in each review ranged from 4 to Type of primary research study included in the reviews could not be determined because the authors did not consistently report this information.

Of the articles that did describe study type, there was a broad range. Six reviews included findings from randomised control trials [ 19 , 20 , 21 , 22 , 23 , 24 ], while others reported on a mix of quasi-experimental design studies, qualitative studies, basic descriptions of models either in use or hypothetical and evaluation outcomes. Overall, a number of the authors of the review articles commented on the lack of reported outcomes and evaluations of cross-sector service provision arrangements [ 15 , 16 , 25 , 26 , 27 ].

Lack of evaluation will be discussed later in this article see Table 4 for an overview of the purpose and main findings of the included studies. The previously conducted review of reviews by Sloper [ 10 ] published in will be referenced in this article as baseline knowledge to see how the field has evolved over the last 10 years.

Sloper [ 10 ] explored what they refer to as coordinated multi-agency working which the author also calls Joint Working and Collaboration. Throughout this article, we will refer to similarities and differences and indicate gaps that remain, as well as highlight novel areas to consider in moving the field of research forward. In this section, we discuss the emergent terminology that appears to inform the overarching concept of cross-sector service provision. Determining how the authors conceptualised cross-sector service provision was challenging. Numerous terms are used interchangeably and with great frequency in the included articles see Table 5 for the frequency breakdown.

Cross-sector service provision appears to be informed by a number of separate bodies of literature. The current findings suggest that three concepts primarily inform the cross-sector service provision included in the studies: Integration, Collaboration and Partnership. Integration is the most commonly used term and is used in each of the 16 included articles. Collaboration is the second most used term, found in all but one of the included articles. Interestingly, multidisciplineary is used in 12 of the 16 articles despite none of the authors adopting it as a primary term.

Authors in the included studies also frequently use team and teamwork, as well as case management. Authors who do include a definition use a number of different terms as though they are synonymous with the primary term. The range of different terms used ranges from 5 to 16 terms, with the average being 9, and midpoint being seven terms used per article. On average, authors use nine different terms, often synonymously, when referring to cross-sector service provision, yet it can be argued that each of those terms are not synonymous with one another.

There is also variation in how the authors define the same primary term see Table 6 for a breakdown of definitions articulated by the authors. Even when the same primary term is used across different articles, rarely do the authors define the terms in the same way.

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In addition, elements of the definitions overlap regardless of the primary term. Common elements from the various definitions include independent sectors working together to improve care, focusing on the consumer and understanding that consumer needs are complex [ 4 , 15 , 17 , 18 , 19 , 21 , 22 , 24 , 28 ]. Integration and collaboration literatures have begun to discuss cross-sector service provision as occurring at different levels but differences exist in how these levels are conceptualised.

As Davies et al. Davies et al. With slight variation, Green et al. Although similarly discussed, there are variations in how the terms are used in the literature. Other authors who adopt different primary terms Integration, Collaboration and Partnership do not formally make the distinction between the levels, but do speak to elements required for effective cross-sector service provision that are similar to the levels outlined above. Craven MA, Bland R. Better practices in collaborative mental health care: an analysis of the evidence base. Leutz WN.

Five laws for integrating medical and social services: lessons from the United States and the United Kingdom. Milbank Quart ; 77— Kodner DL, Spreeuwenberg C: Integrated care: meaning, logic, applications, and implications — a discussion paper. International journal of integrated care , 2[1]: 1—6.

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Guide Partnerships in Social Care: A Handbook for Developing Effective Services

Age and Ageing , — JAmMedAssoc; — Audit Commission, London. Although not all of the included reviews specify a theoretical framework, some authors name theories that might be helpful in working towards bringing greater conceptual clarity to cross-sector service provision.

Partnership working in child protection

Some of the theories mentioned include federalism theory, governance theory, interorganisational theory, intersectoral theory, institutional change theory, innovation theory, public choice theory, humanistic theory, boundary theory [ 25 ] and professional socialisation theory [ 29 ]. However, how these theories specifically align with the included articles was not specified. The findings above indicate the need to clearly identify what is meant by cross-sector service provision and to pay particular attention to the differences between some of the more commonly used terms such as integration, collaboration, partnership and coordination.

As described above, these terms have different meanings and should not be used synonymously As Kodner [ 2, p. Thus, the definitions that are commonly used tend to be vague and confusing.

Partnerships in Social Care: A Handbook for Developing Effective Services

More consideration of terminology is needed. The authors of the included reviews strongly support the need to collaborate across sectors to provide more comprehensive, faster and more appropriate care to consumers [ 15 , 16 , 19 , B20 , 21 , 22 , 23 , 24 , 28 , 29 ]. Despite the strong support for cross-sector service provision and many articles reporting positive impacts related to processes, only four included reviews report positive outcomes related to cross-sector service provision. Seven articles in Collet et al.


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The authors conclude that there is some preliminary evidence to suggest that integrated models of cares are helpful in improving care for this complex population. Dowling et al. The majority of the studies reviewed by Butler et al. All other included reviews conclude that before any claims to positive outcomes related to cross-sector service provision are possible, further research is needed.

Almost half of the included studies stress the importance of placing the consumer at the centre of the cross-sector service provision arrangement [ 4 , 17 , 23 , 27 , 29 ].


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Notably, almost all authors discuss the glaring gap of the missing consumer perspective in all levels of service provision: planning, delivery, policy and research. This will be discussed further in the next section. The general consensus is that taking a consumer-centred approach facilitates cross-sector service provision. Striving for a shared vision of care across sectors is mentioned as integral to the success of cross-sector service provision by a number of authors [ 4 , 15 , 25 , 27 , 29 ]. A number of authors suggest that for cross-sector service provision arrangements to be successful, there must first be a perceived need for the arrangement [ 15 , 26 , 27 , 29 ] and commitment from all sectors [ 26 , 27 , 29 ].

Authors stress the importance of involving staff early on in the conceptualisation phase [ 4 ] and in an on-going and iterative manner for the duration of the cross-sector service provision arrangement [ 4 , 26 ]. Clarity of goals and purpose are seen as important by a number of authors [ 15 , 25 , 29 ]. Furthermore, a number of authors suggest that goals of the cross-sector service provision are best developed in a cooperative and coordinated manner [ 26 , 27 , 29 ].

Decision making that occurs in a collaborative and shared manner is also reported to facilitate cross-sector service provision [ 26 , 27 ]. Winters et al. Sloper [ 10 ] highlights similar findings and notes that if the reverse lack of perceived need and shared vision is found to be the case, it acts as a barrier to the success of cross-sector service provision. Many authors mention that equality across sectors involved in cross-sector service provision plays an important role in providing better care [ 4 , 17 , 21 , 26 , 29 ].

In particular, Soto et al. Similarly, Davies et al.

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Many home care staff in their studies reported feeling like their knowledge and views were not valued. Equal participation across sectors is therefore viewed to be important for achieving success related to cross-sector service provision. Effective leadership is considered to be an integral element of cross-sector service provision [ 15 , 17 , 21 , 25 , 27 , 28 ].

Sloper [ 10 ] indicates that appropriate leadership, if present, is a facilitator to cross-sector service provision and, if lacking, is a barrier in many of the articles they reviewed. Buy-in, on-going support and consistent involvement by leadership are viewed as mechanisms to challenge ways of thinking that preclude cross-sector service provision facilitation [ 17 , 21 , 25 , 27 ].