In this cluster, we define ‘System’, ‘Network’ and ‘Pathway’, all of which need to be in place for the delivery of ‘Integrated care’.


A system is a set of activities with a common aim, a common set of objectives, and a set of criteria against which progress towards the objectives can be measured. … Although the activities in a set can take place in different locations and in different organisations, it is possible for them to have ‘a common set of objectives’, in which:

  • more than one activity can relate to a single objective;
  • a single activity can relate to more than one objective.

Source: Gray JAM (2011) How To Build Healthcare Systems. Offox Press. Pages 9-10.

Two examples of the term in use:

Calling a group of healthcare organizations a “system” has become common practice. … however, true systems involve a functionally related group of interacting, interrelated or interdependent elements forming a complex whole with a common aim. In simpler terms, systems elements must be capable of working together to achieve shared goals; otherwise, they are merely individual parts with separate missions.

Baker GR, Macintosh-Murray A, Porcellato C, Dionne C, Stelmakovich K, Born K (2008) High Performing Healthcare Systems. Delivering Quality by Design. Longwoods Publishing Corporation. Page 14.

… EBM [evidence-based medicine] should not just be concerned with clinical content but also about the processes of changing care and systems of care.

Glasziou P, Haynes B (2005) The paths from research to improved health outcomes. BMJ 2005; 10(1): 4-7.


A network is a set of organisations and individuals that deliver the system’s objectives.

Source: Gray JAM (2011) How To Build Healthcare Systems. Offox Press. Page 11.

Example of the term in use:

We see the decline of the traditionally dominant role of the acute hospital with a growth of networks and partners around it as more routine work is devolved to primary care and other settings. Private sector and voluntary sector providers take on outsourced work from a traditionally public sector dominated delivery arm as separate commissioning roles emerge.

Ferlie E, Fitzgerald L, McGivern G, Dopson S, Exworthy M et al (2010) Networks in Health care: a Comparative Study of Their Management, Impact and Performance. Report for the National Institute for Health Research Service Delivery and Organisation programme. SDO Project (08/1518/102). Queen’s Printer and Controller of HMSO. Page 18.


…, the pathway is the course an individual follows as they go through the system, and at each point in the system a decision is made for the patient to follow one route or another. In breast screening, for example, all women follow the pathway up to the point where mammography is carried out; then, depending on the results of mammography, individual women will be told either that no cancer can be seen, and they are at low risk, or that they need a referral, in which case they follow another pathway through the referral process to the assessment clinic and, if necessary, on to treatment.

Source: Gray JAM (2011) How To Build Healthcare Systems. Offox Press. Page 25.

Examples of the term in use:

Care pathways vary in content, implementation, and place of service. In some healthcare systems, reduction in resource use can be achieved effectively by integrating patient management across different treatment settings. In these situations, such as in the United Kingdom healthcare system, pathways may place greater emphasis on clinical flow than management of prescription drugs.

Chawla A, Westrich K, Matter S, Kaltenboeck A, Dubois R (2016) Care Pathways in US Healthcare Settings: Current Successes and Limitations, and Challenges. Am J Managed Care 2016; 22(1): 53-62.

The development and use of care pathways pervades many areas of health and social care. Today, it would probably be difficult to find an area of health care in the UK for which a care pathway approach has not been attempted. A 2004 survey of health professionals in Europe found that the perceived level of present and future adoption of care pathways was highest in the UK.

Centre for Policy on Ageing – Rapid review. The effectiveness of care pathways in health and social care. Page 3.

Integrated care

Integrated care is an organising principle for care delivery with the aim of achieving improved patient care through better coordination of services provided. Integration is the combined set of methods, processes and models that seek to bring about this improved coordination of care.

Source: Shaw S, Rosen R, Rumbold B (2011) What is integrated care? An overview of integrated care in the NHS. Research report. June 2011. The Nuffield Trust. Page 7.

Example of the term in use:

Successful integrated care (i.e. models that are effective in meeting patient needs) demands the ongoing involvement of patients and family carers in programme planning, implementation and oversight. This will ensure that user needs and expectations are reflected where it counts, and that consumer satisfaction issues can be realistically addressed.

Kodner DL, Spreeuwenberg C (2002) Integrated care: meaning, logic, applications, and implications – a discussion paper.  Int J Integr Care 2002 Oct-Dec; 2: e12. Published online 14 November 2002.