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Logo of ijicareInternational Journal of Integrated Care
Int J Integr Care. 2010 Oct-Dec; 10(Suppl): e70.
Published online 6 December 2010.
PMCID: PMC3031804
Annual Conference Supplement 2010

Studying integrated health care systems with a structurationist approach



To implement an integrated health care system is not an easy task and to ensure its sustainability is yet more difficult.


Discuss how a structurationist approach can shed light on the stakes of these processes and guide the managers of such endeavours.

Theory and method

Structuration theory [1] has been used by numerous authors to cast new light on complex organizational phenomena. One of the central tenets of this theory is that social systems, such as integrated health care systems, are recurrent social practices across time-space and are characterized by structural properties which simultaneously constrain and enable the constitutive social actors who reproduce and transform the system through their practices. We will illustrate our theoretical standpoint with empirical material gathered during the study of an integrated health care system for the frail elderly in Quebec, Canada. This system has been implemented in 1997 and is still working well in 2010.

Results and conclusion

To implement an integrated health care system that is both effective and sustainable, its managers must shrewdly allow for the existing system and progressively introduce changes in the way managers and practitioners at work in the system view their role and act on a daily basis.

Keywords: integration, structuration, health care system, frail elderly, Canada

Contributor Information

Louis Demers, PhD, Professor, École nationale d’administration publique, Quebec City, Canada.

Stéphane Arseneault, PhD (candidate), École nationale d’administration publique, Montreal, Canada.

Yves Couturier, PhD, Professor, Université de Sherbrooke, Sherbrooke, Canada.


1. Giddens A. The constitution of society. London: Policy Press; 1984.

Articles from International Journal of Integrated Care are provided here courtesy of Ubiquity Press