| CONCEPTS |
Process that improves education and training |
The integration of education and training into services widens learning opportunities and tailors learning to the student’s future professional needs |
| Process that contributes to the development of the SUS |
It allows the health system to influence the education and training of future human resources, ensuring they are committed to underlying principles and guidelines, improving practices, and increasing technical and scientific output |
| Process that broadens the development of competencies |
Integration facilitates the development of interprofessional, leadership, and management competencies, as well as technical and care skills |
| Process that drive the formation of a policy management network |
The presence of 3 or more legally autonomous organizations that cooperate to achieve common goals driven by a public policy encompasses several phenomena attributable to networks |
| Process that drives changes in the curriculum |
The needs arising from government, health system or community demands related to integration drive curriculum changes |
| Process that promote social responsibility on the part of the school |
The ties established commit schools to improving community living conditions, facilitating the development of social accountability policies |
| PRACTICES |
Practice tailored to care |
Biomedical care practices resulting from predominant curricular demands are rare in non-care settings such as health management or surveillance |
| Practice conditioned by reality |
As TSI takes place in real-life settings, integration promotes a practice determined by the evolving daily needs of services and communities |
| Practice developed by aligning academic interests |
Practices are based more on satisfying the needs and interests of academia and less on cooperation to achieve common goals |
| Practice conditioned by counterpart contributions |
Integration relationships are determined by available counterparts, promoting different practices in the same catchment area depending on the different counterparts offered/demanded |
| Practice influenced by dichotomies of the policy management networks |
Integration relations express paradoxes that are common to policy management networks, including competing interests, the singularities of participating entities, and overlap between personal and interinstitutional relationships |
| Practice poorly institutionalized |
Practices are piecemeal, lack clearly defined policies and permanent funding, are not a priority for managers, and often lack staff |
| DETERMINING FACTORS |
Degree of local alignment to national health and education policies |
Capacity of schools and services to align projects that are understood and accepted by all staff with national guidelines and the lack of capacity of central guidelines to meet/recognize local needs and specific characteristics |
| Interinstitutional recognition of complementarity |
Recognition of common objectives, demands, and outcomes and the need for mutual support between participating entities at all levels of the institutional hierarchy |
| Professionalization of teaching activities |
Permanent professional training and development for teachers and preceptors in teaching activities and management of educational programs |
| Level of institutionalization of integration |
Expressed in the institutions’ policy priorities, capacity to meet guidelines, low level of dependence on specific and temporary actions, people, and sustained funding |
| Processes for managing the integration of those involved |
Operational characteristics of intraorganizational governance and joint management of the integration process (interorganizational) |
| Legal framework for integration |
Capacity of regulatory norms to encompass all aspects involved in complex integration relationships, minimizing antinomies |
| Singularities of the participating services |
Intrinsic characteristics of the services where integration takes place (infrastructure, level of care, location, quality of care, care strategy) |
| MODES AND PROCESSES OF EVALUATION |
Evaluation of integration poorly institutionalized |
Poor systematization of evaluation in the routines of schools and services. Evaluation is inconsistent, lacks feedback, and make a limited contribution to decision-making by managers. Existing processes are weak and mainly perception-based |
| Lack of specific integration indicators |
Lack of specific integration process and outcome indicators. When there are indicators, they are generally linked to regulatory or production processes in practice settings. Indicators are not monitored |
| Poor systematization of structural conditions available for integration |
Structural conditions of participating practice settings (physical infrastructure, human and financial resources) poorly systematized |
| Lack of organizational structure for evaluation |
Evaluation performed separately by each participating entity. There are no specific shared evaluation structures |
| MANAGEMENT CHARACTERISTICS |
Management does not view teaching-service integration as a network |
Governance processes do not address the network’s characteristics and needs (interorganizational), despite some elements being identified by the participating entities |
| Lack of structure for the management of integration |
There is no specific shared management structure capable of dealing with the complexity of the process. Management is performed by each institution’s general structures |
| Management has limited capacity for dealing with antinomies |
Regulatory framework for integration has real or apparent antinomies (unforeseen, conflicting or unclear situations) that management has not always been able to address |
| Lack of suitable contractualization instruments |
Contracts do not encompass all process interfaces and the entire spectrum of actions, fail to clearly explain responsibilities and objectives, and do not include all hierarchical levels of those involved |
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