Barriers to Inter-Organisational Collaboration in the Preoperative Management of Patients with Osteoarthritis of the Hip or Knee.

Introduction: Integrated clinical pathways should provide the best and most efficient treatment. As no study on barriers to inter-organisational collaboration has investigated the barriers to unimplemented integrated clinical care in a country with less efficiently organised health system, the study aimed to identify these barriers in the preoperative management of patients with hip or knee osteoarthritis in Slovenia. Methods: A cross-sectional study was conducted using multiple methods, including a quantitative survey with participants involved in target patient groups, and in-depth interviews with involved key actors at micro, meso and macro levels in Slovenia. Results: Respondents predominantly expressed a lack of inter-organisational collaboration. The exposed barriers are individualistic culture, the level of development of the health system, financing, administration, and regulatory frame at the macro level, shortage of staff at the meso level, and the lack of technological standards, trust, communication, and perception of pressures at the micro level. Discussion and conclusion: In addition to the barriers identified in previous studies, our study shows that individualistic culture and the level of development of the health system at the macro level, manifested as a pressure on health professionals and other actors at the micro level, are important barriers to inter-organisational collaboration.