How to improve care across boundaries.

### What you need to know Integrated care is a healthcare approach focused around the patient perspective, which aims to promote better coordination and continuity of care across organisational boundaries.1 Integrated care can improve patient experience2 and reduce duplication.3 However, structural and cultural differences between physical and mental health services and across the primary and secondary care divide can impede its delivery. Perverse financial incentives and outdated expectations of doctor and patient roles are further barriers to improving care across boundaries.4 Changes in service commissioning and organisational culture may promote integrated care, but its delivery ultimately depends on the skills, behaviour, and engagement of healthcare workers. This article will explore the rationale and evidence base for integrated care and highlight salient examples of quality improvement (QI) across organisational boundaries in the UK and beyond. We aim to provide clinicians with a practical guide to implementing locally relevant, sustainable, and patient-centred change across boundaries. The consequences of ill health extend beyond physical symptoms. Disease can affect an individual’s mental health, independence and family life. Patients want to receive responsive and holistic care from a trusted professional, in the right place and at the right time. Siloed and fragmented health systems encourage professionals to treat clinical problems in isolation; patients’ wider health and social and spiritual needs may remain unmet. Integrated care moves beyond reductive and compartmentalised approaches towards cross-boundary, coordinated, and person-centred care. In the UK, many primary and secondary care organisations are working at maximum capacity. Finding new ways of working that bridge traditional divides can improve patient …