**4. Discussion**

The aim of this reflective paper was to highlight the presence of emotions in the context of integrated care regarding, in particular, care for people with multiple complex problems. Although we as the authors of this paper are not experts in research on emotions, we hope this contribution could serve to raise more discussion on why–or if–emotional dimensions also deserve more attention regarding integrated care.

This paper was based on a study conducted only in one country, Finland, and elsewhere its findings can only be indicative. In the whole study, a total of 250 care professionals were involved through the workshops and material they produced in the course of a development project, based on close partnership with the research and development project. However, only a limited number of professionals and managers were interviewed. It is also noteworthy that the original aim of the study was concerned with integrated care in general and not specifically emotional aspects.

Nevertheless, the context of the study adds to its value: Finland's extensive national-level reform, which is expected to take place in 2021, is aiming at full integration of both health and social care (Regional Government 2018), which is still quite a rare effort internationally. Because of increasing interest and need to integrate care services in many other European countries as well (Goodwin 2015), experiences of how to combine rational and technical system level integration with the interactive level of human beings may be of interest to a larger audience. We claim specifically that the human side of integrated care should be taken into account when dealing with people whose life situations are complex and whose needs for care services from different care providers are high and complicated.

Based on the study reflected in this paper the following issues were highlighted:


emotions may result in avoiding confronting clients' problems. By integrated care arrangements, through cross-boundary collaboration, the temptation to just send a complicated client on to the next professional could be avoided.


To sum up, according to the research findings reflected here, integrated care is not only rational action. As Griffith and Glasby (2015) state, public policies on integrated care focus mainly on structural issues. However, although macro- and meso-level integration form the grounds for cross-boundary collaboration, the ultimate implementation of integration is accomplished at micro level by grassroots actors in interaction between care professionals and clients. There is no need to exaggerate the significance of emotional dimensions of integrated care, but no reason to avoid or neglect them, either. The aim should perhaps be to 'normalize' emotions (Ashforth and Kreiner 2002) and emotion labor (Hochschild 1983) as part of the implementation of integrated care. This means 'making the extraordinary seem ordinary' (Ashforth and Kreiner 2002) so that both the identification and sharing of the emotional burden among care professionals would be an accepted and routine way of working in cross-boundary collaboration. As stated in systems psychodynamics (Pratt and Crosina 2016), organizational structures may be established to protect individuals from emotions; structural arrangements enhancing collaboration may thus also serve as arenas for professionals to share the burden of emotions. In addition, training for professionals in confronting emotional situations and emotional pressures in cross-boundary collaboration is needed (Diefendorff et al. 2011). We believe that the emotional dimensions present in everyday life interactions (Jacobsen 2019; Williams 2001) deserve more attention—hopefully from multidisciplinary perspectives—in the future research of integrated care, in particular in the context of cross-boundary collaboration among care professionals needed by people with multiple complex problems.

**Author Contributions:** The authors contributed equally to this paper.

**Funding:** The research project Onnistu sote-integraatiossa (Successful Integration of Health and Social Care) was funded by the Finnish Foundation for Municipal Development (KAKS) and the development project Parempi Arki (Better Everyday Life) by the Ministry of Social Affairs and Health (Finland).

**Conflicts of Interest:** 'The authors declare no conflicts of interest.
