Structure refers to the way that the organisation fulfils its day-to-day functions. Structural factors have been
acknowledged as important success factors in the HSI literature. Alexander6 noted eleven strategic/structural
barriers including boundaries or authority and delegation, gaps in service delivery, and internal fragmentation of
services. Before integration there were three executives: the Assistant Director of Nursing, and two medical
Directors. After integration, one of the original medical executives was appointed as the sole Director, while the
Assistant Director of Nursing was away on secondment. Subsequently, the single executive was supported by
an executive committee comprising the other two former directors of the service.