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Article
Publication date: 8 April 2022

Annelies van der Ham, Arno Van Raak, Dirk Ruwaard and Frits van Merode

This study explores how a hospital works, which is important for further enhancing hospital performance. Following the introduction of a Hospital Planning Centre (HPC), changes…

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Abstract

Purpose

This study explores how a hospital works, which is important for further enhancing hospital performance. Following the introduction of a Hospital Planning Centre (HPC), changes are explored in a hospital in terms of integration (the coordination and alignment of tasks), differentiation (the extent to which tasks are segmented into subsystems), rules, coordination mechanisms and hospital performance.

Design/methodology/approach

A case study was conducted examining the hospital’s social network, rules, coordination mechanisms and performance both before and after the introduction of the HPC. All planning and execution tasks for surgery patients were studied using a naturalistic inquiry and mixed-method approach.

Findings

After the introduction of the HPC, the overall network structure and coordination mechanisms and coordination mechanisms remained largely the same. Integration and certain rules changed for specific planning tasks. Differentiation based on medical discipline remained. The number of local rules decreased and hospital-wide rules increased, and these remained largely in people’s minds. Coordination mechanisms remained largely unchanged, primarily involving mutual adjustment and standardization of work both before and after the introduction of the HPC. Overall, the hospital’s performance did not change substantially. The findings suggest that integration seems to “emerge” instead of being designed. Hospitals could benefit, we argue, from a more conscious system-wide approach that includes collective learning and information sharing.

Originality/value

This exploratory study provides in-depth insight into how a hospital works, yielding important knowledge for further research and the enhancement of hospital performance.

Details

Journal of Health Organization and Management, vol. 36 no. 9
Type: Research Article
ISSN: 1477-7266

Keywords

Available. Open Access. Open Access
Article
Publication date: 23 February 2021

Annelies van der Ham, Arno van Raak, Dirk Ruwaard and Frits van Merode

Integration, that is, the coordination and alignment of tasks, is widely promoted as a means to improve hospital performance. A previous study examined integration and…

2405

Abstract

Purpose

Integration, that is, the coordination and alignment of tasks, is widely promoted as a means to improve hospital performance. A previous study examined integration and differentiation, that is, the extent to which tasks are segmented into subsystems, in a hospital's social network. The current study carries this research further, aiming to explain integration and differentiation by studying the rules and coordination mechanisms that agents in a hospital network use.

Design/methodology/approach

The current case study deepens the analysis of the social network in a hospital. All planning tasks and tasks for surgery performance were studied, using a naturalistic inquiry approach and a mixed method.

Findings

Of the 314 rules found, 85% predominantly exist in people's minds, 31% are in documents and 7% are in the information system. In the early planning stages for a surgery procedure, mutual adjustment based on hospital-wide rules is dominant. Closer to the day of surgery, local rules are used and open loops are closed through mutual adjustment, thus achieving integration. On the day of surgery, there is mainly standardization of work and output, based on hospital-wide rules. The authors propose topics for future research, focusing on increasing the hospital's robustness and stability.

Originality/value

This exploratory case study provides an overview of the rules and coordination mechanisms that are used for organizing hospital-wide logistics for surgery patients. The findings are important for future research on how integration and differentiation are effectively achieved in hospitals.

Details

Journal of Health Organization and Management, vol. 35 no. 9
Type: Research Article
ISSN: 1477-7266

Keywords

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Article
Publication date: 1 June 2000

Aggie Paulus, Arno van Raak, Frits van Merode and Eddy Adang

In many countries, health care reforms are being made with the purpose of stimulating actors to make economically sound decisions. Recent attempts in The Netherlands encompass the…

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Abstract

In many countries, health care reforms are being made with the purpose of stimulating actors to make economically sound decisions. Recent attempts in The Netherlands encompass the development and introduction of integrated health care arrangements. Since these arrangements are directly tailored to care demand, it is generally expected that integrated health care will enhance efficiency. This paper analyses whether a shift towards integrated health care actually represents a Pareto‐optimal change. An analysis of the consequences shows that care demanders, providers and informal care givers, to some extent and under certain conditions, can be expected to benefit from the introduction of integrated health care. Under long‐term considerations, the introduction of integrated care may be categorised as a potential Pareto‐improvement.

Details

Journal of Economic Studies, vol. 27 no. 3
Type: Research Article
ISSN: 0144-3585

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Article
Publication date: 1 December 1999

Arno van Raak, Aggie Paulus, Frits van Merode and Ingrid Mur‐Veeman

Delivery of integrated care by interorganisational networks attracts much attention in Europe. Such care is required to meet the demands of multi‐problem patients. Many efforts…

757

Abstract

Delivery of integrated care by interorganisational networks attracts much attention in Europe. Such care is required to meet the demands of multi‐problem patients. Many efforts are made to establish networks. Often, established networks do not deliver integrated care. Managers must understand the background of this problem, in order to deal with it. The issue addressed here concerns behaviour control in networks of autonomous care‐providing organisations. So far, publications have focused on behaviour control in single organisations. Based on empirical data we argue that, due to an essential distinction between networks and single organisations, behaviour control in the former should be approached differently. In addition, we discuss the implications of our findings for the management of integrated care delivery.

Details

Journal of Management in Medicine, vol. 13 no. 6
Type: Research Article
ISSN: 0268-9235

Keywords

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