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Improving inter-organizational care-cure designs: specialization versus integration

Improving inter-organizational care-cure designs: specialization versus integration
Improving inter-organizational care-cure designs: specialization versus integration

Purpose: The purpose of this paper is to investigate inter-organizational designs for care–cure conditions in which low-risk patients are cared for in specialized care organizations and high-risk patients are cared for in specialized cure organizations. Performance impacts of increasing levels of integration between these organizations are analyzed. Design/methodology/approach: Mixed methods were used in Dutch perinatal care: analysis of archival data, clinical research and system dynamics simulation modeling. Findings: Inter-organizational design has an effect on inter-organizational dynamics such as collaboration and trust, and also on the operational aspects such as patient flows through the system. Solutions are found in integrating care and cure organizations. However, not all levels of integrated designs perform better than a design based on organizational separation of care and cure. Practical implications: A clear split between midwifery practices (care) and obstetric departments (cure) will not work since all pregnant women need both care and cure. Having midwifery practices only works well when there are high levels of collaboration and trust with obstetric departments in hospitals. Integrated care designs are likely to exhibit superior performance. However, these designs will have an adverse effect on organizations that are not part of this integration, since integrating only a subset of organizations will feed distrust, low collaboration and hence low performance. Originality/value: The originality of this research is derived from its multi-method approach. Archival data and clinical research revealed the dynamic relations between organizations. The caveat of some integrated care models was found through simulation.

Healthcare, Inter-organizational collaboration, Organization design, System dynamics
1476-9018
Pieters, Angele
cb51787e-e410-4c0c-8281-d603f925a4a2
van Oorschot, Kim E.
041fdcf8-9205-4ba8-8f93-6ead770bce89
Akkermans, Henk A.
b55e0c78-1b50-4d5a-9136-7628680555cd
Brailsford, Sally C.
634585ff-c828-46ca-b33d-7ac017dda04f
Pieters, Angele
cb51787e-e410-4c0c-8281-d603f925a4a2
van Oorschot, Kim E.
041fdcf8-9205-4ba8-8f93-6ead770bce89
Akkermans, Henk A.
b55e0c78-1b50-4d5a-9136-7628680555cd
Brailsford, Sally C.
634585ff-c828-46ca-b33d-7ac017dda04f

Pieters, Angele, van Oorschot, Kim E., Akkermans, Henk A. and Brailsford, Sally C. (2018) Improving inter-organizational care-cure designs: specialization versus integration. Journal of Integrated Care. (doi:10.1108/JICA-02-2018-0018).

Record type: Article

Abstract

Purpose: The purpose of this paper is to investigate inter-organizational designs for care–cure conditions in which low-risk patients are cared for in specialized care organizations and high-risk patients are cared for in specialized cure organizations. Performance impacts of increasing levels of integration between these organizations are analyzed. Design/methodology/approach: Mixed methods were used in Dutch perinatal care: analysis of archival data, clinical research and system dynamics simulation modeling. Findings: Inter-organizational design has an effect on inter-organizational dynamics such as collaboration and trust, and also on the operational aspects such as patient flows through the system. Solutions are found in integrating care and cure organizations. However, not all levels of integrated designs perform better than a design based on organizational separation of care and cure. Practical implications: A clear split between midwifery practices (care) and obstetric departments (cure) will not work since all pregnant women need both care and cure. Having midwifery practices only works well when there are high levels of collaboration and trust with obstetric departments in hospitals. Integrated care designs are likely to exhibit superior performance. However, these designs will have an adverse effect on organizations that are not part of this integration, since integrating only a subset of organizations will feed distrust, low collaboration and hence low performance. Originality/value: The originality of this research is derived from its multi-method approach. Archival data and clinical research revealed the dynamic relations between organizations. The caveat of some integrated care models was found through simulation.

Text
JICA-02-2018-0018 - Manuscript - Improving Inter-Organizational Care-Cure Designs - Accepted Manuscript
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More information

Accepted/In Press date: 3 May 2018
e-pub ahead of print date: 10 July 2018
Keywords: Healthcare, Inter-organizational collaboration, Organization design, System dynamics

Identifiers

Local EPrints ID: 423067
URI: http://eprints.soton.ac.uk/id/eprint/423067
ISSN: 1476-9018
PURE UUID: 0be346d1-96e9-4209-a5a6-bb6275f7a891
ORCID for Sally C. Brailsford: ORCID iD orcid.org/0000-0002-6665-8230

Catalogue record

Date deposited: 13 Aug 2018 16:31
Last modified: 26 Nov 2021 06:18

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Contributors

Author: Angele Pieters
Author: Kim E. van Oorschot
Author: Henk A. Akkermans

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