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

Improving inter-organizational care-cure designs: specialization versus integration 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/approachMixed methods were used in Dutch perinatal care: analysis of archival data, clinical research and system dynamics simulation modeling.FindingsInter-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 implicationsA 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/valueThe 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. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Journal of Integrated Care Emerald Publishing

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

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References (78)

Publisher
Emerald Publishing
Copyright
© Emerald Publishing Limited
ISSN
1476-9018
DOI
10.1108/jica-02-2018-0018
Publisher site
See Article on Publisher Site

Abstract

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/approachMixed methods were used in Dutch perinatal care: analysis of archival data, clinical research and system dynamics simulation modeling.FindingsInter-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 implicationsA 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/valueThe 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.

Journal

Journal of Integrated CareEmerald Publishing

Published: Oct 5, 2018

Keywords: System dynamics; Healthcare; Organization design; Inter-organizational collaboration

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