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Belrhiti Z, Bigdeli M, Lakhal A, Kaoutar D, Zbiri S, Belabbes S. Unravelling collaborative governance dynamics within healthcare networks: a scoping review. Health Policy Plan 2024; 39:412-428. [PMID: 38300250 PMCID: PMC11005841 DOI: 10.1093/heapol/czae005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 01/18/2024] [Accepted: 01/30/2024] [Indexed: 02/02/2024] Open
Abstract
In many countries, healthcare systems suffer from fragmentation between hospitals and primary care. In response, many governments institutionalized healthcare networks (HN) to facilitate integration and efficient healthcare delivery. Despite potential benefits, the implementation of HN is often challenged by inefficient collaborative dynamics that result in delayed decision-making, lack of strategic alignment and lack of reciprocal trust between network members. Yet, limited attention has been paid to the collective dynamics, challenges and enablers for effective inter-organizational collaborations. To consider these issues, we carried out a scoping review to identify the underlying processes for effective inter-organizational collaboration and the contextual conditions within which these processes are triggered. Following appropriate methodological guidance for scoping reviews, we searched four databases [PubMed (n = 114), Web of Science (n = 171), Google Scholar (n = 153) and Scopus (n = 52)] and used snowballing (n = 22). A total of 37 papers addressing HN including hospitals were included. We used a framework synthesis informed by the collaborative governance framework to guide data extraction and analysis, while being sensitive to emergent themes. Our review showed the prominence of balancing between top-down and bottom-up decision-making (e.g. strategic vs steering committees), formal procedural arrangements and strategic governing bodies in stimulating participative decision-making, collaboration and sense of ownership. In a highly institutionalized context, the inter-organizational partnership is facilitated by pre-existing legal frameworks. HN are suitable for tackling wicked healthcare issues by mutualizing resources, staff pooling and improved coordination. Overall performance depends on the capacity of partners for joint action, principled engagement and a closeness culture, trust relationships, shared commitment, distributed leadership, power sharing and interoperability of information systems To promote the effectiveness of HN, more bottom-up participative decision-making, formalization of governance arrangement and building trust relationships are needed. Yet, there is still inconsistent evidence on the effectiveness of HN in improving health outcomes and quality of care.
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Affiliation(s)
- Zakaria Belrhiti
- International School Mohammed VI of Public Health, Mohammed VI University of Sciences and Health (UM6SS), UM6SS – Anfa City : Bld Mohammed Taïeb Naciri, Commune Hay Hassani 82 403, Casablanca 20230, Morocco
- Knowledge for Health Policies, UM6SS, Anfa City : Bld Mohammed Taïeb Naciri, Commune Hay Hassani 82 403, Casablanca 20230, Morocco
- Mohammed VI Center for Research and Innovation (CM6RI), Rue Mohamed Al Jazouli – Madinat Al Irfane Rabat 10 100, Rabat Rue, Mohamed Al Jazouli – 10 100, Morocco
| | - Maryam Bigdeli
- World Health Organization, 3 Av. S.A.R. Sidi Mohamed, Rabat, Geneva 10170, Morocco
| | - Aniss Lakhal
- Knowledge for Health Policies, UM6SS, Anfa City : Bld Mohammed Taïeb Naciri, Commune Hay Hassani 82 403, Casablanca 20230, Morocco
- Directorate of Hospitals and Ambulatory Care, Ministry of Health and Social Protection, Route d’El Jadida, Agdal, Rabat 10100, Morocco
| | - Dib Kaoutar
- Knowledge for Health Policies, UM6SS, Anfa City : Bld Mohammed Taïeb Naciri, Commune Hay Hassani 82 403, Casablanca 20230, Morocco
- Directorate of Hospitals and Ambulatory Care, Ministry of Health and Social Protection, Route d’El Jadida, Agdal, Rabat 10100, Morocco
| | - Saad Zbiri
- International School Mohammed VI of Public Health, Mohammed VI University of Sciences and Health (UM6SS), UM6SS – Anfa City : Bld Mohammed Taïeb Naciri, Commune Hay Hassani 82 403, Casablanca 20230, Morocco
- Knowledge for Health Policies, UM6SS, Anfa City : Bld Mohammed Taïeb Naciri, Commune Hay Hassani 82 403, Casablanca 20230, Morocco
- Mohammed VI Center for Research and Innovation (CM6RI), Rue Mohamed Al Jazouli – Madinat Al Irfane Rabat 10 100, Rabat Rue, Mohamed Al Jazouli – 10 100, Morocco
| | - Sanaa Belabbes
- International School Mohammed VI of Public Health, Mohammed VI University of Sciences and Health (UM6SS), UM6SS – Anfa City : Bld Mohammed Taïeb Naciri, Commune Hay Hassani 82 403, Casablanca 20230, Morocco
- Knowledge for Health Policies, UM6SS, Anfa City : Bld Mohammed Taïeb Naciri, Commune Hay Hassani 82 403, Casablanca 20230, Morocco
- Mohammed VI Center for Research and Innovation (CM6RI), Rue Mohamed Al Jazouli – Madinat Al Irfane Rabat 10 100, Rabat Rue, Mohamed Al Jazouli – 10 100, Morocco
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De Pourcq K, De Regge M, Van den Heede K, Van de Voorde C, Paul G, Eeckloo K. The role of governance in different types of interhospital collaborations: A systematic review. Health Policy 2019; 123:472-479. [PMID: 30878172 DOI: 10.1016/j.healthpol.2019.02.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 01/13/2019] [Accepted: 02/25/2019] [Indexed: 10/27/2022]
Abstract
CONTEXT Financial challenges and the need for high-quality care have vastly increased the number of hospital collaborations in recent decades. The governance of these collaborations remains a challenge. The goal of this study is twofold: (1) to investigate the governance characteristics in an interhospital collaboration and (2) explore the impact on the performance of the interhospital collaboration. METHODS A systematic review was conducted to provide a comprehensive overview of the evidence on governance in interhospital collaborations. Database searches yielded 9304 candidate articles, of which 26 studies fulfilled the inclusion criteria. FINDINGS Governance in collaborations differs in collaboration structure, governance characteristics and contextual factors. Although outcome factors are influenced by contextual determinants and the collaboration structure itself, governance characteristics are of great importance. CONCLUSIONS A critical challenge for managers is to successfully adapt collaborations structures and governance characteristics to rapidly changing conditions. Policy makers should ensure that new legislation and guidelines for internal governance can be adapted to different contextual factors. Research in the future should investigate the impact of governance as a dynamic process. More longitudinal case study research is needed to provide an in-depth view of the relationship between this process and the performance of a collaboration.
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Affiliation(s)
- Kaat De Pourcq
- Department of Marketing, Innovation and Organisation, Ghent University, Tweekerkenstraat 2 9000 Ghent, Belgium.
| | - Melissa De Regge
- Department of Marketing, Innovation and Organisation, Ghent University, Tweekerkenstraat 2 9000 Ghent, Belgium; Strategic Policy Cell, Ghent University Hospital, De Pintelaan 185 9000 Ghent, Belgium.
| | - Koen Van den Heede
- Belgian Health Care Knowledge Centre, Kruidtuinlaan 55 1000 Brussels, Belgium.
| | | | - Gemmel Paul
- Department of Marketing, Innovation and Organisation, Ghent University, Tweekerkenstraat 2 9000 Ghent, Belgium.
| | - Kristof Eeckloo
- Strategic Policy Cell, Ghent University Hospital, De Pintelaan 185 9000 Ghent, Belgium; Department of Public Health, Faculty of Medicine and Health Science, Ghent University, De Pintelaan 185 9000 Ghent, Belgium.
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Bazzoli GJ, Dynan L, Burns LR, Yap C. Two Decades of Organizational Change in Health Care: What Have we Learned? Med Care Res Rev 2016; 61:247-331. [PMID: 15358969 DOI: 10.1177/1077558704266818] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The 1980s and 1990s witnessed a substantial wave of organizational restructuring among hospitals and physicians, as health providers rethought their organizational roles given perceived market imperatives. Mergers, acquisitions, internal restructuring, and new interorganizational relationships occurred at a record pace. Matching this was a large wave of study and discourse among health services researchers, industry experts, and consultants to understand the causes and consequences of organizational change. In many cases, this literature provides mixed signals about what was accomplished through these organizational efforts. The purpose of this review is to synthesize this diverse literature. This review examines studies of horizontal consolidation and integration of hospitals, horizontal consolidation and integration of physician organizations, and integration and relationship development between physicians and hospitals. In all, around 100 studies were examined to assess what was learned through two decades of research on organizational change in health care.
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Patru D, Lauche K, van Kranenburg H, Ziggers GW. Multilateral Boundary Spanners: Creating Virtuous Cycles in the Development of Health Care Networks. Med Care Res Rev 2015; 72:665-86. [PMID: 26067578 DOI: 10.1177/1077558715590233] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 05/12/2015] [Indexed: 11/15/2022]
Abstract
Understanding how health care networks achieve their goals is critical for managers and researchers alike. Our study addresses this issue by applying qualitative methods to retrospectively study the involvement of boundary spanners in the setup and implementation of a health care network in the Netherlands. We found that boundary spanners who acted multilaterally, that is, both within and across organizations, could successfully represent their organizations' interests at the network level and implement the required intraorganizational developments. By acting multilaterally, these boundary spanners generated virtuous cycles in the development of the network, whereby their successful actions supported the actions of their subordinates in setting up and implementing network agreements. In contrast, boundary spanners who had not been acting multilaterally before the network's kickoff were insufficiently prepared to enact their network-related tasks, and only successfully did so once they began operating both within and across organizations.
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Affiliation(s)
- Daniela Patru
- Radboud University, Institute for Management Research, Nijmegen, The Netherlands
| | - Kristina Lauche
- Radboud University, Institute for Management Research, Nijmegen, The Netherlands
| | - Hans van Kranenburg
- Radboud University, Institute for Management Research, Nijmegen, The Netherlands
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Pink GH, Holmes GM, D'Alpe C, Strunk LA, McGee P, Slifkin RT. Financial indicators for critical access hospitals. J Rural Health 2006; 22:229-36. [PMID: 16824167 DOI: 10.1111/j.1748-0361.2006.00037.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
CONTEXT There is a growing recognition of the need to measure and report hospital financial performance. However, there exists little comparative financial indicator data specifically for critical access hospitals (CAHs). CAHs differ from other hospitals on a number of dimensions that might affect appropriate indicators of performance, including differences in Medicare reimbursement, limits on bed size and average length of stay, and relaxed staffing rules. PURPOSE To develop comparative financial indicators specifically designed for CAHs using Medicare cost report data. METHODS A technical advisory group of individuals with extensive experience in rural hospital finance and operations provided advice to a research team from the University of North Carolina at Chapel Hill. Twenty indicators deemed appropriate for assessment of CAH financial condition were chosen and formulas determined. Issues 1 and 2 of the CAH Financial Indicators Report were mailed to the chief executive officers of 853 CAHs in the summer of 2004 and 1,092 CAHs in the summer of 2005, respectively. Each report included indicator values specifically for their CAH, indicator medians for peer groups, and an evaluation form. FINDINGS Chief executive officers found the indicators to be useful and the underlying formulas to be appropriate. The multiple years of data provide snapshots of the industry as a whole, rather than trend data for a constant set of hospitals. CONCLUSIONS The CAH Financial Indicators Report is a useful first step toward comparative financial indicators for CAHs.
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Affiliation(s)
- George H Pink
- North Carolina Rural Health Research and Policy Analysis Center, Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7590, USA.
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Wells R, Lemak CH, D'Aunno TA. Factors associated with interorganizational relationships among outpatient drug treatment organizations 1990-2000. Health Serv Res 2005; 40:1356-78. [PMID: 16174138 PMCID: PMC1361209 DOI: 10.1111/j.1475-6773.2005.00426.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To identify the factors associated with drug abuse treatment center participation in interorganizational relationships (IORs). DATA SOURCES Three nationally representative samples of outpatient drug abuse treatment units surveyed in 1990, 1995, and 1999/2000 as part of the National Drug Abuse Treatment System Survey (NDATSS), stratified by public/private status, treatment modality (methadone or nonmethadone), and organizational affiliation. STUDY DESIGN Probit analyses on 647 lagged treatment center-year observations from the years 1990 to 1995 with outcomes in 1995 and 2000, respectively. Standard errors were adjusted for clustering of center-year observations within centers. PRINCIPAL FINDINGS Centers with greater motivation to form IORs (e.g., as a result of client diversity or government revenue) were more likely to do so, as were centers with greater opportunities to form IORs (e.g., centers whose directors participated in policy making). CONCLUSIONS Both motivating and enabling factors promoted the formation of IORs by drug abuse treatment centers. Managed care also played a distinct role, in this case appearing to undermine interorganizational cooperation. Because IORs can improve access to care and quality, policy makers should consider using both incentives and support such as management training to promote IOR formation.
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Affiliation(s)
- Rebecca Wells
- Penn State University, 116 Henderson Building, University Park, PA 16802, USA
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Nauenberg E, Andrijuk Y, Eisinger M. Reconsideration of discharge data to measure competition in the hospital industry. HEALTH ECONOMICS 2001; 10:271-276. [PMID: 11288192 DOI: 10.1002/hec.595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Economists have long used state-collected discharge data to construct Hirschman-Herfindahl (HH) indices measuring hospital competition. Since data are collected to determine the facility providing the service rather than ownership, the difference between the number of reporting facilities and the number of competitors has grown over time due to mergers and networking activities. Consequently, the validity of the discharge HH methodology, as currently employed, is in doubt. Comparing the annual census of New York state acute-care hospitals by the State and the American Hospital Association (AHA), we find that it is increasingly important to account for changes in ownership when constructing such indices.
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Affiliation(s)
- E Nauenberg
- Department of Economics, State University of New York at Buffalo, Buffalo, NY, USA.
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