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Murray GF, Lewis VA. Cross-Sector Strategic Alliances Between Health Care Organizations and Community-Based Organizations: Marrying Theory and Practice. Adv Health Care Manag 2022; 21:89-110. [PMID: 36437618 DOI: 10.1108/s1474-823120220000021005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
While it has long been established that social factors, such as housing, transportation, and income, influence health and health care outcomes, over the last decade, attention to this topic has grown dramatically. Reforms that promote high-quality care as well as responsibility for total cost of care have shifted focus among health care providers toward upstream determinants of health care outcomes. As a result, there has been a proliferation of activity focused on integrating and aligning social and medical care, many of which depend critically on cross-sector alliances. Despite considerable activity in this area, cross-sector alliances in health care remain largely undertheorized. Both literatures stand to gain from more attention to carefully knitting together the theoretical and management literature on alliances with the empirical, health policy and health services literature on cross-sector alliances in health care. In this chapter, we lay out what exists in the current scientific literature as well as a framework for considering much needed work in this area. We organize the literature and our commentary around the lifecycle of alliances: alliance formation, including factors prompting alliance formation, partner selection, and alliance goals; alliance maturity, including the work of these cross-sector alliances, governance, finance and contracts, staffing structure, and rewards; and critical crossroads, including alliance timelines, definitions of success, and dissolution. We also lay out critical areas for future inquiry, including better theorizing on cross-sector alliances, developing typologies of these cross-sector health care alliances, and the role of policy in cross-sector alliances.
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Peeters R, Westra D, van Raak AJA, Ruwaard D. So Happy Together: A Review of the Literature on the Determinants of Effectiveness of Purpose-Oriented Networks in Health Care. Med Care Res Rev 2022; 80:266-282. [PMID: 36000492 PMCID: PMC10126450 DOI: 10.1177/10775587221118156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
While purpose-oriented networks are widely recognized as organizational forms to address wicked problems in health care such as increasing demands and expenditure, the associated literature is fragmented. We therefore reviewed empirical studies to identify the determinants of the effectiveness of these networks. Our search yielded 3,657 unique articles, of which 19 met our eligibility criteria. After backward snowballing and expert consultation, 33 articles were included. Results reveal no less than 283 determinants of effective health care networks. The majority of these determinants are processual and involving professionals from the operational level is particularly salient. In addition, most studies relate determinants to process outcomes (e.g., improved collaboration or sustainability of the network) and only a few to members' perception of whether the network attains its goals. We urge future research to adopt configurational approaches to identify which sets of determinants are associated with networks' ability to attain their goal of addressing wicked problems.
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Slåtten T, Mutonyi BR, Lien G. Does organizational vision really matter? An empirical examination of factors related to organizational vision integration among hospital employees. BMC Health Serv Res 2021; 21:483. [PMID: 34016114 PMCID: PMC8139162 DOI: 10.1186/s12913-021-06503-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 05/10/2021] [Indexed: 11/11/2022] Open
Abstract
Background There seems to be a consensus that a vision for an organization is a valuable thing for organizations to have. However, research on organizational vision has predominantly been studied from a leadership perspective. In contrast to previous research, organizational vision in this paper takes an employee perspective. Specifically, the purpose is to examine factors associated with the integration of organizational vision among employees in hospital organizations. Consequently, it focuses on a relatively neglected domain within health services research. Methods A conceptual model, centred on the concept of organizational vision integration, was developed and tested on a sample (N=1008) consisting of hospital employees. Partial least-squares structural equation modelling (PLS-SEM) was used to test the hypotheses, using SmartPLS 3 software. Furthermore, a bootstrapping test was used to inspect potential mediating effects. Specifically, the test assessed whether the proposed direct and indirect effects were statistically significant, and at the same time revealed the nature of the mediation effect. Results The results from the empirical study reveal three key findings: i) organizational vision integration among employees is directly and positively related to creative performance in their respective work role ( = 0.16). Organizational vision integration and employees psychological capital explains almost 40% (R2 = 0.36) in employees creative performance, ii) psychological capital and employees perception of organizational attractiveness are directly and positively related to employees organizational vision integration ( = 0.19 and = 0.40, respectively) and explains about 30% (R2 = 0.29) of employees organizational vision integration, iii) employees organizational vision integration mediates the relationship between employees psychological capital, perception of organizational attractiveness and employees creative performance. Conclusions Taking an employee perspective, this study contributes to revealing whether and how organizational vision matters and its impact on hospital employees work performance. To achieve organizational vision integration among hospital employees successfully, this study shows that it is important for hospital leaders to be aware of the pattern of impact of both personal as well as environmental-related factors. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06503-3.
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Affiliation(s)
- Terje Slåtten
- Inland Norway University of Applied Sciences, Campus Lillehammer, 2604, Lillehammer, Norway.
| | | | - Gudbrand Lien
- Inland Norway University of Applied Sciences, Campus Lillehammer, 2604, Lillehammer, Norway
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Akmal A, Gauld R. What components are important for effective healthcare alliance governance? Findings from a modified Delphi study in New Zealand. Health Policy 2020; 125:239-245. [PMID: 33390279 DOI: 10.1016/j.healthpol.2020.12.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 09/15/2020] [Accepted: 12/22/2020] [Indexed: 11/17/2022]
Abstract
Alliance governance is a form of governance developed in industry settings and more recently applied to healthcare. The core idea behind alliance governance is to involve the many stakeholders in the system to collaboratively develop a joint programme that promotes an integrated and whole of systems approach to care. Little is known about the model in healthcare, nor what those involved in an alliance should be focused upon. Using a modified Delphi method, this research presents a set of components that research participants agreed should underpin development of an effective alliance governance arrangement. These characteristics include a systems perspective-a truly shared governance protocol based on a shared vision and a common purpose; performance measurement-collecting and using real-time data that depicts the realities of an end-to-end system to establish better and more achievable goals based on alliance performance; a relational perspective to promote trust, respect and collaboration amongst alliance members, who historically have been competing for contracts and resources; structural changes that enable and promote a shared governance system; and, finally, equity and inclusion to ensure a diverse alliance which promotes diversity of ideas, and involvement of all stakeholders in the decision making process. This research is relevant to policymakers seeking to develop effective alliance-type arrangements as well as to those involved in the practice of alliance governance.
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Affiliation(s)
- Adeel Akmal
- Centre for Health Systems and Technology, Otago Business School, University of Otago, 60 Clyde Street, Dunedin 9016, New Zealand.
| | - Robin Gauld
- Centre for Health Systems and Technology, Otago Business School, University of Otago, 60 Clyde Street, Dunedin 9016, New Zealand.
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Gauld R, Asgari-Jirhandeh N, Patcharanarumol W, Tangcharoensathien V. Reshaping public hospitals: an agenda for reform in Asia and the Pacific. BMJ Glob Health 2018; 3:e001168. [PMID: 30588348 PMCID: PMC6278916 DOI: 10.1136/bmjgh-2018-001168] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 10/15/2018] [Accepted: 10/23/2018] [Indexed: 01/17/2023] Open
Abstract
Hospitals in the Asia-Pacific today face the 'triple aim' challenge, proposed by the Institute for Healthcare Improvement, of how to improve quality of care and population health, while at the same time controlling healthcare costs. Yet, pursuing these challenges in combination is presently a remote prospect for many hospitals and, indeed, in a majority of countries in the region. The roles and functions of the public hospital sector within local health systems need redefinition and reform in the context of demographic and epidemiological transitions. Policymakers, managers and health professionals have an obligation to reshape the future of public hospitals. This article outlines actions for how public hospitals can be reshaped from a health system perspective. First, hospitals should be integrated into the fabric of the local health system; they can lead in this through working in alliances with other healthcare facilities, including primary care and private hospitals. Policymakers have a role in facilitating this as it contributes to health improvement of the population. Second, investments in system innovation, management improvement and information systems are required and their impact assessed. Such investments can contribute to cost control and efficiency. Public hospital sector investments should be strategic, efficient and should not bias investment in broader determinants of health. Third, reorienting health workforce competencies and appropriate skills should be central to hospital sector reforms, from policy to frontline services delivery. Creative thinking is needed to build and support flexible care delivery arrangements for services designed to respond to patients ' and providers' needs. Pivotal to achievement of each of these three areas of reform is good governance and leadership.
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Affiliation(s)
- Robin Gauld
- Otago Business School, University of Otago, Dunedin, New Zealand
| | - Nima Asgari-Jirhandeh
- Asia-Pacific Observatory on Health Systems and Policies, World Health Organization, Delhi, India
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The new frontier of strategic alliances in health care: New partnerships under accountable care organizations. Soc Sci Med 2017; 190:1-10. [PMID: 28806586 DOI: 10.1016/j.socscimed.2017.04.054] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 02/03/2017] [Accepted: 04/30/2017] [Indexed: 11/20/2022]
Abstract
Accountable care organizations (ACOs) and similar reforms aim to improve coordination between health care providers; however, due to the fragmented nature of the US health care system, successful coordination will hinge in large part on the ability of health care organizations to successfully partner across organizational boundaries. Little is known about new partnerships formed under the ACO model. We use mixed methods data from the National Survey of ACOs, Medicare ACO performance data and interviews with executive leaders across 31 ACOs to examine the prevalence, characteristics, and capabilities of partnership ACOs and why and how ACO partnerships form. We find that a striking percentage of ACOs - 81% - involve new partnerships between independent health care organizations. These "partnership ACOs" generally report lower capabilities on care management, care coordination, and health information technology. Additionally, under Medicare ACO programs partnership ACO achieved somewhat lower quality performance. Qualitative interviews revealed that providers are motivated to partner for resource complementarity, risk reduction, and legislative requirements, and are using a variety of formal and informal accountability mechanisms. Most partnership ACOs were formed out of existing, positive relationships, but a minority of ACOs formed out of previously competitive or conflictual relationships. Our findings suggests that the success of the ACO model will hinge in large part upon the success of new partnerships, with important implications for understanding ACO readiness and capabilities, the relatively small savings achieved to date by ACO programs, and the path to providers bearing more risk for population health management. In addition, ACO partnerships may provide an important window to monitor a potential wave of health care consolidation or, in contrast, a new model of independent providers successfully coordinating patient care.
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Francis L, Dunt D, Cadilhac DA. How is the sustainability of chronic disease health programmes empirically measured in hospital and related healthcare services?-a scoping review. BMJ Open 2016; 6:e010944. [PMID: 27246000 PMCID: PMC4893855 DOI: 10.1136/bmjopen-2015-010944] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES Programmes to address chronic disease are a focus of governments worldwide. Despite growth in 'implementation science', there is a paucity of knowledge regarding the best means to measure sustainability. The aim of this review was to summarise current practice for measuring sustainability outcomes of chronic disease health programmes, providing guidance for programme planners and future directions for the academic field. SETTINGS A scoping review of the literature spanning 1985-2015 was conducted using MEDLINE, CINAHL, PsychINFO and The Cochrane Library limited to English language and adults. Main search terms included chronic disease, acute care, sustainability, institutionalisation and health planning. A descriptive synthesis was required. Settings included primary care, hospitals, mental health centres and community health. PARTICIPANTS Programmes included preventing or managing chronic conditions including diabetes, heart disease, depression, respiratory disease, cancer, obesity, dental hygiene and multiple chronic diseases. PRIMARY AND SECONDARY OUTCOME MEASURES Outcome measures included clarifying a sustainability definition, types of methodologies used, timelines for assessment, criteria levels to determine outcomes and how methodology varies between intervention types. RESULTS Among 153 abstracts retrieved, 87 were retained for full article review and 42 included in the qualitative synthesis. Five definitions for sustainability outcome were identified with 'maintenance of programme activities' most frequent. Achieving sustainability was dependent on inter-relationships between various organisational and social contexts supporting a broad scale approach to evaluation. An increasing trend in use of mixed methods designs over multiple time points to determine sustainability outcomes was found. CONCLUSIONS Despite the importance and investment in chronic disease programmes, few studies are undertaken to measure sustainability. Methods to evaluate sustainability are diverse with some emerging patterns in measurement found. Use of mixed methods approaches over multiple time points may serve to better guide measurement of sustainability. Consensus on aspects of standardised measurement would promote the future possibility of meta-analytic syntheses.
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Affiliation(s)
- Linda Francis
- The University of Melbourne, Melbourne School of Population and Global Health, Centre for Health Policy, Melbourne Health Centre for Excellence in Neuroscience, Ballarat, Victoria, Australia
| | - David Dunt
- Centre for Health Policy, The University of Melbourne, Melbourne School of Population and Global Health, Parkville, Victoria, Australia
| | - Dominique A Cadilhac
- Translational Public Health Unit, Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
- Head Public Health: Stroke Division, Florey Institute of Neuroscience and Mental Health, Melbourne Brain Centre, Heidelberg, Victoria, Australia
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Meads G, Russell G, Lees A. Community governance in primary health care: towards an international Ideal Type. Int J Health Plann Manage 2016; 32:554-574. [PMID: 27230589 DOI: 10.1002/hpm.2360] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 12/01/2015] [Accepted: 04/06/2016] [Indexed: 11/10/2022] Open
Abstract
Against a global background of increased resource management responsibilities for primary health care agencies, general medical practices, in particular, are increasingly being required to demonstrate the legitimacy of their decision making in market oriented environments. In this context a scoping review explores the potential utility for health managers in primary health care of community governance as a policy concept. The review of recent research suggests that applied learning from international health systems with enhanced approaches to public and patient involvement may contribute to meeting this requirement. Such approaches often characterise local health systems in Latin America and North West Europe where innovative models are beginning to respond effectively to the growing demands on general practice. The study design draws on documentary and secondary data analyses to identify common components of community governance from the countries in these regions, supplemented by other relevant international studies and sources where appropriate. Within a comprehensive framework of collaborative governance the components are aggregated in an Ideal Type format to provide a point of reference for possible adaptation and transferable learning across market oriented health systems. Each component is illustrated with international exemplars from recent organisational practices in primary health care. The application of community governance is considered for the particular contexts of GP led Clinical Commissioning Groups in England and Primary Health Networks in Australia. Some components of the Ideal Type possess potentially powerful negative as well as positive motivational effects, with PPI at practice levels sometimes hindering the development of effective local governance. This highlights the importance of careful and competent management of the growing resources attributed to primary health care agencies, which possess an increasingly diverse range of non-governmental status. Future policy and research priorities are outlined. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
| | - Grant Russell
- Southern Academic Primary Care Research Unit, School of Primary Health Care, Monash University, Melbourne, Australia
| | - Amanda Lees
- Health and Wellbeing Research and Development Group, University of Winchester, UK
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McHugh M, Harvey J, Hamil J, Verevkina NI, Alexander J, Scanlon DP. The Impact of the Affordable Care Act on Health Care Alliances' Quality Improvement Efforts in Targeted Communities: Perceptions of Health Care Alliance Leaders. Jt Comm J Qual Patient Saf 2016; 42:137-45. [PMID: 26892703 DOI: 10.1016/s1553-7250(16)42017-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Megan McHugh
- Center for Healthcare Studies and Department of Emergency Medicine, Northwestern University, Feinberg School of Medicine, Chicago, USA
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