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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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Implementing standardised flow: navigating operational and professional dependencies. INTERNATIONAL JOURNAL OF OPERATIONS & PRODUCTION MANAGEMENT 2020. [DOI: 10.1108/ijopm-06-2019-0493] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeThe purpose of this study had two aims: (1) to extend insight regarding the challenges of implementing standardised work, via care pathways, in a healthcare setting by considering interactions with other operational (i.e. resource sharing, portfolio alignment) and professional (i.e. autonomous expertise) dependencies and (2) to develop novel insights regarding a specific flow mechanism, the stroke nurse practitioner, a form of flow “pilo” or guide.Design/methodology/approachThis was a longitudinal case study of implementing the acute stroke care pathway in a National Health Service hospital in England based on 185 hours of non-participant observations and 68 semi-structured interviews. Archival documents were also analysed.FindingsThe combined flow, operational and professional dependency lens extends operations management understanding of the challenge of implementing standardised work in healthcare. One observed practice, the process pilot role, may be particularly valuable in dealing with these dependencies but it requires specific design and continuous support, for which the authors provide some initial guidance.Research limitations/implicationsThe research was a single case study and was focussed on a single care pathway. The findings require replication and extension but offer a novel set of insights into the implications of standardised work in healthcare.Originality/valueIn addition to confirming that a multidependency lens adds conceptual and practical insight to the challenges of implementing standardised work in a healthcare setting, the findings and recommendations regarding flow “pilots” are novel. The authors' analysis of this role reveals new insights regarding the need for continued improvisation in standardised work.
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Keijser WA, Handgraaf HJM, Isfordink LM, Janmaat VT, Vergroesen PPA, Verkade JMJS, Wieringa S, Wilderom CPM. Development of a national medical leadership competency framework: the Dutch approach. BMC MEDICAL EDUCATION 2019; 19:441. [PMID: 31779632 PMCID: PMC6883542 DOI: 10.1186/s12909-019-1800-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 09/09/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND The concept of medical leadership (ML) can enhance physicians' inclusion in efforts for higher quality healthcare. Despite ML's spiking popularity, only a few countries have built a national taxonomy to facilitate ML competency education and training. In this paper we discuss the development of the Dutch ML competency framework with two objectives: to account for the framework's making and to complement to known approaches of developing such frameworks. METHODS We designed a research approach and analyzed data from multiple sources based on Grounded Theory. Facilitated by the Royal Dutch Medical Association, a group of 14 volunteer researchers met over a period of 2.5 years to perform: 1) literature review; 2) individual interviews; 3) focus groups; 4) online surveys; 5) international framework comparison; and 6) comprehensive data synthesis. RESULTS The developmental processes that led to the framework provided a taxonomic depiction of ML in Dutch perspective. It can be seen as a canonical 'knowledge artefact' created by a community of practice and comprises of a contemporary definition of ML and 12 domains, each entailing four distinct ML competencies. CONCLUSIONS This paper demonstrates how a new language for ML can be created in a healthcare system. The success of our approach to capture insights, expectations and demands relating leadership by Dutch physicians depended on close involvement of the Dutch national medical associations and a nationally active community of practice; voluntary work of diverse researchers and medical practitioners and an appropriate research design that used multiple methods and strategies to circumvent reverberation of established opinions and conventionalisms. IMPLICATIONS The experiences reported here may provide inspiration and guidance for those anticipating similar work in other countries to develop a tailored approach to create a ML framework.
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Affiliation(s)
- Wouter A. Keijser
- Faculty of Behavioural, Management and Social Sciences (BMS) Change, Management and Organizational Behavior (CMOB), University Twente, Enschede, The Netherlands
- DIRMI Foundation, Utrecht, The Netherlands
| | | | - Liz M. Isfordink
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Vincent T. Janmaat
- Erasmus Medical Center, Wytemaweg 80, 3015 CP Rotterdam, The Netherlands
| | - Pieter-Paul A. Vergroesen
- Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | | | - Sietse Wieringa
- Institute of Health and Society, University of Oslo, Oslo, Norway
- Department of Continuing Education, University of Oxford, Oxford, OX1 2JD UK
| | - Celeste P. M. Wilderom
- Faculty of Behavioural, Management and Social Sciences (BMS) Change, Management and Organizational Behavior (CMOB), University Twente, Enschede, The Netherlands
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Hermans S, Sevenants A, Declercq A, Broeck NV, Deliens L, Cohen J, Audenhove CV. Inter-organisational collaboration in palliative care trajectories for nursing home residents: A nation-wide mixed methods study among key persons. INTERNATIONAL JOURNAL OF CARE COORDINATION 2019. [DOI: 10.1177/2053434519857352] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction Multiple care organisations, such as home care services, nursing homes and hospitals, are responsible for providing an appropriate response to the palliative care needs of older people admitted into long-term care facilities. Integrated palliative care aims to provide seamless and continuous care. A possible organisational strategy to help realise integrated palliative care for this population is to create a network in which these organisations collaborate. The aim is to analyse the collaboration processes of the various organisations involved in providing palliative care to nursing home residents. Method A sequential mixed-methods study, including a survey sent to 502 participants to evaluate the collaboration between home and residential care, and between hospital and residential care, and additionally three focus group interviews involving a purposive selection among the survey participants. Participants are key persons from the nursing homes, hospitals and home care organisations that are part of the 15 Flemish palliative care networks dispersed throughout the region of Flanders, Belgium. Results Survey data were gathered from 308 key persons (response rate: 61%), and 16 people participated in three focus group interviews. Interpersonal dimensions of collaboration are rated higher than structural dimensions. This effect is statistically significant. Qualitative analyses identified guidelines, education, and information-transfer as structural challenges. Additionally, for further development, members should become acquainted and the network should prioritise the establishment of a communication infrastructure, shared leadership support and formalisation. Discussion The insights of key persons suggest the need for further structuration and can serve as a guideline for interventions directed at improving inter-organisational collaboration in palliative care trajectories for nursing home residents.
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Affiliation(s)
| | | | | | | | - Luc Deliens
- Vrije Universiteit Brussel (VUB), Belgium
- Ghent University, Belgium
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Bainbridge D, Brazil K, Krueger P, Ploeg J, Taniguchi A, Darnay J. Evaluating Program Integration and the Rise in Collaboration: Case study of A Palliative Care Network. J Palliat Care 2018. [DOI: 10.1177/082585971102700403] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction: There is increasing global interest in using regional palliative care networks (PCNs) to integrate care and create systems that are more cost-effective and responsive. We examined a PCN that used a community development approach to build capacity for palliative care in each distinct community in a region of southern Ontario, Canada, with the goal of achieving a competent integrated system. Methods: Using a case study methodology, we examined a PCN at the structural level through a document review, a survey of 20 organizational administrators, and an interview with the network director. Results: The PCN identified 14 distinct communities at different stages of development within the region. Despite the lack of some key features that would facilitate efficient palliative care delivery across these communities, administrators largely viewed the network partnership as beneficial and collaborative. Conclusion: The PCN has attempted to recognize specific needs in each local area. Change is gradual but participatory. There remain structural issues that may negatively affect the functioning of the PCN.
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Affiliation(s)
- Daryl Bainbridge
- D Bainbridge (corresponding author) Department of Clinical Epidemiology and Biostatistics, and Department of Oncology, McMaster University, Juravinski Cancer Centre, 699 Concession Street, Room 4-203, Hamilton, Ontario, Canada L8V 5C2
| | - Kevin Brazil
- Department of Clinical Epidemiology and Biostatistics, and Division of Palliative Care, Department of Family Medicine, McMaster University, and St. Joseph's Health System Research Network, Hamilton, Ontario, Canada
| | - Paul Krueger
- Department of Family and Community Medicine, and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Jenny Ploeg
- School of Nursing, and Department of Health, Aging and Society, McMaster University, and Health Sciences Centre, Hamilton, Ontario, Canada
| | - Alan Taniguchi
- Division of Palliative Care, Department of Family Medicine, McMaster University, and Health Sciences Centre, Hamilton, Ontario, Canada
| | - Julie Darnay
- Hamilton, Niagara, Haldimand, Brant Hospice Palliative Care Network, St. Catharines, Ontario, Canada
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Bainbridge D, Brazil K, Ploeg J, Krueger P, Taniguchi A. Measuring healthcare integration: Operationalization of a framework for a systems evaluation of palliative care structures, processes, and outcomes. Palliat Med 2016; 30:567-79. [PMID: 26934948 DOI: 10.1177/0269216315619862] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Healthcare integration is a priority in many countries, yet there remains little direction on how to systematically evaluate this construct to inform further development. The examination of community-based palliative care networks provides an ideal opportunity for the advancement of integration measures, in consideration of how fundamental provider cohesion is to effective care at end of life. AIM This article presents a variable-oriented analysis from a theory-based case study of a palliative care network to help bridge the knowledge gap in integration measurement. DESIGN Data from a mixed-methods case study were mapped to a conceptual framework for evaluating integrated palliative care and a visual array depicting the extent of key factors in the represented palliative care network was formulated. SETTING/PARTICIPANTS The study included data from 21 palliative care network administrators, 86 healthcare professionals, and 111 family caregivers, all from an established palliative care network in Ontario, Canada. RESULTS The framework used to guide this research proved useful in assessing qualities of integration and functioning in the palliative care network. The resulting visual array of elements illustrates that while this network performed relatively well at the multiple levels considered, room for improvement exists, particularly in terms of interventions that could facilitate the sharing of information. CONCLUSION This study, along with the other evaluative examples mentioned, represents important initial attempts at empirically and comprehensively examining network-integrated palliative care and healthcare integration in general.
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Affiliation(s)
- Daryl Bainbridge
- Department of Oncology, McMaster University, Hamilton, ON, Canada
| | - Kevin Brazil
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Jenny Ploeg
- School of Nursing, McMaster University, Hamilton, ON, Canada Department of Health, Aging & Society, McMaster University, Hamilton, ON, Canada
| | - Paul Krueger
- Department of Family & Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Alan Taniguchi
- Division of Palliative Care, Department of Family Medicine, McMaster University, Hamilton, ON, Canada
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van Leijen-Zeelenberg JE, van Raak AJA, Duimel-Peeters IGP, Kroese MEAL, Brink PRG, Vrijhoef HJM. Interprofessional communication failures in acute care chains: How can we identify the causes? J Interprof Care 2015; 29:320-30. [PMID: 25614228 DOI: 10.3109/13561820.2014.1003802] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Although communication failures between professionals in acute care delivery occur, explanations for these failures remain unclear. We aim to gain a deeper understanding of interprofessional communication failures by assessing two different explanations for them. A multiple case study containing six cases (i.e. acute care chains) was carried out in which semi-structured interviews, physical artifacts and archival records were used for data collection. Data were entered into matrices and the pattern-matching technique was used to examine the two complementary propositions. Based on the level of standardization and integration present in the acute care chains, the six acute care chains could be divided into two categories of care processes, with the care chains equally distributed among the categories. Failures in communication occurred in both groups. Communication routines were embedded within organizations and descriptions of communication routines in the entire acute care chain could not be found. Based on the results, failures in communication could not exclusively be explained by literature on process typology. Literature on organizational routines was useful to explain the occurrence of communication failures in the acute care chains. Organizational routines can be seen as repetitive action patterns and play an important role in organizations, as most processes are carried out by means of routines. The results of this study imply that it is useful to further explore the role of organizational routines on interprofessional communication in acute care chains to develop a solution for failures in handover practices.
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Affiliation(s)
- Janneke E van Leijen-Zeelenberg
- Department of Health Services Research, School for Public Health and Primary Care (CAPHRI) , Maastricht University, Maastricht , The Netherlands
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Bainbridge D, Brazil K, Krueger P, Ploeg J, Taniguchi A, Darnay J. Measuring horizontal integration among health care providers in the community: an examination of a collaborative process within a palliative care network. J Interprof Care 2014; 29:245-52. [PMID: 25418319 DOI: 10.3109/13561820.2014.984019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
In many countries formal or informal palliative care networks (PCNs) have evolved to better integrate community-based services for individuals with a life-limiting illness. We conducted a cross-sectional survey using a customized tool to determine the perceptions of the processes of palliative care delivery reflective of horizontal integration from the perspective of nurses, physicians and allied health professionals working in a PCN, as well as to assess the utility of this tool. The process elements examined were part of a conceptual framework for evaluating integration of a system of care and centred on interprofessional collaboration. We used the Index of Interdisciplinary Collaboration (IIC) as a basis of measurement. The 86 respondents (85% response rate) placed high value on working collaboratively and most reported being part of an interprofessional team. The survey tool showed utility in identifying strengths and gaps in integration across the network and in detecting variability in some factors according to respondent agency affiliation and profession. Specifically, support for interprofessional communication and evaluative activities were viewed as insufficient. Impediments to these aspects of horizontal integration may be reflective of workload constraints, differences in agency operations or an absence of key structural features.
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Affiliation(s)
- Daryl Bainbridge
- Department of Oncology, Juravinski Cancer Centre, McMaster University , Hamilton, Ontario , Canada
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Walshe C. The evaluation of complex interventions in palliative care: an exploration of the potential of case study research strategies. Palliat Med 2011; 25:774-81. [PMID: 21865294 DOI: 10.1177/0269216311419883] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Complex, incrementally changing, context dependent and variable palliative care services are difficult to evaluate. Case study research strategies may have potential to contribute to evaluating such complex interventions, and to develop this field of evaluation research. AIM This paper explores definitions of case study (as a unit of study, a process, and a product) and examines the features of case study research strategies which are thought to confer benefits for the evaluation of complex interventions in palliative care settings. RESULTS Ten features of case study that are thought to be beneficial in evaluating complex interventions in palliative care are discussed, drawing from exemplars of research in this field. Important features are related to a longitudinal approach, triangulation, purposive instance selection, comprehensive approach, multiple data sources, flexibility, concurrent data collection and analysis, search for proving-disproving evidence, pattern matching techniques and an engaging narrative. The limitations of case study approaches are discussed including the potential for subjectivity and their complex, time consuming and potentially expensive nature. CONCLUSIONS Case study research strategies have great potential in evaluating complex interventions in palliative care settings. Three key features need to be exploited to develop this field: case selection, longitudinal designs, and the use of rival hypotheses. In particular, case study should be used in situations where there is interplay and interdependency between the intervention and its context, such that it is difficult to define or find relevant comparisons.
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Affiliation(s)
- Catherine Walshe
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK.
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Vos L, Chalmers SE, Dückers MLA, Groenewegen PP, Wagner C, van Merode GG. Towards an organisation-wide process-oriented organisation of care: a literature review. Implement Sci 2011; 6:8. [PMID: 21247491 PMCID: PMC3035025 DOI: 10.1186/1748-5908-6-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2009] [Accepted: 01/19/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Many hospitals have taken actions to make care delivery for specific patient groups more process-oriented, but struggle with the question how to deal with process orientation at hospital level. The aim of this study is to report and discuss the experiences of hospitals with implementing process-oriented organisation designs in order to derive lessons for future transitions and research. METHODS A literature review of English language articles on organisation-wide process-oriented redesigns, published between January 1998 and May 2009, was performed. RESULTS Of 329 abstracts identified, 10 articles were included in the study. These articles described process-oriented redesigns of five hospitals. Four hospitals tried to become process-oriented by the implementation of coordination measures, and one by organisational restructuring. The adoption of the coordination mechanism approach was particularly constrained by the functional structure of hospitals. Other factors that hampered the redesigns in general were the limited applicability of and unfamiliarity with process improvement techniques. CONCLUSIONS Due to the limitations of the evidence, it is not known which approach, implementation of coordination measures or organisational restructuring (with additional coordination measures), produces the best results in which situation. Therefore, more research is needed. For this research, the use of qualitative methods in addition to quantitative measures is recommended to contribute to a better understanding of preconditions and contingencies for an effective application of approaches to become process-oriented. Hospitals are advised to take the factors for failure described into account and to take suitable actions to counteract these obstacles on their way to become process-oriented organisations.
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Affiliation(s)
- Leti Vos
- NIVEL, Netherlands Institute for Health Services Research, P.O. Box 1568, 3500 BN Utrecht, the Netherlands
- Department of Medical Decision Making, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, the Netherlands
| | | | - Michel LA Dückers
- Impact, Dutch knowledge and advice center for post-disaster psychosocial care, P.O. Box 78, 1110 AB Diemen, the Netherlands
| | - Peter P Groenewegen
- NIVEL, Netherlands Institute for Health Services Research, P.O. Box 1568, 3500 BN Utrecht, the Netherlands
- Department of Sociology, Department of Human Geography, Utrecht University, P.O. Box 80140, 3508 TC Utrecht, the Netherlands
| | - Cordula Wagner
- NIVEL, Netherlands Institute for Health Services Research, P.O. Box 1568, 3500 BN Utrecht, the Netherlands
- The EMGO Institute for Health and Care Research (EMGO+), VU University Medical Centre Amsterdam, P.O. Box 7057, 1007 MB Amsterdam, the Netherlands
| | - Godefridus G van Merode
- Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Centre+, P.O. Box 5800, 6202 AZ Maastricht, the Netherlands
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Elissen AMJ, van Raak AJA, Paulus ATG. Can we make sense of multidisciplinary co-operation in primary care by considering routines and rules? HEALTH & SOCIAL CARE IN THE COMMUNITY 2011; 19:33-42. [PMID: 21143542 DOI: 10.1111/j.1365-2524.2010.00946.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Although it is widely acknowledged that the complex health problems of chronically ill and elderly persons require care provision across organisational and professional boundaries, achieving widespread multidisciplinary co-operation in primary care has proven problematic. We developed an explanation for this on the basis of the concepts of routines (patterns of behaviour) and rules, which form a relatively new yet promising perspective for studying co-operation in health-care. We used data about primary care providers situated in the Dutch region of Limburg, a region that, despite high numbers of chronically and elderly persons, has traditionally few healthcare centres and where multidisciplinary co-operation is limited. A qualitative study design was used, in which interviews and documents were the main data sources. Semi-structured interviews were conducted with providers from six primary care professions in the Dutch region of Limburg; relevant documents included co-operation agreements, annual reports and internal memos. To analyse the evidence, several data matrices were developed and all data were structured according to the main concepts under study, i.e. routines and rules. Although more research is needed, our study suggests that the emergence of more extensive multidisciplinary co-operation in primary care is hampered by the organisational rules and regulations prevailing in the sector. By emphasising individual care delivery rather than co-operation, these rules stimulate the perseverance of diversity between the routines by which providers perform their solo care delivery activities, rather than the creation of the amount of compatibility between those routines that is necessary for the current, rather limited shape of multidisciplinary co-operation to expand. Further research should attempt to validate this explanation by utilising a larger research population and systematically operationalising the rules existing in the legal and--more importantly--organisational environment of primary care.
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Affiliation(s)
- Arianne M J Elissen
- Department of Health Organization, Policy and Economics (HOPE), School of Public Health and Primary Care (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
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van Raak A, Groothuis S, van der Aa R, Limburg M, Vos L. Shifting stroke care from the hospital to the nursing home: explaining the outcomes of a Dutch case. J Eval Clin Pract 2010; 16:1203-8. [PMID: 20695954 DOI: 10.1111/j.1365-2753.2009.01295.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Supply chains can contribute to better care for stroke patients and more efficiency. However, such outcomes are hampered when links in the chain are weak. The article aims to further the knowledge about the causes and possible improvements of weak links thereby using theory about rules for action and routines (action patterns). METHOD We executed a single case study of a chain of service delivery to stroke patients by a university hospital and a nursing home in the city of Maastricht, the Netherlands. Methods included document study, interviews, observations, process mapping, use of data matrices and performance of t-tests. RESULTS In the case, the care delivery process in the chain was redesigned to improve the flow of patients and to reduce the length of hospital stay. Length of stay was reduced. However, transfer of patients from the hospital to the nursing home was hampered. At this weak link in the chain, the redesign clashed with the routines of hospital paramedics who did not want to work according to the redesign. CONCLUSIONS The applied theory is useful to understand why a link in a supply chain is weak. Negotiations can be used to strengthen a link.
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Affiliation(s)
- Arno van Raak
- Department of Health Organisation, Policy and Economics (HOPE), School of Public Health and Primary Care: CAPHRI, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands.
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Cinnamon J, Schuurman N, Crooks VA. Assessing the suitability of host communities for secondary palliative care hubs: a location analysis model. Health Place 2009; 15:792-800. [PMID: 19269241 DOI: 10.1016/j.healthplace.2009.01.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2008] [Revised: 01/13/2009] [Accepted: 01/22/2009] [Indexed: 11/25/2022]
Abstract
An increased need for palliative care has been acknowledged world-wide. However, recent Canadian end-of-life care frameworks have largely failed to consider the unique challenges of delivery in rural and remote regions. In the Canadian province of British Columbia (BC), urban areas are well-served for specialized palliative care; however, rural and remote regions are not. This study presents a location analysis model designed to determine appropriate locations to allocate palliative care services. Secondary palliative care hubs (PCH) are introduced as an option for delivering these services in rural and remote regions. Results suggest that several BC communities may be appropriate locations for secondary PCHs. This model could be applied to the allocation of palliative care resources in other jurisdictions with similar rural and remote regions.
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Affiliation(s)
- Jonathan Cinnamon
- Department of Geography, Simon Fraser University, Burnaby, British Columbia, Canada V5A 1S6.
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