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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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Nava M, English AS, Fulmer L, Sanchez K. An action research partnership in an urban Texas county to explore barriers and opportunities for collaborative community health needs assessments. Front Public Health 2023; 11:1244143. [PMID: 37900035 PMCID: PMC10613110 DOI: 10.3389/fpubh.2023.1244143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 09/19/2023] [Indexed: 10/31/2023] Open
Abstract
Background The Affordable Care Act mandated triennial community health needs assessments (CHNAs) for greater nonprofit hospital accountability in responding to community health needs. Over 10 years later, hospital spending on community benefits remains largely unchanged. While greater collaboration in CHNA implementation can increase hospital investment in community-based initiatives, nonprofit hospitals in conservative states are subject to policy, political, and economic factors that inhibit public health partnerships and magnify existing disparities in health care access. This participatory action research study explores the decision-making environment of collaborative CHNA implementation within a group of nonprofit hospitals in a north Texas urban county. Methods In 2017 faculty from an urban anchor institution initiated an academic-community partnership with a coalition of nonprofit hospitals, public health departments, and academic institutions. An interdisciplinary research team engaged in multi-method document review and qualitative data collection to describe historical barriers for local CHNA processes and develop practical strategies for joint CHNA initiatives. Local CHNA documents were first reviewed through team-based content analysis and results applied to develop a qualitative study protocol. Key informants were recruited from county-based nonprofit hospitals, community-based nonprofit organizations, and public health systems. Seventeen senior- and mid-level professionals participated in semi-structured research interviews to describe their perspectives relating to CHNA-related planning and implementation decisions. Through iterative data collection and analysis, the research team explored CHNA-related knowledge, experiences, and processes. A constructivist lens was subsequently applied to examine historical barriers and future opportunities for local collaboration. Results Findings reveal CHNA implementation is a multi-stage cyclical process in organizational environments with accountability to a wide range of public and private stakeholders. This promotes varied levels of inclusivity and conservatism in data collection and community benefit implementation. Decisions to collaborate are hindered by competing priorities, including compliance with existing guidelines, administrative simplicity, alignment with health care service delivery, and efficient resource use. Efforts to promote greater CHNA collaboration may be facilitated through intentional alignment with organizational priorities and clearly communicated benefits of participation for leaders in both public and private nonprofit health systems. Discussion We consider implications for policymakers and health systems in restrictive political environments and advance a conceptual framework for greater CHNA collaboration.
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Affiliation(s)
- Marcela Nava
- School of Social Work, The University of Texas at Arlington, Arlington, TX, United States
| | - Amanda S. English
- Institute for Implementation Science, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Linda Fulmer
- Institute for Implementation Science, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Katherine Sanchez
- Institute for Implementation Science, The University of Texas Health Science Center at Houston, Houston, TX, United States
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The impact of healthcare executive seniority on implementation of innovative methods of diagnosis and prevention. Health Policy 2022; 126:996-1001. [PMID: 35882588 DOI: 10.1016/j.healthpol.2022.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 09/17/2020] [Accepted: 07/17/2022] [Indexed: 11/21/2022]
Abstract
Innovative methods of diagnosis and prevention play a key role in the survival of healthcare systems as well as the wellbeing of patients. Effective healthcare management is a critical factor in implementing hospital innovation. Healthcare executive (HE) personal and job characteristics such as age and seniority have been found to affect innovative decision-making. However, no study has yet investigated age and seniority effects on the propensity to implement innovation in health prevention strategies. This study fills the literature gap by providing evidence for the effect of HE age and seniority on the implementation of innovative methods for diagnosis and prevention. Predicated on 57 in-depth interviews with HEs, we employ mixed methods research, combining qualitative and quantitative analysis. Structural Equation Modeling was used to test the model's goodness-of-fit. Results show that while HE age and number of years in the organization positively affect job tenure, job tenure, in turn, negatively affects willingness to implement innovative methods of diagnosis and prevention in hospitals. This study extends the Upper-Echelon Theory to health workforce management. Practical implications are discussed.
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van der Weert G, Burzynska K, Knoben J. An integrative perspective on interorganizational multilevel healthcare networks: a systematic literature review. BMC Health Serv Res 2022; 22:923. [PMID: 35850683 PMCID: PMC9289349 DOI: 10.1186/s12913-022-08314-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 07/07/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Interorganizational networks in healthcare do not always attain their goals. Existing models outline the factors that could explain poor network performance: governance; structure; and the alignment of professional, organizational and network levels. However, these models are very generic and assume a functional approach. We investigate available empirical knowledge on how network structure and governance relate to each other and to network performance in a multilevel context, to get deeper insight, supported with empirics, of why networks (fail to) achieve their goals. METHOD A systematic literature review based on a search of Web of Science, Business Source Complete and PubMed was executed in May 2021 and repeated in January 2022. Full papers were included if they were written in English and reported empirical data in a healthcare interorganizational setting. Included papers were coded for the topics of governance, structure, performance and multilevel networks. Papers from the scientific fields of management, administration and healthcare were compared. Document citation and bibliographic coupling networks were visualized using Vosviewer, and network measures were calculated with UCINET. RESULTS Overall, 184 papers were included in the review, most of which were from healthcare journals. Research in healthcare journals is primarily interested in the quality of care, while research in management and administration journals tend to focus on efficiency and financial aspects. Cross-citation is limited across different fields. Networks with a brokered form of governance are the most prevalent. Network performance is mostly measured at the community level. Only a few studies employed a multilevel perspective, and interaction effects were not usually measured between levels. CONCLUSIONS Research on healthcare networks is fragmented across different scientific fields. The current review revealed a range of positive, negative and mixed effects and points to the need for more empirical research to identify the underlying reasons for these outcomes. Hardly any empirical research is available on the effects of different network structures and governance modes on healthcare network performance at different levels. We find a need for more empirical research to study healthcare networks at multiple levels while acknowledging hybrid governance models that may apply across different levels.
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Affiliation(s)
- Galina van der Weert
- Radboud University Nijmegen; Institute for Management Research, Elinor Ostrom Building, Heyendaalseweg 141m, 6525 AJ Nijmegen, The Netherlands
| | - Katarzyna Burzynska
- Radboud University Nijmegen; Institute for Management Research, Elinor Ostrom Building, Heyendaalseweg 141m, 6525 AJ Nijmegen, The Netherlands
| | - Joris Knoben
- Tilburg University; Tilburg School of Economics and Management, Warandelaan 2, 5037 AB Tilburg, The Netherlands
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Chrusciel J, Le Guillou A, Daoud E, Laplanche D, Steunou S, Clément MC, Sanchez S. Making sense of the French public hospital system: a network-based approach to hospital clustering using unsupervised learning methods. BMC Health Serv Res 2021; 21:1244. [PMID: 34789235 PMCID: PMC8600901 DOI: 10.1186/s12913-021-07215-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 10/22/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Hospitals in the public and private sectors tend to join larger organizations to form hospital groups. This increasingly frequent mode of functioning raises the question of how countries should organize their health system, according to the interactions already present between their hospitals. The objective of this study was to identify distinctive profiles of French hospitals according to their characteristics and their role in the French hospital network. METHODS Data were extracted from the national hospital database for year 2016. The database was restricted to public hospitals that practiced medicine, surgery or obstetrics. Hospitals profiles were determined using the k-means method. The variables entered in the clustering algorithm were: the number of stays, the effective diversity of hospital activity, and a network-based mobility indicator (proportion of stays followed by another stay in a different hospital of the same Regional Hospital Group within 90 days). RESULTS Three hospital groups were identified by the clustering algorithm. The first group was constituted of 34 large hospitals (median 82,100 annual stays, interquartile range 69,004 - 117,774) with a very diverse activity. The second group contained medium-sized hospitals (with a median of 258 beds, interquartile range 164 - 377). The third group featured less diversity regarding the type of stay (with a mean of 8 effective activity domains, standard deviation 2.73), a smaller size and a higher proportion of patients that subsequently visited other hospitals (11%). The most frequent type of patient mobility occurred from the hospitals in group 2 to the hospitals in group 1 (29%). The reverse direction was less frequent (19%). CONCLUSIONS The French hospital network is organized around three categories of public hospitals, with an unbalanced and disassortative patient flow. This type of organization has implications for hospital planning and infectious diseases control.
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Affiliation(s)
- Jan Chrusciel
- Pôle Territorial Santé Publique et Performance, Centre Hospitalier de Troyes, F-10000, Troyes, France.
| | - Adrien Le Guillou
- Pôle Recherche et Santé Publique, Centre Hospitalier Universitaire de Reims, 51100, Reims, France
| | - Eric Daoud
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, INSERM, U932 Immunity and Cancer, Institut Curie, Université Paris, 75005, Paris, France
| | - David Laplanche
- Pôle Territorial Santé Publique et Performance, Centre Hospitalier de Troyes, F-10000, Troyes, France
| | - Sandra Steunou
- Department of Data, Agence Technique d'Information sur l'Hospitalisation, 69003, Lyon, France
| | - Marie-Caroline Clément
- Department of Classifications in Healthcare, Medical Information and Financing Models, Agence Technique d'Information sur l'Hospitalisation, 75012, Paris, France
| | - Stéphane Sanchez
- Pôle Territorial Santé Publique et Performance, Centre Hospitalier de Troyes, F-10000, Troyes, France
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Le Guillou A, Chrusciel J, Sanchez S. The impact of hospital support function centralization on patient outcomes: A before-after study. PUBLIC HEALTH IN PRACTICE 2021; 2:100174. [PMID: 36101612 PMCID: PMC9461299 DOI: 10.1016/j.puhip.2021.100174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 07/14/2021] [Accepted: 07/26/2021] [Indexed: 11/02/2022] Open
Abstract
Objectives Study design Methods Results Conclusions Integrated health systems including multiple hospitals are increasingly frequent and can lead to economies of scale. We found a decrease in readmissions and average length of stay associated with the centralization of support functions. Additional studies are needed to evaluate the effect of health systems integration on patient outcomes.
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De Regge M, Eeckloo K. Balancing hospital governance: A systematic review of 15 years of empirical research. Soc Sci Med 2020; 262:113252. [PMID: 32771874 DOI: 10.1016/j.socscimed.2020.113252] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 05/24/2020] [Accepted: 07/22/2020] [Indexed: 01/23/2023]
Abstract
It is crucial that we gain a deeper understanding of the features of organizational governance and how they contribute to hospital performance. Health care governance research has traditionally had a strong focus on the size and composition (i.e., the attributes) of the governing bodies, but less attention has been given to the dynamics, processes, and roles. Furthermore, evidence regarding the interconnection between the board and the executive management is lacking. This systematic literature review is thus intended to give a detailed summary of the attributes, the dynamics, and the processes, as well as the roles of governing bodies, by synthesizing the findings of published empirical studies. The framework of Kane et al. (2009) was used to position the results, taking into account external constraints and outputs/performance. Sixty-three studies were included in the systematic review. The majority of these studies deal with attributes (n = 34) and roles (n = 27); the smallest number of studies (n = 11) focus on dynamics and processes. There is a lack of consistency in the research findings on attributes and there is too little research into the dynamics and processes of hospital governance. However, it has been shown that clinical participation on the hospital board and the focus on quality in hospital board roles can have a beneficial effect. The studies do not provide sufficient direction on what best practice for governing hospitals should be. For this reason, we here provide a useful framework for understanding the aspects of governance and their impact on performance in hospitals and compare these with general corporate governance literature. Therefrom we propose avenues for further research.
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Affiliation(s)
- Melissa De Regge
- Strategic Policy Cell, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium; Department of Marketing, Innovation and Organisation, Faculty of Economics and Business Administration, Ghent University, Tweekerkenstraat 2, 9000, Ghent, Belgium.
| | - Kristof Eeckloo
- Strategic Policy Cell, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium; Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Corneel heymanslaan 10, 9000, Ghent, Belgium.
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