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Blanken M, Mathijssen J, van Nieuwenhuizen C, Raab J, van Oers H. Examining preconditions for integrated care: a comparative social network analysis of the structure and dynamics of strong relations in child service networks. BMC Health Serv Res 2023; 23:1146. [PMID: 37875928 PMCID: PMC10598897 DOI: 10.1186/s12913-023-10128-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 10/08/2023] [Indexed: 10/26/2023] Open
Abstract
BACKGROUND To help ensure that children and families get the right support and services at the right time, strong and stable relationships between various child service organizations are vital. Moreover, strong and stable relationships and a key network position for gatekeepers are important preconditions for interprofessional collaboration, the timely and appropriate referral of clients, and improved health outcomes. Gatekeepers are organizations that have specific legal authorizations regarding client referral. However, it is largely unclear how strong relations in child service networks are structured, whether the gatekeepers have strong and stable relationships, and what the critical relations in the overall structure are. The aim of this study is to explore these preconditions for integrated care by examining the internal structure and dynamics of strong relations. METHODS A comparative case study approach and social network analysis of three inter-organizational networks consisting of 65 to 135 organizations within the Dutch child service system. Multiple network measures (number of active organizations, isolates, relations, average degree centrality, Lambda sets) were used to examine the strong relation structure and dynamics of the networks. Ucinet was used to analyze the data, with use of the statistical test: Quadratic Assignment Procedure. Visone was used to visualize the graphs of the networks. RESULTS This study shows that more than 80% of the organizations in the networks have strong relations. A striking finding is the extremely high number of strong relations that gatekeepers need to maintain. Moreover, the results show that the most important gatekeepers have key positions, and their strong relations are relatively stable. By contrast, considering the whole network, we also found a considerable measure of instability in strong relationships, which means that child service networks must cope with major internal dynamics. CONCLUSIONS Our study addressed crucial preconditions for integrated care. The extremely high number of strong relations that particularly gatekeepers need to build and maintain, in combination with the considerable instability of strong relations considering the whole network, is a serious point of concern that need to be managed, in order to enable child service networks to improve internal coordination and integration of service delivery.
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Affiliation(s)
- Mariëlle Blanken
- TRANZO - Scientific center for care and wellbeing, Tilburg University, 5000 LE, Tilburg, PO BOX 90153, the Netherlands.
| | - Jolanda Mathijssen
- TRANZO - Scientific center for care and wellbeing, Tilburg University, 5000 LE, Tilburg, PO BOX 90153, the Netherlands
| | - Chijs van Nieuwenhuizen
- TRANZO - Scientific center for care and wellbeing, Tilburg University, 5000 LE, Tilburg, PO BOX 90153, the Netherlands
| | - Jörg Raab
- Department of Organization Studies, School of Social and Behavioral Sciences, Tilburg University, NL-5000 LE, Tilburg, P.O. Box 90153, The Netherlands
| | - Hans van Oers
- TRANZO - Scientific center for care and wellbeing, Tilburg University, 5000 LE, Tilburg, PO BOX 90153, the Netherlands
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Mukinda FK, Djellouli N, Akter K, Sarker M, Tufa AA, Mwandira K, Seruwagi G, Kyamulabi A, Mwaba K, Marchant T, Shawar YR, English M, Namakula H, Gonfa G, Colbourn T, Kinney MV. Individual interactions in a multi-country implementation-focused quality of care network for maternal, newborn and child health: A social network analysis. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001769. [PMID: 37733733 PMCID: PMC10513266 DOI: 10.1371/journal.pgph.0001769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 08/22/2023] [Indexed: 09/23/2023]
Abstract
The Network for Improving Quality of Care for Maternal, Newborn and Child Health (QCN) was established to build a cross-country platform for joint-learning around quality improvement implementation approaches to reduce mortality. This paper describes and explores the structure of the QCN in four countries and at global level. Using Social Network Analysis (SNA), this cross-sectional study maps the QCN networks at global level and in four countries (Bangladesh, Ethiopia, Malawi and Uganda) and assesses the interactions among actors involved. A pre-tested closed-ended structured questionnaire was completed by 303 key actors in early 2022 following purposeful and snowballing sampling. Data were entered into an online survey tool, and exported into Microsoft Excel for data management and analysis. This study received ethical approval as part of a broader evaluation. The SNA identified 566 actors across the four countries and at global level. Bangladesh, Malawi and Uganda had multiple-hub networks signifying multiple clusters of actors reflecting facility or district networks, whereas the network in Ethiopia and at global level had more centralized networks. There were some common features across the country networks, such as low overall density of the network, engagement of actors at all levels of the system, membership of related committees identified as the primary role of actors, and interactions spanning all types (learning, action and information sharing). The most connected actors were facility level actors in all countries except Ethiopia, which had mostly national level actors. The results reveal the uniqueness and complexity of each network assessed in the evaluation. They also affirm the broader qualitative evaluation assessing the nature of these networks, including composition and leadership. Gaps in communication between members of the network and limited interactions of actors between countries and with global level actors signal opportunities to strengthen QCN.
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Affiliation(s)
| | - Nehla Djellouli
- Institute for Global Health, University College London, London, United Kingdom
| | - Kohenour Akter
- Perinatal Care Project, Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Mithun Sarker
- Perinatal Care Project, Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | | | | | - Gloria Seruwagi
- School of Public Health, Makerere University, Kampala, Uganda
| | - Agnes Kyamulabi
- School of Public Health, Makerere University, Kampala, Uganda
| | - Kasonde Mwaba
- Institute for Global Health, University College London, London, United Kingdom
| | - Tanya Marchant
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Yusra R. Shawar
- Department of International Health, School of Public Health, John Hopkins University, Baltimore, MD, United States of America
- School of Advanced International Studies, John Hopkins University, Baltimore, MD, United States of America
| | - Mike English
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
| | - Hilda Namakula
- School of Public Health, Makerere University, Kampala, Uganda
| | - Geremew Gonfa
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | | | - Tim Colbourn
- Institute for Global Health, University College London, London, United Kingdom
| | - Mary V. Kinney
- School of Public Health, University of the Western Cape, Cape Town, South Africa
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Troisi R, De Simone S, Vargas M, Franco M. The other side of the crisis: organizational flexibility in balancing Covid-19 and non-Covid-19 health-care services. BMC Health Serv Res 2022; 22:1096. [PMID: 36038878 PMCID: PMC9421103 DOI: 10.1186/s12913-022-08486-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 08/22/2022] [Indexed: 11/11/2022] Open
Abstract
Background Many healthcare systems have been unable to deal with Covid-19 without influencing non-Covid-19 patients with pre-existing conditions, risking a paralysis in the medium term. This study explores the effects of organizational flexibility on hospital efficiency in terms of the capacity to deliver healthcare services for both Covid-19 and non-Covid-19 patients. Method Focusing on Italian health system, a two-step strategy is adopted. First, Data Envelope Analysis is used to assess the capacity of hospitals to address the needs of Covid-19 and non-Covid-19 patients relying on internal resource flexibility. Second, two panel regressions are performed to assess external organizational flexibility, with the involvement in demand management of external operators in the health-care service, examining the impact on efficiency in hospital capacity management. Results The overall response of the hospitals in the study was not fully effective in balancing the needs of the two categories of patients (the efficiency score is 0.87 and 0.58, respectively, for Covid-19 and non-Covid-19 patients), though responses improved over time. Furthermore, among the measures providing complementary services in the community, home hospitalization and territorial medicine were found to be positively associated with hospital efficiency (0.1290, p < 0.05 and 0.2985, p < 0.01, respectively, for non-Covid-19 and Covid-19 patients; 0.0026, p < 0.05 and 0.0069, p < 0.01, respectively, for non-Covid-19 and Covid-19). In contrast, hospital networks are negatively related to efficiency in Covid-19 patients (-0.1037, p < 0.05), while the relationship is not significant in non-Covid-19 patients. Conclusions Managing the needs of Covid-19 patients while also caring for other patients requires a response from the entire healthcare system. Our findings could have two important implications for effectively managing health-care demand during and after the Covid-19 pandemic. First, as a result of a naturally progressive learning process, the resource balance between Covid-19 and non-Covid-19 patients improves over time. Second, it appears that demand management to control the flow of patients necessitates targeted interventions that combine agile structures with decentralization. Finally, untested integration models risk slowing down the response, giving rise to significant costs without producing effective results.
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Affiliation(s)
- Roberta Troisi
- Department of Political and Communication Science, University of Salerno, Via Giovanni Paolo II, Fisciano (Salerno), Italy.
| | - Stefania De Simone
- Department of Political Sciences, University of Naples Federico II, Largo S. Marcellino, Naples, Italy
| | - Maria Vargas
- Department of Neurosurgical, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Via Pansini, Naples, Italy
| | - Massimo Franco
- Department of Political Sciences, University of Naples Federico II, Largo S. Marcellino, Naples, Italy
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Blanken M, Mathijssen J, van Nieuwenhuizen C, Raab J, van Oers H. Cross-sectoral collaboration: comparing complex child service delivery systems. J Health Organ Manag 2022; 36:79-94. [DOI: 10.1108/jhom-07-2021-0281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeTo help ensure that children with social and behavioral health problems get the support services they need, organizations collaborate in cross-sectoral networks. In this article, the authors explore and compare the structure of these complex child service delivery networks in terms of differentiation (composition) and integration (interconnection). In particular, the authors investigate the structure of client referral and identify which organizations are most prominent within that network structure and could therefore fulfill a coordinating role.Design/methodology/approach The authors used a comparative case study approach and social network analysis on three interorganizational networks consisting of 65 to 135 organizations within the Dutch child service delivery system. Semi-structured interviews with the network managers were conducted, and an online questionnaire was sent out to the representatives of all network members.Findings The networks are similarly differentiated into 11 sectors with various tasks. Remarkably, network members have contact with an average of 20–26 organizations, which is a fairly high number to be handled successfully. In terms of integration, the authors found a striking diversity in the structures of client referral and not all organizations with a gatekeeper task hold central positions.Originality/value Due to the scarcity of comparative whole network research in the field, the strength of this study is a deeper understanding of the differentiation and integration of complex child service delivery systems. These insights are crucial in order to deliver needed services and to minimize service silos and fragmentation.
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Haemophilia in France: Modelisation of the Clinical Pathway for Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19020646. [PMID: 35055467 PMCID: PMC8775796 DOI: 10.3390/ijerph19020646] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/02/2022] [Accepted: 01/04/2022] [Indexed: 11/24/2022]
Abstract
Process-of-care studies participate in improving the efficiency of the care pathway for patient with haemophilia (CPPH) and rationalize the multidisciplinary management of patients. Our objective is to establish a current overview of the different actors involved in the management of patients with haemophilia and to provide an accurate description of the patient trajectory. This is a qualitative exploratory research based on interviews of the principal health professionals of four haemophilia services, between November 2019 and February 2020, in France. Mapping of the CPPH processes within the different institutions and/or services, as well as the rupture zones, were identified. Treatment delivery and biological analyses were carried out exclusively in healthcare institutions. The main liberal health professionals solicited were nurses, physiotherapists and general practitioner. Obstacles and barriers within the specialized service, with other hospital services and external hospital or private services, community health care providers et community environment and individual one was complex and multiples. Our research identified potential concerns that need to be addressed to improve future studies to identify influential elements. Similarly, other qualitative studies will have to be conducted on the perceptions and literacy of patients with haemophilia to develop a global interactive mapping of their trajectories.
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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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van der Ham A, van Raak A, Ruwaard D, van Merode F. Explaining integration and differentiation by identifying the rules and coordination mechanisms in a hospital's logistical system. J Health Organ Manag 2021; 35:66-84. [PMID: 33645173 PMCID: PMC9251638 DOI: 10.1108/jhom-06-2020-0236] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 11/26/2020] [Accepted: 01/06/2021] [Indexed: 11/18/2022]
Abstract
PURPOSE Integration, that is, the coordination and alignment of tasks, is widely promoted as a means to improve hospital performance. A previous study examined integration and differentiation, that is, the extent to which tasks are segmented into subsystems, in a hospital's social network. The current study carries this research further, aiming to explain integration and differentiation by studying the rules and coordination mechanisms that agents in a hospital network use. DESIGN/METHODOLOGY/APPROACH The current case study deepens the analysis of the social network in a hospital. All planning tasks and tasks for surgery performance were studied, using a naturalistic inquiry approach and a mixed method. FINDINGS Of the 314 rules found, 85% predominantly exist in people's minds, 31% are in documents and 7% are in the information system. In the early planning stages for a surgery procedure, mutual adjustment based on hospital-wide rules is dominant. Closer to the day of surgery, local rules are used and open loops are closed through mutual adjustment, thus achieving integration. On the day of surgery, there is mainly standardization of work and output, based on hospital-wide rules. The authors propose topics for future research, focusing on increasing the hospital's robustness and stability. ORIGINALITY/VALUE This exploratory case study provides an overview of the rules and coordination mechanisms that are used for organizing hospital-wide logistics for surgery patients. The findings are important for future research on how integration and differentiation are effectively achieved in hospitals.
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Affiliation(s)
- Annelies van der Ham
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences,
Maastricht University Medical Centre+
, Maastricht,
The Netherlands
| | - Arno van Raak
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences,
Maastricht University Medical Centre+
, Maastricht,
The Netherlands
| | - Dirk Ruwaard
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences,
Maastricht University Medical Centre+
, Maastricht,
The Netherlands
| | - Frits van Merode
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences,
Maastricht University Medical Centre+
, Maastricht,
The Netherlands
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