Perceptions of traumatic brain injury network participants about network performance

Building on the EGIPPS performance assessment: the multipolar framework as a heuristic to tackle the complexity of performance of public service oriented health care organisations

Background

Performance of health care systems is a key concern of policy makers and health service managers all over the world. It is also a major challenge, given its multidimensional nature that easily leads to conceptual and methodological confusion. This is reflected by a scarcity of models that comprehensively analyse health system performance.

Discussion

In health, one of the most comprehensive performance frameworks was developed by the team of Leggat and Sicotte. Their framework integrates 4 key organisational functions (goal attainment, production, adaptation to the environment, and values and culture) and the tensions between these functions.

We modified this framework to better fit the assessment of the performance of health organisations in the public service domain and propose an analytical strategy that takes it into the social complexity of health organisations. The resulting multipolar performance framework (MPF) is a meta-framework that facilitates the analysis of the relations and interactions between the multiple actors that influence the performance of health organisations.

Summary

Using the MPF in a dynamic reiterative mode not only helps managers to identify the bottlenecks that hamper performance, but also the unintended effects and feedback loops that emerge. Similarly, it helps policymakers and programme managers at central level to better anticipate the potential results and side effects of and required conditions for health policies and programmes and to steer their implementation accordingly.

Front-office/back-office configurations and operational performance in complex health services

BACKGROUND

Acquired brain injury (ABI) occurs from various causes at different ages and leads to many different types of healthcare needs. Several Dutch ABI-networks installed a local co-ordination and contact point (CCP) which functions as a central and easily accessible service for people to consult when they have questions related to ABI.

GOALS

To explore the relationship between front/back office design and operational performance by investigating the particular enquiry service provided by different CCPs for people affected by an ABI.

METHODS

In-depth interviews with 14 FO/BO employees from three case organizations, complemented with information from desk research and three one-day field visits.

RESULTS

The CCPs applied different FO/BO configurations in terms of customer contact and in terms of grouping of front and/or back office activities into tasks for one employee.

DISCUSSION

It is the complexity of the enquiry that determines which approach is more appropriate. For complex enquiries, the level of decoupling is high in all CCPs. This allows multiple experts to be involved in the process. For regular enquiries, CCPs have a choice: either working in the same way as in the complex enquiries or coupling FO/BO activities to be able to serve clients faster and without handovers.

Analysis of the strengths, weaknesses, opportunities and threats of the network form of organization of traumatic brain injury service delivery systems

Networks are an increasingly popular way to deal with the lack of integration of traumatic brain injury (TBI) care. Knowledge of the stakes of the network form of organization is critical in deciding whether or not to implement a TBI network to improve the continuity of TBI care.

GOALS OF THE STUDY

To report the strengths, weaknesses, opportunities, and threats of a TBI network and to consider these elements in a discussion about whether networks are a suitable solution to fragmented TBI care.

METHODS

In-depth interviews with 12 representatives of network organization members. Interviews were qualitatively analyzed using the EGIPSS model of performance.

RESULTS

The majority of elements reported were related to the network's adaptation to its environment and more precisely to its capacity to acquire resources. The issue of value maintenance also received considerable attention from participants.

DISCUSSION

The network form of organization seems particularly sensitive to environmental issues, such as resource acquisition and legitimacy. The authors suggest that the network form of organization is a suitable way to increase the continuity of TBI care if the following criteria are met: (1) expectations toward network effectiveness to increase continuity of care are moderate and realistic; (2) sufficient resources are devoted to the design, implementation, and maintenance of the network; (3) a network's existence and actions are deemed legitimate by community and organization member partners; and (4) there is a good collaborative climate between the organizations.

Consensus group sessions: a useful method to reconcile stakeholders' perspectives about network performance evaluation

Background

Having a common vision among network stakeholders is an important ingredient to developing a performance evaluation process. Consensus methods may be a viable means to reconcile the perceptions of different stakeholders about the dimensions to include in a performance evaluation framework.

Objectives

To determine whether individual organizations within traumatic brain injury (TBI) networks differ in perceptions about the importance of performance dimensions for the evaluation of TBI networks and to explore the extent to which group consensus sessions could reconcile these perceptions.

Methods

We used TRIAGE, a consensus technique that combines an individual and a group data collection phase to explore the perceptions of network stakeholders and to reach a consensus within structured group discussions.

Results

One hundred and thirty-nine professionals from 43 organizations within eight TBI networks participated in the individual data collection; 62 professionals from these same organisations contributed to the group data collection. The extent of consensus based on questionnaire results (e.g. individual data collection) was low, however, 100% agreement was obtained for each network during the consensus group sessions. The median importance scores and mean ranks attributed to the dimensions by individuals compared to groups did not differ greatly. Group discussions were found useful in understanding the reasons motivating the scoring, for resolving differences among participants, and for harmonizing their values.

Conclusion

Group discussions, as part of a consensus technique, appear to be a useful process to reconcile diverging perceptions of network performance among stakeholders.