IDEAS home Printed from https://ideas.repec.org/a/gam/jijerp/v20y2023i3p1993-d1043456.html
   My bibliography  Save this article

Towards Process-Oriented Hospital Structures; Drivers behind the Development of Hospital Designs

Author

Listed:
  • Jeroen D. H. van Wijngaarden

    (Health Services Management & Organisation, Erasmus School of Health Policy and Management, Erasmus University Rotterdam, 3062 PA Rotterdam, The Netherlands)

  • Anoek Braam

    (Health Services Management & Organisation, Erasmus School of Health Policy and Management, Erasmus University Rotterdam, 3062 PA Rotterdam, The Netherlands)

  • Martina Buljac-Samardžić

    (Health Services Management & Organisation, Erasmus School of Health Policy and Management, Erasmus University Rotterdam, 3062 PA Rotterdam, The Netherlands)

  • Carina G. J. M. Hilders

    (Health Services Management & Organisation, Erasmus School of Health Policy and Management, Erasmus University Rotterdam, 3062 PA Rotterdam, The Netherlands
    Raad van Bestuur, Reinier de Graaf Gasthuis, 2625 AD Delft, The Netherlands)

Abstract

Hospitals have been encouraged to develop more process-oriented designs, structured around patient needs, to better deal with patients suffering from multi-morbidity. However, most hospitals still have traditional designs built around medical specialties. We aimed to understand how hospital designs are currently developing and what the important drivers are. We built a typology to categorize all Dutch general hospitals (61), and we interviewed hospital managers and staff. The inventory showed three types of hospital building blocks: units built around specific medical specialties, clusters housing different medical specialty units, and centers; multi-specialty entities provide the most suitable structure for a process-oriented approach. Only some Dutch hospitals (5) are mainly designed around centers. However, most hospitals are slowly developing towards hybrid designs. Competitive drivers are not important for stimulating these redesigns. Institutional pressures from within the health care sector and institutional ‘mimicking’ are the main drivers, but the specific path they take is dependent on their ‘heritage’. We found that hospital structures are more the result of incremental, path-dependent choices than ‘grand-designs’. Although the majority of the Dutch general hospitals still have a general design built around medical specialties, most hospitals are moving towards a more process-oriented design.

Suggested Citation

  • Jeroen D. H. van Wijngaarden & Anoek Braam & Martina Buljac-Samardžić & Carina G. J. M. Hilders, 2023. "Towards Process-Oriented Hospital Structures; Drivers behind the Development of Hospital Designs," IJERPH, MDPI, vol. 20(3), pages 1-12, January.
    • Handle: RePEc:gam:jijerp:v:20:y:2023:i:3:p:1993-:d:1043456
    as

    Download full text from publisher

    File URL: https://www.mdpi.com/1660-4601/20/3/1993/pdf
    Download Restriction: no
    File URL: https://www.mdpi.com/1660-4601/20/3/1993/
    Download Restriction: no
    ---><---

    References listed on IDEAS

    as
    1. Lega, Federico & DePietro, Carlo, 2005. "Converging patterns in hospital organization: beyond the professional bureaucracy," Health Policy, Elsevier, vol. 74(3), pages 261-281, November.
    2. Sandra G. Leggat & Timothy Bartram & Pauline Stanton & Greg J. Bamber & Amrik S. Sohal, 2015. "Have process redesign methods, such as Lean, been successful in changing care delivery in hospitals? A systematic review," Public Money & Management, Taylor & Francis Journals, vol. 35(2), pages 161-168, March.
    3. Martin van Ineveld & Jeroen van Wijngaarden & Gerard Scholten, 2018. "Choosing cooperation over competition; hospital strategies in response to selective contracting," International Journal of Health Planning and Management, Wiley Blackwell, vol. 33(4), pages 1082-1092, October.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Koelewijn, Wout T. & Ehrenhard, Michel L. & Groen, Aard J. & van Harten, Wim H., 2012. "Intra-organizational dynamics as drivers of entrepreneurship among physicians and managers in hospitals of western countries," Social Science & Medicine, Elsevier, vol. 75(5), pages 795-800.
    2. Per Magnus Mæhle & Ingrid Kristine Small Hanto & Sigbjørn Smeland, 2020. "Practicing Integrated Care Pathways in Norwegian Hospitals: Coordination through Industrialized Standardization, Value Chains, and Quality Management or an Organizational Equivalent to Improvised Jazz," IJERPH, MDPI, vol. 17(24), pages 1-32, December.
    3. Keon-Hyung Lee & Seunghoo Lim & Jieun Moon, 2022. "The Link Between Hospital Competition and Hospital Behaviors in Korea: Competitive Interorganizational Relations," Global Journal of Flexible Systems Management, Springer;Global Institute of Flexible Systems Management, vol. 23(1), pages 1-14, December.
    4. Etienne Minvielle & Claude Sicotte & François Champagne & André-Pierre Contandriopoulos & Marine Jeantet & Nathalie Préaubert & Annie Bourdil & Christian Richard, 2008. "Hospital performance: Competing or shared values?," Post-Print hal-03477095, HAL.
    5. Marciánová, Pavla & Pirožek, Petr, 2023. "The entrepreneurial orientation of general practitioners—Current theory and practice in the Czech Republic," Health Policy, Elsevier, vol. 131(C).
    6. Faridah Djellal & Faïz Gallouj, 2007. "Innovation in hospitals: a survey of the literature," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 8(3), pages 181-193, September.
    7. Emil Lucian Crisan & Bogdan Florin Covaliu & Diana Maria Chis, 2021. "A Systematic Literature Review of Quality Management Initiatives in Dental Clinics," IJERPH, MDPI, vol. 18(21), pages 1-16, October.
    8. Cleven, Anne & Mettler, Tobias & Rohner, Peter & Winter, Robert, 2016. "Healthcare quality innovation and performance through process orientation: Evidence from general hospitals in Switzerland," Technological Forecasting and Social Change, Elsevier, vol. 113(PB), pages 386-395.
    9. Stefano Villa & Marta Barbieri & Federico Lega, 2009. "Restructuring patient flow logistics around patient care needs: implications and practicalities from three critical cases," Health Care Management Science, Springer, vol. 12(2), pages 155-165, June.
    10. Liberati, Elisa Giulia & Gorli, Mara & Scaratti, Giuseppe, 2016. "Invisible walls within multidisciplinary teams: Disciplinary boundaries and their effects on integrated care," Social Science & Medicine, Elsevier, vol. 150(C), pages 31-39.
    11. Sajjad Nazir & Wang Qun & Li Hui & Amina Shafi, 2018. "Influence of Social Exchange Relationships on Affective Commitment and Innovative Behavior: Role of Perceived Organizational Support," Sustainability, MDPI, vol. 10(12), pages 1-20, November.
    12. Mara Gorli & Serena Barello, 2021. "Patient Centredness, Values, Equity and Sustainability: Professional, Organizational and Institutional Implications," Sustainability, MDPI, vol. 13(23), pages 1-7, November.
    13. Rafael L. Patrão & Reinaldo C. Garcia & João M. da Silva, 2022. "An Integrated Two-Level Integer Linear Program (ILP) Model for Elective Surgery Scheduling: A Case Study in an Italian Hospital," Mathematics, MDPI, vol. 10(11), pages 1-18, June.
    14. Guillaume Lamé & Oualid Jouini & Julie Stal-Le Cardinal, 2017. "Combining the Viable System Model and Kotter’s 8 Steps for Multidepartment Integration in Hospitals," Post-Print hal-01519593, HAL.
    15. Liberati, Elisa Giulia, 2017. "Separating, replacing, intersecting: The influence of context on the construction of the medical-nursing boundary," Social Science & Medicine, Elsevier, vol. 172(C), pages 135-143.
    16. Marie Ferrua & Claude Sicotte & Benoît Lalloué & Etienne Minvielle, 2016. "Comparative Quality Indicators for Hospital Choice: Do General Practitioners Care?," PLOS ONE, Public Library of Science, vol. 11(2), pages 1-9, February.
    17. Villa, Stefano & Prenestini, Anna & Giusepi, Isabella, 2014. "A framework to analyze hospital-wide patient flow logistics: Evidence from an Italian comparative study," Health Policy, Elsevier, vol. 115(2), pages 196-205.
    18. Justyna Matysiewicz & Sławomir Smyczek, 2020. "Determinants of the Relationship of Medical Service Entities in the Virtual Environment," Sustainability, MDPI, vol. 12(18), pages 1-16, September.
    19. Lega, Federico, 2008. "The rise and fall(acy) of clinical directorates in Italy," Health Policy, Elsevier, vol. 85(2), pages 252-262, February.
    20. Albert-Cromarias, Anne & Dos Santos, Catherine, 2020. "Coopetition in healthcare: Heresy or reality? An exploration of felt outcomes at an intra-organizational level," Social Science & Medicine, Elsevier, vol. 252(C).

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:gam:jijerp:v:20:y:2023:i:3:p:1993-:d:1043456. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: MDPI Indexing Manager (email available below). General contact details of provider: https://www.mdpi.com .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.