Christopher J. Louis, PhD, MHA, is Clinical Assistant Professor, Department of Health Law, Policy and Management, School of Public Health, Boston University, Boston, Massachusetts. E-mail:
Health Care Manage Rev. 2019 Jan/Mar;44(1):41-56. doi: 10.1097/HMR.0000000000000172.
Scholars have noted a disconnect between the level at which structure is typically examined (the organization) and the level at which the relevant coordination takes place (service delivery). Accordingly, our understanding of the role structure plays in care coordination is limited.
In this article, we explore service line structure, with an aim of advancing our understanding of the role service line structure plays in producing coordinated, patient-centered care. We do so by giving special attention to the cognitive roots of patient-centeredness.
METHODOLOGY/APPROACH: Our exploratory study relied on comparative case studies of the breast cancer service lines in three health systems. Nonprobability discriminative snowball sampling was used to identify the final sample of key informants. We employed a grounded approach to analyzing and interpreting the data.
We found substantial variation across the three service lines in terms of their structure. We also found corresponding variation across the three case sites in terms of where informant attention was primarily focused in the process of coordinating care. Drawing on the attention-based view of the firm, our results draw a clear connection between structural characteristics and the dominant focus of attention (operational tactics, provider roles and relationships, or patient needs and engagement) in health care service lines.
Our exploratory results suggest that service line structures influence attention in two ways: (a) by regulating the type and intensity of the problems facing service line participants and (b) by encouraging (or discouraging) a shared purpose around patient needs.
Patient-centered attention-a precursor to coordinated, patient-centered care-depends on the internal choices organizations make around service line structure. Moreover, a key task for organizational and service line leaders is to structure service lines to create a context that minimizes distractions and enables care providers to focus their attention on the needs of their patients.
学者们注意到，结构通常被检查的水平（组织）与相关协调发生的水平（服务提供）之间存在脱节。因此，我们对结构在护理协调中所起作用的理解是有限的。
在本文中，我们探讨了服务线结构，旨在深入了解服务线结构在产生协调的、以患者为中心的护理方面所起的作用。我们特别关注以患者为中心的认知根源。
方法/方法：我们的探索性研究依赖于对三个医疗系统中的乳腺癌服务线的比较案例研究。非概率判别性滚雪球抽样被用于确定关键信息提供者的最终样本。我们采用扎根方法对数据进行分析和解释。
我们发现，这三个服务线在结构方面存在显著差异。我们还发现，在三个案例地点，在协调护理的过程中，信息提供者的注意力主要集中在哪些方面也存在相应的差异。基于企业的注意力基础观，我们的研究结果清楚地表明，结构特征与注意力的主导焦点（运营策略、提供者角色和关系、或患者需求和参与）之间存在联系。
我们的探索性结果表明，服务线结构以两种方式影响注意力：（a）通过调节服务线参与者面临的问题的类型和强度；（b）通过鼓励（或不鼓励）围绕患者需求的共同目标。
以患者为中心的注意力-协调的、以患者为中心的护理的前提-取决于组织在服务线结构方面所做的内部选择。此外，组织和服务线领导者的一个关键任务是构建服务线，以创造一个最小化干扰并使护理提供者能够专注于患者需求的环境。
