Prades Joan, Morando Verdiana, Tozzi Valeria D, Verhoeven Didier, Germà Jose R, Borras Josep M
1 Catalonian Cancer Plan, Department of Health, and Biomedical Research Institute of Bellvitge (IDIBELL), University of Barcelona (UB), Spain.
2 SDA School of Management, Health, Government and No Profit Division, Bocconi University, Milan, Italy.
Health Serv Manage Res. 2018 Aug;31(3):120-129. doi: 10.1177/0951484817745219. Epub 2017 Dec 14.
Background The study examines two meso-strategic cancer networks, exploring to what extent collaboration can strengthen or hamper network effectiveness. Unlike macro-strategic networks, meso-strategic networks have no hierarchical governance structures nor are they institutionalised within healthcare services' delivery systems. This study aims to analyse the models of professional cooperation and the tools developed for managing clinical practice within two meso-strategic, European cancer networks. Methods Multiple case study design based on the comparative analysis of two cancer networks: Iridium, in Antwerp, Belgium and the Institut Català d'Oncologia in Catalonia, Spain. The case studies applied mixed methods, with qualitative research based on semi-structured interviews ( n = 35) together with case-site observation and material collection. Results The analysis identified four levels of collaborative intensity within medical specialties as well as in multidisciplinary settings, which became both platforms for crosscutting clinical work between hubs' experts and local care teams and the levers for network-based tools development. The organisation of clinical practice relied on professional-based cooperative processes and tiers, lacking vertical integration mechanisms. Conclusions The intensity of professional linkages largely shaped the potential of meso-strategic cancer networks to influence clinical practice organisation. Conversely, the introduction of managerial techniques or network governance structures, without introducing vertical hierarchies, was found to be critical solutions.
背景 本研究考察了两个中观层面的癌症网络，探讨合作在多大程度上能够增强或阻碍网络效能。与宏观层面的网络不同，中观层面的网络没有层级治理结构，也未在医疗服务提供系统中制度化。本研究旨在分析两个欧洲中观层面癌症网络内的专业合作模式以及为管理临床实践而开发的工具。方法 基于对两个癌症网络（比利时安特卫普的铱星网络和西班牙加泰罗尼亚的加泰罗尼亚肿瘤研究所）的比较分析，采用多案例研究设计。案例研究运用了混合方法，定性研究基于半结构化访谈（n = 35）以及案例现场观察和资料收集。结果 分析确定了医学专科领域以及多学科环境中的四个合作强度级别，这些级别既成为了中心专家与当地护理团队之间跨部门临床工作的平台，也成为了基于网络的工具开发的杠杆。临床实践的组织依赖于基于专业的合作流程和层级，缺乏垂直整合机制。结论 专业联系的强度在很大程度上塑造了中观层面癌症网络影响临床实践组织的潜力。相反，在不引入垂直层级的情况下引入管理技术或网络治理结构，被认为是关键解决方案。
