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.
J Health Organ Manag. 2021 Feb 23;35(9):66-84. doi: 10.1108/JHOM-06-2020-0236.
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.
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.
整合，即任务的协调与统一，被广泛推广为提高医院绩效的手段。先前的一项研究考察了医院社会网络中任务的整合和分化，即任务在多大程度上被分割成子系统。本研究进一步推进了这一研究，旨在通过研究医院网络中的代理所使用的规则和协调机制来解释整合和分化。
设计/方法/途径：本案例研究深化了对医院社会网络的分析。使用自然主义探究方法和混合方法，研究了所有的规划任务和手术绩效任务。
在所发现的 314 条规则中，85%主要存在于人们的头脑中，31%存在于文件中，7%存在于信息系统中。在手术程序的早期规划阶段，基于全院范围规则的相互调整占主导地位。接近手术日时，使用局部规则，并通过相互调整来封闭开环，从而实现整合。在手术日，主要基于全院范围的规则进行标准化的工作和产出。作者提出了未来研究的主题，重点是提高医院的稳健性和稳定性。
原创性/价值：这项探索性案例研究提供了一个概述，说明了用于组织手术患者全院范围内后勤工作的规则和协调机制。这些发现对于未来研究医院如何有效实现整合和分化具有重要意义。
