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.
Int J Environ Res Public Health. 2023 Jan 21;20(3):1993. doi: 10.3390/ijerph20031993.
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.
医院已被鼓励开发更多以患者需求为导向的流程导向型设计，以更好地应对患有多种疾病的患者。然而，大多数医院仍然采用围绕医疗专业构建的传统设计。我们旨在了解医院设计的现状发展以及重要的驱动因素。我们构建了一个分类法来对所有荷兰综合医院（61 家）进行分类，并采访了医院经理和工作人员。该清单显示了三种医院建筑模块：围绕特定医疗专业建造的单位、容纳不同医疗专业单位的集群以及中心；多专业实体为面向流程的方法提供了最合适的结构。只有少数荷兰医院（5 家）主要围绕中心设计。然而，大多数医院正在缓慢地向混合设计发展。竞争驱动因素对刺激这些重新设计并不重要。来自医疗保健部门内部的制度压力和机构“模仿”是主要的驱动因素，但它们采取的具体路径取决于它们的“传统”。我们发现，医院结构更多地是渐进式、路径依赖选择的结果，而不是“宏大设计”。尽管大多数荷兰综合医院仍然采用围绕医疗专业构建的通用设计，但大多数医院正在向更注重流程的设计方向发展。
