The collaborative hospital: Observations from practice

INTRODUCTION: To meet demands for high quality and efficient care, hospitals increasingly organize horizontally around standardized processes (like lean and care pathways) and/or set-up formal structural arrangements (such as using performance or lean boards, having daily team huddles or assigning specific roles to health care professionals). Interestingly, recent literature indicates that standardized processes and structures can foster and facilitate collaboration in organizations. However, the micro-mechanisms underlying the potential of standardization remain unclear. This research project investigates how standardized care processes and structural arrangements can facilitate and/or hamper collaboration in hospitals?
METHODS: A qualitative multiple, embedded case study of four hospitals that relies on interviews, observation and archival data to get an in-depth understanding of collaboration mechanisms in the collaborative hospital. The research is embedded because three instances of standardized processes/structural arrangements are investigated in relation to each individual hospital. Embedded cases are selected theoretically based on, e.g., department type (fast versus slow-response) and interdependence level. Only tentative observations from practice are presented as the research is still work in progress.
FINDINGS: Structural arrangements: (s1) Performance management boards and white-boards. Represent instances of artifacts which bring health care professionals across professions together and allow them to coordinate and collaborate about solving the care tasks. (s2) Role structures. Assignment of specific roles to, for example, forming ward round teams of a physician and a nurse with shared responsibility for a group of patients. This improves coordination, reduces mutual waiting time and improves patient contact. (s3) Simulation training of collaboration skills. Represent an instance of team competence development. This renders it possible to train inter-personal skills and learn about how each health care professional contributes to the whole care task. (s4) Formal meeting spaces such as having scheduled morning meetings where everybody gets an overview of the day, including who does why, when and where, or scheduled team huddles during the day to update, coordinate and help each other. Standardized processes: (p1) Integrated care pathways which create collaboration across departments and professional specialties. (p2) Lean standard operating procedures which facilitate joint understanding of each other and foster collaborative interaction typically inside organizational units.
CONCLUSIONS: Observations of hospital instances of standardized processes and structural arrangements suggest that hospitals can use many different types of institutionalized dialogue to foster and maintain collaboration, thereby pointing towards mechanisms for developing the collaborative hospital.