Towards an organisation-wide process-oriented organisation of care: a literature review.
BACKGROUND
Many hospitals have taken actions to make care delivery for specific patient groups more process-oriented, but struggle with the question how to deal with process orientation at hospital level. The aim of this study is to report and discuss the experiences of hospitals with implementing process-oriented organisation designs in order to derive lessons for future transitions and research.


METHODS
A literature review of English language articles on organisation-wide process-oriented redesigns, published between January 1998 and May 2009, was performed.


RESULTS
Of 329 abstracts identified, 10 articles were included in the study. These articles described process-oriented redesigns of five hospitals. Four hospitals tried to become process-oriented by the implementation of coordination measures, and one by organisational restructuring. The adoption of the coordination mechanism approach was particularly constrained by the functional structure of hospitals. Other factors that hampered the redesigns in general were the limited applicability of and unfamiliarity with process improvement techniques.


CONCLUSIONS
Due to the limitations of the evidence, it is not known which approach, implementation of coordination measures or organisational restructuring (with additional coordination measures), produces the best results in which situation. Therefore, more research is needed. For this research, the use of qualitative methods in addition to quantitative measures is recommended to contribute to a better understanding of preconditions and contingencies for an effective application of approaches to become process-oriented. Hospitals are advised to take the factors for failure described into account and to take suitable actions to counteract these obstacles on their way to become process-oriented organisations.
NIVEL, Netherlands Institute for Health Services Research, P.O. Box 1568, 3500 BN Utrecht, The Netherlands. l.vos@lumc.nl
Leti
L
Vos
Sarah E
SE
Chalmers
Michel La
ML
Dückers
Peter P
PP
Groenewegen
Cordula
C
Wagner
Godefridus G
GG
van Merode
D003695:Delivery of Health Care / Q000458:organization & administration; D017598:Efficiency, Organizational; D006739:Hospital Administration; D006748:Hospital Departments / Q000458:organization & administration; D006801:Humans; D009936:Organizational Innovation; D017064:Process Assessment, Health Care / Q000379:methods*
JAMA. 2008 Mar 12;299(10):1182-4
18334694
Ann Surg. 2007 Oct;246(4):585-90; discussion 590-2
17893495
Aust Health Rev. 2007 Feb;31(1):10-5
17266483
J Health Serv Res Policy. 2005 Jul;10 Suppl 1:21-34
16053581
Eur J Health Econ. 2010 Jun;11(3):291-304
19655184
BMJ. 2002 Jan 19;324(7330):135-41
11799029
J Eval Clin Pract. 2010 Dec;16(6):1203-8
20695954
Rays. 1998 Apr-Jun;23(2):295-309
9689850
Health Care Manage Rev. 2007 Jan-Mar;32(1):55-65
17245203
Health Serv Manage Res. 1991 Mar;4(1):25-31
10122451
Health Care Manag Sci. 2009 Jun;12(2):155-65
19469455
Qual Manag Health Care. 2007 Jan-Mar;16(1):68-83
17235253
J Interprof Care. 2008 Mar;22(2):191-203
18320453
Health Policy. 2005 Nov;74(3):261-81
16226138
Aust Health Rev. 1993;16(4):383-404
10138367
Rays. 1998 Apr-Jun;23(2):270-87
9689848
Health Place. 2008 Dec;14(4):768-78
18261949
Health Care Manage Rev. 2009 Jan-Mar;34(1):42-53
19104263
MedGenMed. 2001 Mar 05;3(2):2
11549951
J Interprof Care. 2005 May;19 Suppl 1:188-96
16096155
Med J Aust. 2008 Mar 17;188(S6):S27-31
18341473
N Engl J Med. 2007 Mar 15;356(11):1166-8
17360996
Med J Aust. 2008 Mar 17;188(S6):S32-5
18341474
Jt Comm J Qual Patient Saf. 2006 Jul;32(7):393-9
16884126
Med J Aust. 2008 Mar 17;188(S6):S14-7
18341470
Rays. 1998 Apr-Jun;23(2):263-9
9689847