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Identifying integration and differentiation in a Hospital’s logistical system: a social network analysis of a case study

BACKGROUND: Integration, the coordination and alignment of tasks, has been promoted widely in order to improve the performance of hospitals. Both organization theory and social network analysis offer perspectives on integration. This exploratory study research aims to understand how a hospital’s log...

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Autores principales: van der Ham, Annelies, van Merode, Frits, Ruwaard, Dirk, van Raak, Arno
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7488445/
https://www.ncbi.nlm.nih.gov/pubmed/32917198
http://dx.doi.org/10.1186/s12913-020-05514-w
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author van der Ham, Annelies
van Merode, Frits
Ruwaard, Dirk
van Raak, Arno
author_facet van der Ham, Annelies
van Merode, Frits
Ruwaard, Dirk
van Raak, Arno
author_sort van der Ham, Annelies
collection PubMed
description BACKGROUND: Integration, the coordination and alignment of tasks, has been promoted widely in order to improve the performance of hospitals. Both organization theory and social network analysis offer perspectives on integration. This exploratory study research aims to understand how a hospital’s logistical system works, and in particular to what extent there is integration and differentiation. More specifically, it first describes how a hospital organizes logistical processes; second, it identifies the agents and the interactions for organizing logistical processes, and, third, it establishes the extent to which tasks are segmented into subsystems, which is referred to as differentiation, and whether these tasks are coordinated and aligned, thus achieving integration. METHODS: The study is based on case study research carried out in a hospital in the Netherlands. All logistical tasks that are executed for surgery patients were studied. Using a mixed method, data were collected from the Hospital Information System (HIS), documentation, observations and interviews. These data were used to perform a social network analysis and calculate the network metrics of the hospital network. RESULTS: This paper shows that 23 tasks are executed by 635 different agents who interact through 31,499 interaction links. The social network of the hospital demonstrates both integration and differentiation. The network appears to function differently from what is assumed in literature, as the network does not reflect the formal organizational structure of the hospital, and tasks are mainly executed across functional silos. Nurses and physicians perform integrative tasks and two agents who mainly coordinate the tasks in the network, have no hierarchical position towards other agents. The HIS does not seem to fulfill the interactional needs of agents. CONCLUSIONS: This exploratory study reveals the network structure of a hospital. The cross-functional collaboration, the integration found, and position of managers, coordinators, nurses and doctors suggests a possible gap between organizational perspectives on hospitals and reality. This research sets a basis for further research that should focus on the relation between network structure and performance, on how integration is achieved and in what way organization theory concepts and social network analysis could be used in conjunction with one another.
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spelling pubmed-74884452020-09-16 Identifying integration and differentiation in a Hospital’s logistical system: a social network analysis of a case study van der Ham, Annelies van Merode, Frits Ruwaard, Dirk van Raak, Arno BMC Health Serv Res Research Article BACKGROUND: Integration, the coordination and alignment of tasks, has been promoted widely in order to improve the performance of hospitals. Both organization theory and social network analysis offer perspectives on integration. This exploratory study research aims to understand how a hospital’s logistical system works, and in particular to what extent there is integration and differentiation. More specifically, it first describes how a hospital organizes logistical processes; second, it identifies the agents and the interactions for organizing logistical processes, and, third, it establishes the extent to which tasks are segmented into subsystems, which is referred to as differentiation, and whether these tasks are coordinated and aligned, thus achieving integration. METHODS: The study is based on case study research carried out in a hospital in the Netherlands. All logistical tasks that are executed for surgery patients were studied. Using a mixed method, data were collected from the Hospital Information System (HIS), documentation, observations and interviews. These data were used to perform a social network analysis and calculate the network metrics of the hospital network. RESULTS: This paper shows that 23 tasks are executed by 635 different agents who interact through 31,499 interaction links. The social network of the hospital demonstrates both integration and differentiation. The network appears to function differently from what is assumed in literature, as the network does not reflect the formal organizational structure of the hospital, and tasks are mainly executed across functional silos. Nurses and physicians perform integrative tasks and two agents who mainly coordinate the tasks in the network, have no hierarchical position towards other agents. The HIS does not seem to fulfill the interactional needs of agents. CONCLUSIONS: This exploratory study reveals the network structure of a hospital. The cross-functional collaboration, the integration found, and position of managers, coordinators, nurses and doctors suggests a possible gap between organizational perspectives on hospitals and reality. This research sets a basis for further research that should focus on the relation between network structure and performance, on how integration is achieved and in what way organization theory concepts and social network analysis could be used in conjunction with one another. BioMed Central 2020-09-11 /pmc/articles/PMC7488445/ /pubmed/32917198 http://dx.doi.org/10.1186/s12913-020-05514-w Text en © The Author(s) 2020 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research Article
van der Ham, Annelies
van Merode, Frits
Ruwaard, Dirk
van Raak, Arno
Identifying integration and differentiation in a Hospital’s logistical system: a social network analysis of a case study
title Identifying integration and differentiation in a Hospital’s logistical system: a social network analysis of a case study
title_full Identifying integration and differentiation in a Hospital’s logistical system: a social network analysis of a case study
title_fullStr Identifying integration and differentiation in a Hospital’s logistical system: a social network analysis of a case study
title_full_unstemmed Identifying integration and differentiation in a Hospital’s logistical system: a social network analysis of a case study
title_short Identifying integration and differentiation in a Hospital’s logistical system: a social network analysis of a case study
title_sort identifying integration and differentiation in a hospital’s logistical system: a social network analysis of a case study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7488445/
https://www.ncbi.nlm.nih.gov/pubmed/32917198
http://dx.doi.org/10.1186/s12913-020-05514-w
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