Relational coordination in value-based health care.

BACKGROUND: An important element of value-based health care (VBHC) is interprofessional collaboration in integrated practice units (IPUs) for the delivery of the complete cycle of care. High levels of interprofessional collaboration between clinical and nonclinical staff in IPUs are assumed rather than proven. Factors that may stimulate interprofessional collaboration in the context of VBHC are underresearched. PURPOSE: The aim of this study was to examine relational coordination (RC) in VBHC and its antecedents. APPROACH: A questionnaire was used to examine the association of both team practices and organizational conditions with interprofessional collaboration in IPUs. Gittell's Relational Coordination Survey was drawn upon to measure interprofessional collaboration by capturing the relational dynamics in coordinated working. The questionnaire also included measures of team practices (team meetings and boundary spanning behavior) and organizational conditions (task interdependence and time constraints). RESULTS: The number of different professional groups participating in team meetings is positively associated with RC in IPUs. Boundary spanning behavior, task interdependence, and time constraints are not associated with RC. CONCLUSIONS: In IPUs, the diversity within interprofessional team meetings is important for establishing high-quality communication and relationships. PRACTICE IMPLICATIONS: Hospital managers should prioritize facilitating and encouraging shared meetings to enhance RC levels among professional groups in IPUs.

Differing Professional Perspectives on the Interprofessional Collaboration in IPUs: A Mixed-methods Study.

Introduction: An important aspect of Value-Based Healthcare (VBHC) is providing the full cycle of care for a specific medical condition through interprofessional collaboration. This requires employees from diverse professional backgrounds to interact, but there is limited knowledge on how professionals perceive such interprofessional collaboration. We aimed to provide insight into how different professionals perceive Integrated Practice Unit (IPU) composition and what factors influence the quality of interprofessional collaboration within IPUs. Methods: A survey was administered to employees from different professional backgrounds (medical specialists, nurses, allied health professionals, administrative employees) working in IPUs to assess their perception of the composition of their IPU and the quality of the interactions. Subsequently, semi-structured interviews were conducted to gain a deeper understanding of the findings of the survey. Results: Medical specialists and nurses were most frequently considered to be part of an IPU and indicated that they have high quality interactions. Allied health professionals were less often considered part of the team by all other professional groups and all report low quality interaction with this group. The extent to which a professional group is perceived as a team member depends on their visibility, involvement in the treatment of the patient, and shared interest. Differences in the quality of interprofessional collaboration are influenced by organizational structures, knowledge of each other's expertise, and by ways of communication. Conclusions: In VBHC, there seems to be a lack of common perception of an IPU's composition and a failure to always achieve high quality interprofessional collaboration. Given the importance of interprofessional collaboration in VBHC, effort should be invested in achieving a shared understanding and improved collaboration.

Professionals' health conceptions of clients with psychosocial problems: An analysis based on an empirical exploration of semi-structured interviews.

Background: The care of clients with complex psychosocial problems involves diverse frontline professionals such as general practitioners, psychiatric nurses, police officers, social support consultants and debt counselors. As these professionals have different professional backgrounds and work in different organizations, their health conceptions, or beliefs about what constitutes health and how this should be pursued, may also differ. Having an understanding of various frontline professionals' health conceptions is relevant, as these may affect interprofessional collaboration in their work with clients with psychosocial problems. Objective: To understand various frontline professionals' health conceptions. Design: Inductive qualitative approach. Setting: The Hague, the Netherlands. Participants: Various frontline professionals from social welfare, general healthcare and mental healthcare, working with clients with complex psychosocial problems. Methods: Between September 2020 and April 2021, 23 in-depth semi- structured interviews were conducted with frontline professionals in social welfare, general healthcare and mental healthcare. Based on these interviews, this paper analyzes frontline professionals' health conceptions. After transcription, all interviews were imported into ATLAS.ti for analysis. An iterative process of thematic analysis was used to identify health conception dimensions. Results: The paper found that frontline professionals' health conceptions differ in three main aspects: 1) health definitions, 2) alignment with clients and 3) contextualization of clients' health. Conclusions: The main implication of this research is that this inductive analysis of health conceptions provides a first building block in theorizing frontline professionals' health promotion practices. Tweetable abstract: Knowing about professional's health conceptions gives insight into how health is understood and how good health can best be achieved, which is important in caring for vulnerable clients.

The implementation of value-based healthcare: a scoping review.

BACKGROUND: The aim of this study was to identify and summarize how value-based healthcare (VBHC) is conceptualized in the literature and implemented in hospitals. Furthermore, an overview was created of the effects of both the implementation of VBHC and the implementation strategies used. METHODS: A scoping review was conducted by searching online databases for articles published between January 2006 and February 2021. Empirical as well as non-empirical articles were included. RESULTS: 1729 publications were screened and 62 were used for data extraction. The majority of the articles did not specify a conceptualization of VBHC, but only conceptualized the goals of VBHC or the concept of value. Most hospitals implemented only one or two components of VBHC, mainly the measurement of outcomes and costs or Integrated Practice Units (IPUs). Few studies examined effects. Implementation strategies were described rarely, and were evaluated even less. CONCLUSIONS: VBHC has a high level of interpretative variability and a common conceptualization of VBHC is therefore urgently needed. VBHC was proposed as a shift in healthcare management entailing six reinforcing steps, but hospitals have not implemented VBHC as an integrative strategy. VBHC implementation and effectiveness could benefit from the interdisciplinary collaboration between healthcare and management science. TRIAL REGISTRATION: This scoping review was registered on Open Science Framework https://osf.io/jt4u7/ (OSF | The implementation of Value-Based Healthcare: a Scoping Review).

Collaboration to combat COVID-19: policy responses and best practices in local integrated care settings.

PURPOSE: This illustrative case study describes and evaluates drivers of effective inter-organizational collaboration to mitigate the impact and spread of COVID-19 among homeless people in two cities in the Netherlands. The aims of this study are: (1) to explore the strategic and operational policy responses in two local integrated care settings at the start of the crisis, (2) to identify best policy practices and lessons learned. The authors interpret and evaluate the findings by combining insights from the population health management (PHM) and collaborative governance literature. DESIGN/METHODOLOGY/APPROACH: The authors describe and illustrate the experiences of two Dutch municipalities, Rotterdam and The Hague, in the early policy responses to sudden operational challenges around the impact of COVID-19 on homeless people as experienced by local decision-makers, medical doctors and clients. FINDINGS: The authors show that best policy practices revolve around (1) using data and risk stratification methods for identifying and targeting populations at-risk in local policy making, and (2) having an inter-organizational data sharing architecture in place ex ante. These two factors were clear prerequisites for tailor-made policy responses for newly-defined groups at risk with the existing and well-documented vulnerable population, and executing crisis-induced tasks efficiently. ORIGINALITY/VALUE: This paper is among the first to illustrate the potential of combining collaborative governance and PHM perspectives to identify key drivers of effective local governance responses to a healthcare crisis in an integrated care setting.

[Patient involvement during crises]. / Patiëntbetrokkenheid tijdens crisisbesluitvorming: Lessen voor de toekomst op basis van COVID-19.

Patient involvement is an important topic in health care. Client councils are one way through which patients are involved in decision-making. However, we know little about their role during crises, and what we can learn from these experiences. We argue that there was little patient involvement in the top-down and centralized decision-making during the COVID-19 crisis. Furthermore, many decisions were taken in interorganizational networks, where patient involvement is rare. Based on these findings, we argue that health care organizations and client councils should rethink what effective patient involvement looks like during crises and in interorganizational networks.

Goal Setting in Teams: Goal Clarity and Team Performance in the Public Sector.

With the rise of performance management, work in the public sector has changed. An output focus has become more common. Other changes include decentralization and managing organizations more horizontally. Setting performance goals and working in teams exemplify these developments. Despite an extensive literature on goal setting, research on goal setting in teams and empirical studies in public organizations have been largely absent. This study contributes to the fields of public management and teamwork by examining whether and under what team conditions clear goals contribute to team performance in the Dutch public sector. Analyses on survey data (n = 105 teams) show that both goal clarity and self-management positively affect team performance. The effect of goal clarity on team performance is not affected by teamwork though, indicated by insignificant moderation effects of self-management and information elaboration. Suggestions are offered for future research to better understand goal setting in public sector teams.

Double Standards in Frontline Decision Making: A Theoretical and Empirical Exploration.

Drawing on status characteristics and double standards theory, this study explores how social categories may affect the standards tax officials use in evaluating citizen-clients' trustworthiness, leading to differential evaluation. Whereas the street-level bureaucracy literature mainly focuses on the direct effect of social categories on officials' judgments, this study shows how stereotyping in the public encounter could be much subtler and more pervasive than is hitherto studied. Based on semistructured interviews containing 40 stories of tax officials who inspect entrepreneurs' tax returns, this study suggests that similar signals may indeed be interpreted differently for different social groups.

Why do nurses intend to leave their organization? A large-scale analysis in long-term care.

AIM: To analyse the impact of six job characteristics on the intention of nurses to leave their organization, specifically focusing on long-term care settings: nursing homes, care homes and home care. BACKGROUND: When nurses leave their organization, this can negatively affect organizational performance. Organizations have to recruit new nurses and tacit knowledge is lost. Furthermore, organizational turnover could contribute to the nursing shortage, which will increasingly become a problem given the ageing population. This article adds to the literature, given: (a) its focus on long-term care; and (b) by explicating the differences between nursing and care homes (intramural) on one hand and home care (extramural) on the other. DESIGN: Survey. METHOD: Survey of 9982 nurses in 156 Dutch organizations in 2010-2011, 6321 nurses in nursing and care homes and 3661 nurses working in home care, based on the ActiZ Benchmark in Healthcare. RESULTS: First, the most important reason for nurses' intention to leave is insufficient development and career opportunities. Secondly, a negative working atmosphere strongly influenced intention to leave. The impact of the working atmosphere is not often examined in the literature. However, this research shows that it is an important reason. Thirdly, intention to leave is partly context dependent. More specifically, when nurses in home care felt that their autonomy was reduced, this strongly influenced their intention to leave, although this was not the case for nurses working in nursing and care homes. CONCLUSION: This article provides guidelines for organizations on how to retain their nurses.