Dynamic adaptive decision support for strategic decision-making in healthcare organizations.

PURPOSE: The main objective of this study was to design a dynamic adaptive decision support model for healthcare organizations facing deep uncertainties by considering promising dynamic adaptive approaches. The main argument for this is that healthcare organizations have to make strategic decisions under deep uncertainty, but lack an approach to deal with this. DESIGN/METHODOLOGY/APPROACH: A Dynamic Adaptive Decision Support model (DADS) is designed using the Design Science Research methodology. The evaluation of an initial model leads, through two case studies on ongoing and strategic decision-making, to the final design of this needed model for healthcare organizations. FINDINGS: The research reveals the relevance of the designed dynamic and adaptive tool to support strategic decision-making for healthcare organizations. The final design of DADS innovates Decision Making under Deep Uncertainty (DMDU) approaches in an organizational context for ongoing and strategic decision-making. ORIGINALITY/VALUE: The designed model applies the Dynamic Adaptive Policy Pathways approach in an organizational context and more specifically in health care organizations. It further integrates Corporate Real Estate Management knowledge and experience to develop a most needed tool for decision-makers in healthcare. This is the first DADS designed for an organization facing deep uncertainties in a rapidly changing healthcare environment and dealing with ongoing and strategic decision-making.

The barriers to govern long-term care innovations: the paradoxical role of subsidies in a transition program.

This study deals with the governance of a transition program (2007-2011) that tried to radically change a fragmented, supply-driven long-term care system into an integrated, demand-driven system to deal with an aging population. The transition program was subsidized by the healthcare ministry and enabled 26 projects throughout the Netherlands. The idea was to first experiment with innovative long-term care practices outside the system and then to scale-up these innovations to change the system. However, previous research does not highlight examples of long-term care innovations that scaled-up. Hence, the goal is to explore the barriers to govern the scaling-up of the long-term care innovations. The barriers were identified by participating in the program and interviewing ministry, program and project actors. The core barrier was the lack of commitment to the empowerment. It resulted from the subsidy focus of the projects and the lack of protection of the innovations, and from conflicts of interests and power struggles on the ministry-level. A transition program requires more than providing a subsidy. Policymakers have to learn from innovations outside the system in order to change it. Simultaneously, projects should not be entirely subsidized, otherwise there are no incentives to scale-up the innovations.

Project coalitions in healthcare construction projects and the application of real options: an exploratory survey.

OBJECTIVE: Exploring the impact of the type of project coalition on types of flexibility by analyzing considered and exercised flexibilities in separated and integrated project coalitions in the design and construction phase and the operations and maintenance phase of a healthcare construction project. BACKGROUND: Flexibility in healthcare construction projects is increasingly needed in order to deal with growing uncertainties. Until now, little research has been carried out on how and to what extent flexibility is incorporated in different types of project coalitions chosen by healthcare organizations. METHODS: An exploratory survey was conducted among health organizations in both cure and care. Questions were asked on the position of the real estate department within the organization, the type of project coalitions chosen and the rationale behind this choice, and the extent to which flexibility in terms of a real option was considered and to what extent it had been exercised in a project coalition. RESULTS: Integrated project coalitions pay more attention to flexibility in advance in both the process and the product, but exercise them to a lesser extent than separated project coalitions. The economic feasibility of real options is higher in integrated project coalitions. CONCLUSIONS: The study shows that real options thinking is already incorporated in real estate management of healthcare organizations, although more flexibility is considered in advance of the project than is actually realized during and after construction. KEYWORDS: Built environment, construction, decision making, hospitals, planning.