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Considering the role of context when implementing government policies in hospitals: introduction of a prospective payment system for psychiatry

Nicolas Schippel (Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, IMVR, University of Cologne, Cologne, Germany)
Kira Isabel Hower (Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, IMVR, University of Cologne, Cologne, Germany)
Susanne Zank (Rehabilitative Gerontology, Faculty of Human Sciences, University of Cologne, Cologne, Germany)
Holger Pfaff (Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, IMVR, University of Cologne, Cologne, Germany)
Christian Rietz (Mixed-Methods Research, Heidelberg University of Education, Heidelberg, Germany)

Journal of Health Organization and Management

ISSN: 1477-7266

Article publication date: 22 October 2021

Issue publication date: 25 March 2022

205

Abstract

Purpose

The context in which an innovation is implemented is an important and often neglected mediator of change. A prospective payment system (PPS) for psychiatric and psychosomatic facilities with major implications for inpatient psychiatric care in Germany was implemented from 2013 to 2017. This study aims to examine the determinants of implementation of this government policy using the Diffusion of Innovations theory and consider the role of context.

Design/methodology/approach

An exploratory case study was conducted in two wards of a psychiatric hospital in Germany: geriatric psychiatry (GerP) and general psychiatry (GenP). Fifteen interviews were conducted with different occupational groups and analyzed in-depths. Routine hospital data were analyzed for delimiting the two contexts.

Findings

Routine hospital data show a higher day-mix index (1.08 vs. 0.94) in the GerP context and a very different structure regarding PPS groups, indicating a higher patient complexity. Two types of factors influencing implementation were identified: Context-independent factors included social separation between nurses and doctors, poor communication behavior between the groups and a lack of conveying information about the underlying principles of the PPS. Context-dependent factors included compatibility of the new requirements with existing routines and the relative advantage of the PPS, which were both perceived to be lower in the GerP context.

Practical implications

Depending on the patient characteristics in the specific context, compatibility with existing routines should be ensured when implementing. Clear communication of the underlying principles and reduction of organizational and communicative barriers between professional groups are crucial success factors for implementing such innovations.

Originality/value

This study shows how a diffusion process takes place in an organization even after the organization adopts an innovation. The authors could show how contextual differences in terms of patient characteristics result in different determinants of implementation from the views of the employees affected by the innovation.

Keywords

Acknowledgements

Funding: This research received no grant from any funding agency in the public, commercial, or not-for-profit sectors.

Competing interests: None declared.

Patient consent: Not required.

Ethics approval: Ethics Committee of the Pädagogische Hochschule (PH) Heidelberg (Approval #7741.35-13).

Trial registration: German Clinical Trials Register (DRKS): DRKS00015658

Provenance and peer review: Not commissioned; externally peer reviewed.

Citation

Schippel, N., Hower, K.I., Zank, S., Pfaff, H. and Rietz, C. (2022), "Considering the role of context when implementing government policies in hospitals: introduction of a prospective payment system for psychiatry", Journal of Health Organization and Management, Vol. 36 No. 3, pp. 279-292. https://doi.org/10.1108/JHOM-01-2021-0021

Publisher

:

Emerald Publishing Limited

Copyright © 2021, Emerald Publishing Limited

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