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Article
Publication date: 29 November 2018

Jenny Shand and Simon Turner

Structural integration is increasingly explored as a means of achieving efficiency gains alongside improved health outcomes. In 2015, three boroughs in London, England…

Abstract

Purpose

Structural integration is increasingly explored as a means of achieving efficiency gains alongside improved health outcomes. In 2015, three boroughs in London, England began working together to develop an Accountable Care Organisation for the 750,000 population they serve. The purpose of this paper is to understand the experiences of working across organisational and sectoral boundaries for the benefit of the population, including enablers and barriers encountered, the role of financial incentives and perspectives on Accountable Care Organisations.

Design/methodology/approach

A single site instrumental case study involving 35 semi-structured interviews using a topic guide, with key leaders and decision makers from the site and nationally, between April 2016 and August 2016.

Findings

There are differences in levels of autonomy and operational priorities between councils and the NHS. Existing financial mechanisms can be used to overcome sectoral boundaries, but require strong leadership to implement. There are challenges associated with primary care participating in integration, including reluctance for small organisations to adopt the risk associated with large scale programmes. Interviewees were aligned on espoused ambitions for the Accountable Care Organisation but not on whether one organisation was needed to deliver these in practice.

Research limitations/implications

Progressing the integration agenda requires consideration of the context of primary care and the core differences between health and government. Further, research into ACOs is required as they may not be required to deliver the anticipated integration and system outcomes. Understanding if there are specific population groups for whom cross-organisation and cross-sector working could have particular benefits would help to target efforts.

Originality/value

This paper highlights some of the challenges associated with cross-sector collaboration.

Details

Journal of Integrated Care, vol. 27 no. 1
Type: Research Article
ISSN: 1476-9018

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Article
Publication date: 1 March 2016

Brian Hilligoss, Paula H. Song and Ann Scheck McAlearney

New organization theory posits that coordination mechanisms work by generating three integrating conditions: accountability (clarity about task responsibilities)…

Abstract

New organization theory posits that coordination mechanisms work by generating three integrating conditions: accountability (clarity about task responsibilities), predictability (clarity about which, when, and how tasks will be accomplished), and common understanding (shared perspectives about tasks). We apply this new theory to health care to improve understanding of how accountable care organizations (ACOs) are attempting to reduce the fragmentation that characterizes the US health care system. Drawing on four organizational case studies, we find that ACOs rely on a wide variety of coordination mechanisms that have been designed to leverage existing organizational capabilities, accommodate local contingencies. and, in some instances, interact strategically. We conclude that producing integrating conditions across the care continuum requires suites of interacting coordination mechanisms. Our findings provide a conceptual foundation for future research and improvements.

Details

International Journal of Organization Theory & Behavior, vol. 19 no. 2
Type: Research Article
ISSN: 1093-4537

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Book part
Publication date: 12 August 2014

Stuart Winby, Christopher G. Worley and Terry L. Martinson

This chapter integrates organization design and sustainability concepts to describe an accelerated transformational change at the Fairview Medical Group (United States).

Abstract

Purpose

This chapter integrates organization design and sustainability concepts to describe an accelerated transformational change at the Fairview Medical Group (United States).

Design/methodology/approach

A case study of the transformation at Fairview Medical Group’s primary care clinics was developed from interviews and first-person accounts of the change. Objective data regarding outcomes was used to evaluate the effectiveness of the redesign process.

Findings

The Fairview Medical Group developed an innovation and change capability to transform 35 primary care clinics in six months. All of the clinics were certified by the state of Minnesota as complying with their healthcare standards. Clinical outcomes, costs, and employee and physician engagement also increased. All of the improved measures are sustained.

Originality/value

Healthcare reform in the United States struggles because the organization design challenges are great and the change difficulties even greater. Fairview’s experience provides important evidence and lessons that can help advance our understanding of effective healthcare and create more sustainable healthcare systems. This chapter provides healthcare system administrators evidence and alternatives in the pursuit of implementation.

Details

Reconfiguring the Ecosystem for Sustainable Healthcare
Type: Book
ISBN: 978-1-78441-035-3

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Article
Publication date: 20 June 2016

Frances M Wu, Thomas G. Rundall, Stephen M. Shortell and Joan R Bloom

The purpose of this paper is to describe the current landscape of health information technology (HIT) in early accountable care organizations (ACOs), the different…

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1051

Abstract

Purpose

The purpose of this paper is to describe the current landscape of health information technology (HIT) in early accountable care organizations (ACOs), the different strategies ACOs are using to develop HIT-based capabilities, and how ACOs are using these capabilities within their care management processes to advance health outcomes for their patient population.

Design/methodology/approach

Mixed methods study pairing data from a cross-sectional National Survey of ACOs with in-depth, semi-structured interviews with leaders from 11 ACOs (both completed in 2013).

Findings

Early ACOs vary widely in their electronic health record, data integration, and analytic capabilities. The most common HIT capability was drug-drug and drug-allergy interaction checks, with 53.2 percent of respondents reporting that the ACO possessed the capability to a high degree. Outpatient and inpatient data integration was the least common HIT capability (8.1 percent). In the interviews, ACO leaders commented on different HIT development strategies to gain a more comprehensive picture of patient needs and service utilization. ACOs realize the necessity for robust data analytics, and are exploring a variety of approaches to achieve it.

Research limitations/implications

Data are self-reported. The qualitative portion was based on interviews with 11 ACOs, limiting generalizability to the universe of ACOs but allowing for a range of responses.

Practical implications

ACOs are challenged with the development of sophisticated HIT infrastructure. They may benefit from targeted assistance and incentives to implement health information exchanges with other providers to promote more coordinated care management for their patient population.

Originality/value

Using new empirical data, this study increases understanding of the extent of ACOs’ current and developing HIT capabilities to support ongoing care management.

Details

Journal of Health Organization and Management, vol. 30 no. 4
Type: Research Article
ISSN: 1477-7266

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Article
Publication date: 8 December 2021

Petra Kokko and Harri Laihonen

The article seeks to explain whether and how value-based healthcare principles lead to hybridization. The public management literature has been increasingly interested in…

Abstract

Purpose

The article seeks to explain whether and how value-based healthcare principles lead to hybridization. The public management literature has been increasingly interested in hybrid forms of governance and hybrid performance management, but empirical studies are still rare. Further, the article studies the design of performance management and accounting systems as healthcare organizations reorganize their care processes applying value-based healthcare principles.

Design/methodology/approach

This article first connects the theoretical discussions on value-based healthcare and performance management for hybrids. The conceptual understanding of performance management in hybrid healthcare uses a case study of a Finnish healthcare organization with documentary data and transcribed interviews with healthcare professionals from both the strategic and operative levels of healthcare.

Findings

The article illustrates and analyses how new policy-level objectives and principles of value-based healthcare led to hybridity in healthcare, manifest in mixed ownership of a particular care path and new forms of social and financial control. Further, the article provides empirical evidence of how increased hybridity necessitated new organizational modes and roles, new managerial tools for performance management and created a need to develop the capability to account and measure entire integrated care processes. Important enabling factors for the integration of care and hybrid performance management were commitment created in dialogue, voluntary-based trust and technology to generate factual shared information.

Practical implications

The study is informative for stakeholders, funders and managers of healthcare organizations, namely new knowledge for the discussion of hybrid governance in healthcare, including a critical account of the applicability and impact of a hybrid service model in healthcare management. Moreover, the article illustrates what needs to be reconsidered in performance management and accounting practices when reorganizing care processes according to the principles of value-based healthcare.

Originality/value

The article extends the analysis of performance management in hybrids and sheds new light on hybridization in healthcare. It also provides much-needed empirical evidence on the processes and practices of accounting and performance management after implementing a value-based healthcare strategy.

Details

Journal of Public Budgeting, Accounting & Financial Management, vol. ahead-of-print no. ahead-of-print
Type: Research Article
ISSN: 1096-3367

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Book part
Publication date: 15 September 2014

Thomas T. H. Wan, Maysoun Dimachkie Masri and Judith Ortiz

The implementation of the Patient Protection and Affordable Care Act has facilitated the development of an innovative and integrated delivery care system, Accountable Care

Abstract

Purpose

The implementation of the Patient Protection and Affordable Care Act has facilitated the development of an innovative and integrated delivery care system, Accountable Care Organizations (ACOs). It is timely, to identify how health care managers in rural health clinics (RHCs) are responding to the ACO model. This research examines RHC managers’ perceived benefits and barriers for implementing ACOs from an organizational ecology perspective.

Methodology/approach

A survey was conducted in spring of 2012 covering the present RHC network working infrastructures – (1) Organizational social network; (2) organizational care delivery structure; (3) ACO knowledge, perceived benefits, and perceived barriers; (4) quality and disease management programs; and (5) health information technology (HIT) infrastructure. One thousand one hundred sixty clinics were surveyed in the United States. They cover eight southeastern states (Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, and Tennessee) and California. A total of 91 responses were received.

Findings

RHC managers’ personal perceptions on ACO’s benefits and knowledge level explained the most variance in their willingness to join ACOs. Individual perceptions appear to be more influential than organizational and context factors in the predictive analysis.

Research limitations/implications

The study is primarily focused in the Southeastern region of the United States. The generalizability is limited to this region. The predictors of RHCs’ participation in ACOs are germane to guide the development of organizational strategies for enhancing the general knowledge about the innovativeness of delivering coordinated care and containing health care costs inspired by the Affordable Care Act.

Originality/value of chapter

RHCs are lagged behind the growth curve of ACO adoption. The diffusion of new knowledge about pros and cons of ACO is essential to reinforce the health care reform in the United States.

Details

Technology, Communication, Disparities and Government Options in Health and Health Care Services
Type: Book
ISBN: 978-1-78350-645-3

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Article
Publication date: 2 September 2013

Bernardo Ramirez, Daniel J. West and Michael M. Costell

This paper aims to examine the concept of sustainability in health care organizations and the key managerial competencies and change management strategies needed to…

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2757

Abstract

Purpose

This paper aims to examine the concept of sustainability in health care organizations and the key managerial competencies and change management strategies needed to implant a culture of sustainability. Competencies and management development strategies needed to engrain this corporate culture of sustainability are analyzed in this document.

Design/methodology/approach

This paper draws on the experience of the authors as health care executives and educators developing managerial competencies with interdisciplinary and international groups of executives in the last 25 years, using direct observation, interviews, discussions and bibliographic evidence.

Findings

With a holistic framework for sustainability, health care managers can implement strategies for multidisciplinary teams to respond to the constant change, fine-tune operations and successfully manage quality of care. Managers can mentor students and provide in-service learning experiences that integrate knowledge, skills, and abilities.

Research limitations/implications

Further empirical research needs to be conducted on these interrelated innovative topics.

Practical implications

Health care organizations around the world are under stakeholders' pressure to provide high quality, cost-effective, accessible and sustainable services. Professional organizations and health care providers can collaborate with university graduate health management education programs to prepare competent managers in all the dimensions of sustainability.

Social implications

The newly designated accountable care organizations represent an opportunity for managers to address the need for sustainability.

Originality/value

Sustainability of health care organizations with the holistic approach discussed in this paper is an innovative and practical approach to quality improvement that merits further development.

Details

Journal of Health Organization and Management, vol. 27 no. 5
Type: Research Article
ISSN: 1477-7266

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Article
Publication date: 11 June 2018

Jeffrey Harrison, Aaron Spaulding and Debra A. Harrison

The purpose of this paper is to assess the community dynamics and organizational characteristics of US hospitals that participate in accountable care organizations (ACO).

Abstract

Purpose

The purpose of this paper is to assess the community dynamics and organizational characteristics of US hospitals that participate in accountable care organizations (ACO).

Design/methodology/approach

Data were obtained from the 2015 American Hospital Association annual survey and the 2015 medicare final rule standardizing file. The study evaluated 785 hospitals which operate ACO in contrast to 1,446 hospitals without an ACO.

Findings

In total, 89 percent of hospitals using ACO’s are located in urban communities and 87 percent are not-for-profit. Hospitals with a higher case mix index are more likely to have an ACO.

Practical implications

ACOs allow healthcare organizations to expand their geographic markets, achieve greater efficiencies, and enhance the development of new clinical services. They also shift the focus of care from acute care hospitalization to the full continuum of care.

Originality/value

This research found ACOs with hospital and physician networks are an effective mechanism to control healthcare costs and reduce medical errors.

Details

International Journal of Organization Theory & Behavior, vol. 21 no. 2
Type: Research Article
ISSN: 1093-4537

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Article
Publication date: 29 April 2020

Tatiana Cornell

The purpose of this paper is to identify the primary executive leadership skills required to promote the effectiveness of Medicare Shared Savings Program Accountable Care

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1134

Abstract

Purpose

The purpose of this paper is to identify the primary executive leadership skills required to promote the effectiveness of Medicare Shared Savings Program Accountable Care Organizations (MSSP ACOs) and to create a new substantive theory describing these skills. The author identifies that MSSP ACO is a relatively new value-based care delivery (VBCD) structure in the USA that links clinicians’ compensation to their clinical outcomes. The research question concerns what primary executive leadership skills are essential in the VBCD era.

Design/methodology/approach

This single, embedded, exploratory case study is based on interviews, a focus group discussion and archival record data of MSSP ACO executives in the Northeast, Midwest, South and West of the USA.

Findings

The findings represented seven major categories or the primary executive leadership skills required to succeed in the VBCD environment. Each category or skill included five subcategories or concepts supporting the leadership skills essential for reaching VBCD goals. The categories and subcategories gave rise to a new substantive theory – the Accountable Healthcare Leadership Theory of Five Ps: promoting partnership between providers, patients and payers.

Research limitations/implications

The empirical generalizability of the results was limited by its essence as a single, embedded, exploratory case study of 18 MSSP ACO executives in 4 regions of the USA. The strength of this study, however, lies in its potential for making analytic generalizations for identifying theoretically meaningful leadership skills essential for success in the VBCD era.

Originality/value

The author has developed and validated a new theory describing the primary executive leadership skills required to succeed in the VBCD environment.

Details

Leadership in Health Services, vol. 33 no. 3
Type: Research Article
ISSN: 1751-1879

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Book part
Publication date: 25 July 2012

Christopher G. Worley

Purpose – This chapter argues that the concept of agility is an effective robust framework for designing sustainable health care systems.Design/methodology/approach – This…

Abstract

Purpose – This chapter argues that the concept of agility is an effective robust framework for designing sustainable health care systems.

Design/methodology/approach – This case study of Alegent Health was based on 7 years of data collection. It includes observations of meetings, large-group interventions, and other activities; site visits to different hospitals in the system to observe changes in practice; interviews with Alegent Health executives, primary care physicians, hospital presidents, specialist physicians and physician groups, and health systems staff and nurses; and a variety of archival data including meeting minutes, video tapes, conference proceedings, and web site material.

Findings – The Alegent Health system has evolved over time according to the principles of agility. It built a series of new capabilities that contribute to improved clinical outcomes, sustained financial results, and more socially and ecologically responsible results. Designing health care systems based on agility is a more effective and sustainable approach than relying on legislative or other criteria.

Originality/value – The discussion of sustainability in health care has focused primarily on specific projects or how to respond to specific technological, regulatory, or clinical changes. Alegent Health's experience provides important lessons, opportunities, and challenges that can help advance our understanding of effective health care and use organizational agility to create more sustainable health care systems. This chapter provides health care system administrators an alternative design option.

Details

Organizing for Sustainable Health Care
Type: Book
ISBN: 978-1-78190-033-8

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