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While it has long been established that social factors, such as housing, transportation, and income, influence health and health care outcomes, over the last decade, attention to this topic has grown dramatically. Reforms that promote high-quality care as well as responsibility for total cost of care have shifted focus among health care providers toward upstream determinants of health care outcomes. As a result, there has been a proliferation of activity focused on integrating and aligning social and medical care, many of which depend critically on cross-sector alliances. Despite considerable activity in this area, cross-sector alliances in health care remain largely undertheorized. Both literatures stand to gain from more attention to carefully knitting together the theoretical and management literature on alliances with the empirical, health policy and health services literature on cross-sector alliances in health care. In this chapter, we lay out what exists in the current scientific literature as well as a framework for considering much needed work in this area. We organize the literature and our commentary around the lifecycle of alliances: alliance formation, including factors prompting alliance formation, partner selection, and alliance goals; alliance maturity, including the work of these cross-sector alliances, governance, finance and contracts, staffing structure, and rewards; and critical crossroads, including alliance timelines, definitions of success, and dissolution. We also lay out critical areas for future inquiry, including better theorizing on cross-sector alliances, developing typologies of these cross-sector health care alliances, and the role of policy in cross-sector alliances.

Objective – To understand the role and influence of villagers’ trust for the health insurer on enrollment in a community-based health insurance (CBHI) scheme in Cambodia.

Methodology/approach – This study was conducted in northwest Cambodia where a CBHI scheme operates with the highest enrollment rates in the country. A mixed method approach was employed to gauge how individuals in the community trust the health insurer, and whether this plays a role in their decisions to enroll in CBHI schemes. Focus groups and household surveys were carried out to identify and measure trust levels, and to explore the association between insurer trust and enrollment in CBHI schemes.

Findings – Although villagers generally trusted the health insurance organization, villagers with poor experiences with other organizations in the past were less willing to trust the insurer. Insurer trust represented a combination of interpersonal and impersonal trust. After controlling for demographic factors, health care utilization, and household socio-economic status, insurer trust levels for villagers who newly enrolled (RRR=1.07, p<0.001) and renewed insurance (RRR=1.15, p<0.001) were significantly higher than those who never enrolled in CBHI schemes.

Implications for policy – This study illustrates the relationship between CBHI enrollment and villagers’ trust for the health insurer in a low-income, post-conflict country. It highlights the need for staff of health insurance organizations to place greater emphasis on building trusting interpersonal relationships with villagers. Understanding the nature of trust for the health insurer is essential to improve health insurance enrollment and protect people in poor rural communities against the impact of health-related shocks.

Purpose – This paper uses the theory of interagency information sharing as a lens to determine the benefits, risks, and past experiences of those involved in information sharing.

Design/Methodology/Approach – The authors analyze the current existent literature related to sharing of information between health care employers. A theory that could be useful in the creation of a policy and management framework that would facilitate information sharing is also thoroughly explored. Commentary and analysis result in strategies for health care employers to utilize when facing the challenging issues involved with hiring employees.

Findings – The paper details how human resource professionals can utilize technology and existing theory to properly implement information sharing techniques into their organization.

Originality/Value – The information technology changes that are taking place within health care organizations and systems across the country create the opportunity for these organizations and systems to proactively implement strategies that will positively affect organizational performance. By investing in information sharing techniques while utilizing the theories outlined in this paper, organizations and systems may avoid many of the issues associated with hiring problem employees.

Ivanitskaya, Glazer, and Erofeev (2009) suggest that “the most fundamental element of any organization that helps the organization to survive is the individual person” (p. 109). It is the motivation of human capital that makes a health care organization come to life. Health care is a unique industry; its accomplishments are directly dependent upon the competencies and technical skills of its employees. “When people in the workplace fulfill their organizational roles, then the organization thrives” (Ivanitskaya et al., 2009, p. 110). Health care systems will require organizations that thrive and exhibit characteristics of continuous growth, expressing excessive levels of energy and an immense capacity for flourishing. Anticipating the challenges of the next decade, health care organizations must achieve a higher degree of employee engagement to enhance organizational performance and profitability. The data analyzed for this chapter indicate that employees who are engaged are more enthusiastic and aspired to achieve both individual and organizational success. The chapter concludes by suggesting five operating practices to establish an employee engagement culture – defining the employee's role in fulfilling the organization's purpose, selecting employees with capability and passion, supporting and valuing the employee, creating sustainable reward systems, and developing feedback and reinforcement mechanisms.

There are longstanding concerns about the sustainability of the US health care system. Payment reform has been seen over the last decade as a key strategy to reorienting the US health care system around value. Alternative payment models (APMs) that seek to accomplish this goal have become increasingly prevalent in the US, yet there is a perception that physicians are resistant to their use and that organizations have been slow to adopt such models. The reasons for the limited effectiveness of APM programs are multifactorial and include aspects related to the design and implementation of these programs and lack of alignment and coordination across different payers and health care sectors. Most importantly, however, is that the current organizational structures in US health care serve to dampen the direct impact of these incentives, often because health care delivery organizations face conflicting incentives themselves. Organizations filter and refine the incentives from multiple external payment contracts and develop internal incentive systems that best reflect the amalgamation of the incentives embedded across their contracts, and thus the fragmented nature of the US health care system serves to undermine efforts to transform care under value-based contracts. In addition to organizations having conflicting incentives, there also are fundamental problems with the design and implementation of APMs that hinder their acceptance among physicians and the organizations in which they work. Moreover, much remains to be learned about how organizations can best adapt to succeed under these models, and how organizational culture can be leveraged to transform care.

According to the Census, racial/ethnic minority populations are growing at such a fast rate that by 2050 more than 50% of the population will belong to a minority group (US Census, 2001). The increasing diversity of the U.S. population is one of the many changes that health care delivery organizations need to proactively address in order to better serve their community and improve their performance. In this paper, we argue that cultural competency not only is important from a societal perspective, i.e., reducing health disparities, but can also be a strategy for health care organizations to improve quality, lower cost, and attract customers. We provide detailed recommendations for health care leaders and managers to adopt in order to successfully serve a diverse patient population.

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.

Sociology promotes and describes public health, helping to explain macro-social dynamics of mental health care through studies of organizations, networks, and systems of care.

This chapter summarizes sociological research on mental health care organizations and systems, illustrating a macro-social perspective by examining the problem of transitions in care for young adults. Summary findings from a regional mental health services research project describe a system of care that includes 100 organizations. This system helps young adults with mental health needs.

The scope and management of care involves a focus on modes of treatment supported by research evidence and delivered effectively by people with cultural competencies. Care and continuity of care are delivered through coordinated systems of inter-organizational networks, linking organizations and providers. Active inter-organizational linkages are needed to support mental health for young adults during challenging and sometimes difficult transitions.

This research summarizes original and regional data on mental health care organizations within a regional system of care. Practical implications include support for the importance of coordination, transition planning, and cultural competence within and among organizations. Sociological and original research on organizations and systems should continue to elaborate the needs and values of mental health services for regional planning and public health.

This chapter argues that organizations are not sustainable if they operate in unsustainable societal and ecological contexts, and that operating in a way that contributes to the health of the larger system requires organizations to develop new capabilities. It demonstrates the role that rich internal and external networks play in developing sustainability capability particularly in providing pathways to generate, import, apply, and disseminate knowledge about how to operate more sustainably.

The case study of the sustainability transition of Cleveland Clinic is based on four years of interviews and archival data collection examining the system’s transformational change that began in 2007. The case focuses on the building of sustainability capability, including an internal infrastructure to focus the organization on this outcome, and building of rich networks for learning and action. The case is framed with capability and network theory.

Guided and catalyzed by a small central group called the Office for a Healthy Environment, Cleveland Clinic has achieved measurable progress in key strategic focuses including waste diversion, energy efficiency, and increasing integration of local foods into its supply chain. To do so, it has developed strong internal networks to disseminate knowledge and accelerate innovation and adoption of sustainable practices. Strong, dynamic external networks have enabled Cleveland Clinic to import knowledge about sustainable practice from its environment, and have enabled it to help build the sustainability capability of its vendors, the community upon which it depends, and the health-care industry.

Starting with the perspective that the sustainability of an organization depends on the sustainability of the ecosystems in which it exists, this chapter focuses not on the design of specific sustainability initiatives, but on the dynamic networks that underpin the capability to simultaneously improve the health of the organization and of the larger ecosystem. This perspective provides insight into new organizing principles.

Health care organizations are facing the dual challenge of providing high-quality patient care at an affordable price. In this article, we argue that the role of people, or human resource management (HRM), and information, or health information technologies (HIT), is crucial in surmounting the above challenge. Specifically, we contend that HRM and HIT in health care are fundamental rather than support functions, and health care organizations need to build internal capabilities in both HRM and HIT to manage these resources effectively. Health care organizations vary in their levels of HRM and HIT capabilities. A few exceptional health care organizations have built both of these capabilities and have derived significant complementarities between HRM and HIT that, in turn, have allowed them to be leaders in value-based health care delivery. Several health care organizations have developed capabilities in either HRM or HIT but not in both, and still others have developed capabilities in neither function. Outsourcing of HRM and HIT by health care organizations is likely to hamper the integration and embedding of these functions in organizational operations. Although HIT has attracted significant attention from policy makers and health care organizations alike, it is not so with HRM. Most large-scale HIT initiatives that proceed without strong HRM capabilities are likely to result in disappointing outcomes. This occurs because the organizational change and development embodied in major HIT initiatives often cannot be sustained without strong HRM capabilities.