The organizational impact of value-based health care: structure-related opportunities and challenges of condition-based units integrated within functional hospital structures
Femke Meijer, Paul Van der Nat, Dirk Vriens, Patrick Vermeulen, Dorine van StaalduinenPurpose
Value-based health care proposes that hospitals implement condition-based units (CBUs) to enhance patient value and foster collaboration among professionals. Although CBUs are proposed as an alternative to traditional functional hospital structures, many hospitals insert them within their existing functional structures. Using structural design theory as a framework, this study aims to examine the structure-related opportunities and challenges associated with CBUs integrated within functional hospital structures in order to understand how this integration affects their ability to improve patient value and collaboration.
Design/methodology/approach
A qualitative multiple case study was conducted with members of 6 CBUs across 2 Dutch hospitals, involving 26 interviews analyzed thematically.
Findings
Our findings show that the functional structure provides CBUs with resources and specialized expertise, including support on project management and data analysis. However, integrating CBUs within the functional structure can lead to ambiguity in decision-making authority within CBU processes, involve multiple stakeholders in CBU-related decisions and generate tensions between departmental and CBU goals.
Practical implications
We recommend that hospital managers adopt a learning-oriented, experimental approach to gradually integrate care delivery and decision-making within CBUs, while positioning the functional structure as a supportive infrastructure.
Originality/value
By identifying structure-related opportunities and challenges, this study addresses the lack of understanding regarding the consequences of implementing CBUs within functional hospital structures and indicates the need for hospitals to take additional measures to leverage opportunities and address associated challenges to maximize the potential of CBUs.