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Organization design of integrated delivery systems.
1Veterans Health Administration, Boston, MA 02130, USA.
Hospital & Health Services Administration
|April 2, 1999
Summary
Healthcare integrated delivery systems (IDSs) evolve through four stages, with increasing interdependence. Achieving system effectiveness requires reciprocal interdependence and strong integrative management, particularly in community healthcare systems.
Area of Science:
- Healthcare Management
- Organizational Behavior
- Health Services Research
Background:
- Healthcare integrated delivery systems (IDSs) evolve through distinct developmental stages.
- Each stage exhibits increasing levels of interdependence among facilities and with physicians.
Purpose of the Study:
- To analyze interdependencies at each stage of IDS development.
- To examine organizational design characteristics for addressing interdependencies.
- To evaluate the Veterans Health Administration (VHA) within this framework.
Main Methods:
- Review of empirical and conceptual literature on IDSs.
- Analysis of interdependencies across four IDS developmental stages.
- Examination of organizational design and integrative management strategies.
Main Results:
- IDSs progress from cottage industry (competition) to community healthcare (reciprocal interdependence).
- Higher interdependence necessitates stronger organizational integrating mechanisms like integrative management.
- The VHA's organization aligns with these stages of IDS evolution.
Conclusions:
- Reciprocal interdependence is crucial for community healthcare system effectiveness.
- Integrative management is a key mechanism for addressing complex interdependencies.
- Organizational designs must adapt to meet increasing integration needs in healthcare systems.