Formal and informal inter-organizational coordination: How nurses adapt in complex pathways.

Area of Science:

• Healthcare Management
• Nursing Practice
• Organizational Coordination

Background:

• Healthcare systems face increasing complexity and fragmentation.
• Administrative restructuring alone is insufficient to solve coordination challenges.
• The nursing profession plays a crucial role in inter-organizational coordination.

Purpose of the Study:

• To explore how nurses practice formal and informal inter-organizational coordination in complex healthcare pathways.
• To understand the interplay between formal and informal coordination among nurses.
• To identify specific informal coordination practices and their triggers.

Main Methods:

• Qualitative case study design.
• In-depth study of Danish nurses across hospital, municipality, and general practice settings.
• Analysis of inter-organizational coordination practices at the operative level.

Main Results:

• Nurses demonstrate loyalty to formal coordination mechanisms as a primary strategy.
• Informal coordination is activated when formal procedures are insufficient to address fragmentation.
• Identified informal practices include supplementary and by-passing strategies, with four specific by-passing practices detailed.
• Triggers for informal coordination include patient-centered engagement and the need for comprehensive oversight.

Conclusions:

• Informal coordination practices supplement and bypass formal mechanisms to enhance patient care.
• A lack of agency in formal coordination can lead to negotiated settlements.
• Informal coordination can be viewed as 'rule bending' within complex healthcare systems to achieve integration.