Quality in the interorganizational setting

For many patients, important health services are delivered by a process of care that spans several service organizations. Issues influencing the quality of care delivered across organizations are infrequently discussed in the health care quality literature. In this paper, interorganizational quality problems that detract from the care received by children with spina bifida, lead poisoning, and children who have been sexually abused are identified. Using concepts from the organizational behavior literature, both structural and group process approaches to addressing these problems are discussed to enhance the care received by children. A broader conceptualization of care delivery is required if patients whose care spans institutions are to benefit from quality improvement efforts.