Evaluating organizational change in health care: the patient-centered hospital model

Abstract

BackgroundAn increasing number of hospitals react to recent demographic, epidemiological and managerial challenges moving from a traditional organizational model to a Patient-Centered (PC) hospital model. Although the theoretical managerial literature on the PC hospital model is vast, quantitative evaluations of the performance of hospitals that moved from the traditional to the PC organizational structure is scarce. However, quantitative analysis of effects of managerial changes is important and can provide additional argument in support of innovation.MethodsWe take advantage of a quasi-experimental setting and of a unique administrative data set on the population of hospital discharge charts (HDCs) over a period of 9 years of Lombardy, the richest and one of the most populated region of Italy. During this period three important hospitals switched to the PC model in 2010, whereas all the others remained with the functional organizational model. This allowed us to develop a difference-in-difference analysis of some selected measures of efficiency and effectiveness for PC hospitals focusing on the “between-variability” of the 25 major diagnostic categories (MDCs) in each hospital and estimating a difference-in-difference model.ResultsWe contribute to the literature that addresses the evaluation of healthcare and hospital change by providing a quantitative estimation of efficiency and effectiveness changes following to the implementation of the PC hospital model. Results show that both efficiency and effectiveness have significantly increased in the average MDC of PC hospitals, thus confirming the need for policy makers to invest in new organizational models close to the principles of PC hospital structures.ConclusionsAlthough an organizational change towards the PC model can be a costly process, implying a rebalancing of responsibilities and power among hospital personnel (e.g. medical and nursing staff), our results suggest that changing towards a PC model can be worthwhile in terms of both efficacy and efficiency. This evidence can be used to inform and sustain hospital managers and policy makers in their hospital design efforts and to communicate the innovation advantages within the hospital organizations, among the personnel and in the public debate.

High volumes of recent surgical admissions, time to surgery, and 60-day mortality

“…Patient-centered hospital logistics has been proposed as a method for introducing more effective clinical pathways to alleviate prioritization conflicts. 31 , 32 Following this concept, creating separate pathways for acute surgical patients, such as hip fracture patients, could minimize delays due to organizational factors. This includes the allocation of specific operating rooms and medical teams.…”

Organisational Change in Greece: Exploring Bottlenecks in Public Sector’s Hospital Management

“…Even though the understanding of the factors which define how satisfactory a public healthcare system is considered by society is a grey area (Bleich, Özaltin, & Murray, 2009), it must be stated that public healthcare services delivery doesn't seem to have met the expectations of the Greek society (Economou & Panteli, 2019;OECD, 2019). At the same time, international literature more and more advocates a necessary change of direction towards patient-centered and flatter organisational structures, with reduction of "waste", that is to say "from a functional/divisional model to a process-oriented model" (Martin, 2016;Fiorio, Gorli, & Verzillo, 2018). So, why is it that there was no attempt to implement this new organisational trend in Greek hospitals, so as the public healthcare system can respond to the needs of modern society?…”

Patient perspectives on interpersonal aspects of healthcare and patient-centeredness at primary health facilities: A mixed methods study in rural Eastern Uganda

“…Distinguishing among these similar concepts can be important as organizations progress towards patient-centeredness in their care. Additionally, the bulk of literature on PCC is still shaped by professional perspectives on what PCC should entail [ 20 , 21 ], organizational models [ 22 , 23 ] or health system recommendations [ 2 , 9 , 24 ]. Research on patients’ perspectives on PCC is rare and often guided by, or conducted in conjunction with different professional or disciplinary perspectives [ 25 – 27 ].…”