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Defining hospital's internal boundaries. An organisational complexity criterion

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  • Mariani, Laura
  • Cavenago, Dario

Abstract

The aim of this paper is to provide empirical evidences supporting the definition of hospital wards’ boundaries in organisational designing processes, by suggesting services aggregation criteria that are focused on organisational complexity. In order to test the research hypotheses, a panel data analysis was conducted on Lombardy hospitals in Italy. Information was gathered both from administrative records – aggregated at in-patient ward level – and general registry offices. The results highlight that the wards offering integrated services perform better than those that are more specialised. However, for growing levels of within-complexity, the positive effects of formal integration between wards tend to reduce. Some guidelines for practitioners engaged in defining hospitals’ organisational structures can be drawn from the empirical analysis.

Suggested Citation

  • Mariani, Laura & Cavenago, Dario, 2014. "Defining hospital's internal boundaries. An organisational complexity criterion," Health Policy, Elsevier, vol. 117(2), pages 239-246.
    • Handle: RePEc:eee:hepoli:v:117:y:2014:i:2:p:239-246
    DOI: 10.1016/j.healthpol.2014.04.008
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    1. Alfredo Esposto, 2004. "Contractual Integration of Physician and Hospital Services in the U.S," Journal of Management & Governance, Springer;Accademia Italiana di Economia Aziendale (AIDEA), vol. 8(1), pages 49-69, March.
    2. Robert G. Evans & Hugh D. Walker, 1972. "Information Theory and the Analysis of Hospital Cost Structure," Canadian Journal of Economics, Canadian Economics Association, vol. 5(3), pages 398-418, August.
    3. Sendil K. Ethiraj & Daniel Levinthal, 2004. "Modularity and Innovation in Complex Systems," Management Science, INFORMS, vol. 50(2), pages 159-173, February.
    4. Lee, Kwang-soo & Chun, Ki-hong & Lee, Jung-soo, 2008. "Reforming the hospital service structure to improve efficiency: Urban hospital specialization," Health Policy, Elsevier, vol. 87(1), pages 41-49, July.
    5. Brahm, Francisco & Tarziján, Jorge, 2012. "The impact of complexity and managerial diseconomies on hierarchical governance," Journal of Economic Behavior & Organization, Elsevier, vol. 84(2), pages 586-599.
    6. Lega, Federico & DePietro, Carlo, 2005. "Converging patterns in hospital organization: beyond the professional bureaucracy," Health Policy, Elsevier, vol. 74(3), pages 261-281, November.
    7. Alfons Palangkaraya & Jongsay Yong, 2013. "Effects of competition on hospital quality: an examination using hospital administrative data," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 14(3), pages 415-429, June.
    8. Annette Tomal, 1998. "The relationship between hospital mortality rates, and hospital, market and patient characteristics," Applied Economics, Taylor & Francis Journals, vol. 30(6), pages 717-725.
    9. Stefano Villa & Marta Barbieri & Federico Lega, 2009. "Restructuring patient flow logistics around patient care needs: implications and practicalities from three critical cases," Health Care Management Science, Springer, vol. 12(2), pages 155-165, June.
    10. Sarv Devaraj & Rajiv Kohli, 2003. "Performance Impacts of Information Technology: Is Actual Usage the Missing Link?," Management Science, INFORMS, vol. 49(3), pages 273-289, March.
    11. Whitacre, Brian E. & Fannin, James Matthew & Barnes, James N., 2008. "Factors Affecting Outsourcing for Information Technology Services in Rural Hospitals: Theory and Evidence," 2008 Annual Meeting, February 2-6, 2008, Dallas, Texas 6393, Southern Agricultural Economics Association.
    12. Farley, Dean E., 1989. "Measuring casemix specialization and the concentration of diagnoses in hospitals using information theory," Journal of Health Economics, Elsevier, vol. 8(2), pages 185-207, June.
    13. Paolo Berta & Chiara Seghieri & Giorgio Vittadini, 2013. "Comparing health outcomes among hospitals: the experience of the Lombardy Region," Health Care Management Science, Springer, vol. 16(3), pages 245-257, September.
    14. Wood, Robert E., 1986. "Task complexity: Definition of the construct," Organizational Behavior and Human Decision Processes, Elsevier, vol. 37(1), pages 60-82, February.
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