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Towards Process-Oriented Hospital Structures; Drivers behind the Development of Hospital Designs

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  • Jeroen D. H. van Wijngaarden

    (Health Services Management & Organisation, Erasmus School of Health Policy and Management, Erasmus University Rotterdam, 3062 PA Rotterdam, The Netherlands)

  • Anoek Braam

    (Health Services Management & Organisation, Erasmus School of Health Policy and Management, Erasmus University Rotterdam, 3062 PA Rotterdam, The Netherlands)

  • Martina Buljac-Samardžić

    (Health Services Management & Organisation, Erasmus School of Health Policy and Management, Erasmus University Rotterdam, 3062 PA Rotterdam, The Netherlands)

  • Carina G. J. M. Hilders

    (Health Services Management & Organisation, Erasmus School of Health Policy and Management, Erasmus University Rotterdam, 3062 PA Rotterdam, The Netherlands
    Raad van Bestuur, Reinier de Graaf Gasthuis, 2625 AD Delft, The Netherlands)

Abstract

Hospitals have been encouraged to develop more process-oriented designs, structured around patient needs, to better deal with patients suffering from multi-morbidity. However, most hospitals still have traditional designs built around medical specialties. We aimed to understand how hospital designs are currently developing and what the important drivers are. We built a typology to categorize all Dutch general hospitals (61), and we interviewed hospital managers and staff. The inventory showed three types of hospital building blocks: units built around specific medical specialties, clusters housing different medical specialty units, and centers; multi-specialty entities provide the most suitable structure for a process-oriented approach. Only some Dutch hospitals (5) are mainly designed around centers. However, most hospitals are slowly developing towards hybrid designs. Competitive drivers are not important for stimulating these redesigns. Institutional pressures from within the health care sector and institutional ‘mimicking’ are the main drivers, but the specific path they take is dependent on their ‘heritage’. We found that hospital structures are more the result of incremental, path-dependent choices than ‘grand-designs’. Although the majority of the Dutch general hospitals still have a general design built around medical specialties, most hospitals are moving towards a more process-oriented design.

Suggested Citation

  • Jeroen D. H. van Wijngaarden & Anoek Braam & Martina Buljac-Samardžić & Carina G. J. M. Hilders, 2023. "Towards Process-Oriented Hospital Structures; Drivers behind the Development of Hospital Designs," IJERPH, MDPI, vol. 20(3), pages 1-12, January.
    • Handle: RePEc:gam:jijerp:v:20:y:2023:i:3:p:1993-:d:1043456
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    References listed on IDEAS

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    1. Lega, Federico & DePietro, Carlo, 2005. "Converging patterns in hospital organization: beyond the professional bureaucracy," Health Policy, Elsevier, vol. 74(3), pages 261-281, November.
    2. Sandra G. Leggat & Timothy Bartram & Pauline Stanton & Greg J. Bamber & Amrik S. Sohal, 2015. "Have process redesign methods, such as Lean, been successful in changing care delivery in hospitals? A systematic review," Public Money & Management, Taylor & Francis Journals, vol. 35(2), pages 161-168, March.
    3. Martin van Ineveld & Jeroen van Wijngaarden & Gerard Scholten, 2018. "Choosing cooperation over competition; hospital strategies in response to selective contracting," International Journal of Health Planning and Management, Wiley Blackwell, vol. 33(4), pages 1082-1092, October.
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