the outcomes and best practices documented in the scholarly literature published in top-tier journals in the past decade (D’Aunno, 2012).

Collaboration Among Hospitals

Results from several studies show that certain initial changes in collaborative ventures among hospitals come quickly, relatively easily, and in a sequence: (1) integration of management functions (e.g., finance and accounting, human resources, managed care contracting, quality assurance and improvement programs, and strategic planning), followed by (2) integration of patient support functions (e.g., patient education), and then (3) integration of low-volume clinical services (e.g., Eberhardt, 2001).

However, integrating or consolidating larger-scale clinical services and closure of service lines typically encounters strong opposition—in many cases, clinical service integration did not occur at all. Similarly, some studies report little success at integrating the medical cultures of merged hospitals even after 3 years of effort. In short, substantial changes in core clinical services take a long time, and success is not guaranteed as conflicting interests emerge among stakeholders.

Despite these difficulties, there are examples of successful collaborations in which contextual factors and change processes made important contributions. Specifically, results from several case studies show that creating a centralized decision-making authority promotes effective collaboration, especially to the extent that this authority can develop shared values and vision with which the partner organizations must identify (Bazzoli et al., 2004). Furthermore, support from top managers is critical, but it should be complemented by buy-in from lower levels. This requires a great deal of communication within and across levels of hierarchy. Finally, at least one study identified strong and continuous external pressure on the partner organizations as a key for promoting the integration of clinical services.

Collaboration Among Physician Groups

Coddington et al. (1998) provide a useful case study of the early stages of change that focused on bringing physician partners together. They identify key phases of (1) establishing trust, (2) assessing the fit between the relative strengths of the organizations, (3) assessing the ability to deliver a high-quality product, (4) developing a business strategy, and (5) considering effects on competitive position. Similarly, Robinson (1998) emphasized the importance of fit and relative strengths of partners in bringing them together.

In general, results from studies of collaboration among physician groups emphasize the importance of managing trade-offs and tensions



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