Evaluation of the Lovell Federal Health Care Center Merger Findings, Conclusions, and Recommendations (2012) / Chapter Skim
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Appendix D: Collaboration Among Health Care Organizations: A Review of Outcomes and Best Practices for Effective Performance
Appendix D: Collaboration Among Health Care Organizations: A Review of Outcomes and Best Practices for Effective Performance
Pages 227-258
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review evidence on the context and outcomes of collaboration among health care provider organizations and (2) examine results concerning the processes of change and implementation practices involved in efforts to collaborate (to what extent, and how, these factors affect the outcomes of collaboration)
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and the service delivery models it promotes, as well as related payfor-performance reforms that aim to improve quality of care. Unfortunately, the majority of collaborative ventures among health care organizations fail to significantly improve the overall performance of participants; there is a great deal of variation in outcomes (Bazzoli et al., 2004; Cartwright and Schoenberg, 2006; King et al., 2004)
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Content of Collaboration: Context: Mergers, Processes of Organizational, Alliances, and Change, Outcomes of Local, and Joint Ventures Implementation Collaboration National Among Hospitals Practices and Physician Groups FIGURE D-1 Conceptual framework of collaboration among health care organizations. Figure D-1, BW
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show that hospitals with weak financial performance were more likely to merge or join multihospital arrangements. In contrast, studies of hospital mergers and alliances in the 1990s suggest that these efforts were
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. The potential financial benefits from hospital mergers may stem from (1)
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In addition to examining the effects of hospital mergers and alliances, Bazzoli et al.
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Third, in contrast to the results for mergers, there are fewer improvements in the financial performance of hospitals that join multihospital systems. Results from well-executed studies by Dranove and colleagues (1996; Dranove and Lindrooth, 2003)
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. More work is needed, however, to understand the effects of organizational characteristics, including the structure of decision making, on the financial performance of hospital systems and alliances (see Bazzoli et al., 2006; Luke, 2006; Trinh et al., 2010)
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. PHOs are joint ventures designed to develop new services (e.g., ambulatory care clinics)
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In particular, a review of the empirical literature suggests that collaboration based on economic integration yields few consistent effects on cost, quality, or clinical integration. Alliances based on noneconomic integration are widespread, but have not been subjected to rigorous academic study.
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Results for other outcomes are mixed and, importantly, there is substantial variation in the performance of collaborative ventures. MAKING COLLABORATION WORK: IMPLEMENTATION AND ORGANIZATIONAL CHANGE Researchers and practitioners have proposed several explanations to account for the substantial variation observed in the performance of collaborative ventures in health care and non-health care fields.
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. Prior work indicates that collaborative ventures may be more likely to emerge when potential partners
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A recent review of 40 studies of alliances concluded that the complementarity of partners not only promotes alliance formation, but also contributes to alliance performance (Shah and Swaminathan, 2008)
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Each potential partner should plan carefully by constructing net present valuations of alternative relationships on a continuum ranging from maintaining the status quo (i.e., maintaining independence and arm's-length transactions with other organizations) to forming alliances or joint ventures (i.e., a formal cooperative arrangement among organizations, preserving the independent identity of each partner)
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It is thus critical that managers ensure that initial efforts and programs are responsive to partners' needs, in order to build their commitment to collaboration. Collaboration projects of any form vary in the extent to which their partners are willing to commit resources to initiate and sustain programs and activities.
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and overcoming barriers to effective collaboration is one of the defining challenges for leaders. The critical role of leadership has been largely neglected in prior work, which has focused mainly on the technical aspects of launching and managing mergers, alliances, and joint ventures, or, more often, their outcomes.
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, including the complexity of the organizational change implementation process. The fact that planned organizational change implementation involves different activities in which leadership competencies might play different roles has largely been ignored by the leadership literature (Higgs and Rowland, 2005)
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Managers need a mix of leadership competencies for effectively leading planned organizational change. Leaders undertake specific activities to implement planned organizational change projects (Galpin, 1996; Judson, 1991; Kotter, 1995; Lewin, 1947; Rogers, 1962)
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. In the context of planned organizational change, consideration for others makes them likely to anticipate the emotional reactions of those involved in the change process and to take the required steps to attend to those reactions (Huy, 2002; Oreg, 2003)
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Redesigning existing organizational processes and systems to facilitate coalition building requires task-oriented skills. Leaders who are effective at task-oriented behaviors are skilled in designing organizational processes and systems that induce people to adopt new work patterns (Bass, 1990)
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Despite these difficulties, however, there are examples of successful collaboration 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
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and systems change (especially information systems) are needed to promote change and to improve organizational performance People-Focused Leadership Tasks External pressure In most cases, external pressure/support for change increases both its speed and likelihood of success Buy-in from all levels; critical role Support from top managers and leaders is essential, of central authority and shared but buy-in is also needed from lower-level staff; a vision centralized group with authority for implementation of changes is critical, especially to develop a shared vision and goals for change Communication Communication is needed at all levels: What is the vision; why change is needed; what progress has been achieved Role of physician leaders Involvement of physician leaders, both formal and informal, in key decisions is critical to success Managing tensions, trade-offs Involving physicians versus respecting their time inherent in change for patient care; time needed to build trust versus frustration with slow progress; building stakeholder buy-in versus building technical capacity (especially when buy-in and trust are enhanced by demonstrated technical capacity and improved performance)
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In general, results from studies of collaboration among physician groups emphasize the importance of managing trade-offs and tensions involved in organizational change, for example, • involving physicians versus respecting their time for patient care; • slowly building trust versus frustration with slow progress; and • building stakeholder buy-in versus building technical capacity (es pecially when buy-in and trust are enhanced by demonstrated technical capacity and improved performance)
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An exception to this result is hospital mergers, which seem to improve members' financial performance, though not necessarily to societal advantage; available evidence indicates that improved performance comes mainly from increased market power rather than efficiency from gains. Second, the financial performance of hospital mergers appears to be stronger than results obtained from other forms of collaboration.
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Promoting more effective collaboration in health care will require a broader, interdisciplinary approach. Indeed, it is likely that current collaborative ventures among health care organizations may face greater challenges than in the past due to the increased complexity of the organizations themselves, including, for example, the difficulty of integrating their information technologies.
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2006. The Federal Trade Commission, clinical integration, and the organiza tion of physician practice.
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1997. Strategic hospital alliances: Impact on financial performance.
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2011. The impact of hospital mergers on treatment intensity and health out comes.
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Strategic Management Journal 25(6)
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Strategic Management Journal 30(13)
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1991. New organizational forms for enhanc ing innovation: The case of internal corporate joint ventures.
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