Abstract
The role of time in developing a Boundaryless Hospital is explored, as time is a critical component in the dynamical evolution of a hospital’s interaction with its neighborhood, especially when health systems are calling for more coordination. It is expected that the effective coordination of care would promote, with time, and by a step-by-step process, the removing of the boundaries that still exist in local health systems.
A Local Health Unit in Portugal, established in 1999, was revised using case study approach, combining both qualitative and quantitative data. Kingdon’s “three-streams” theory was used to analyze the gaps between the intentions expressed by policy-makers and the reality of integration as perceived by performance results.
This Local Health Unit, within an organizational and legal framework aiming at optimizing services’ response through an integrated management of various health care facilities, involved several governments and difficult conditions. However, it successfully is presenting today several boundaryless hospital characteristics—from full quality certification in 2012, to strengthened links with primary care to reduce hospital admissions and to an information system that was critical to support referral services and, further, in establishing new connections with patients and other local players. After 16 years of effort trying to build a more integrated organization, time was clearly a critical factor. Time enabled the establishment a culture of working together to solve problems, to learn and understand their different requirements. Time is necessary to nurture the “organizational thread” that bonds the different care levels. The challenge of establishing a boundaryless hospital is multi-dimensional, but yields significant long-term benefits.
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Notes
- 1.
Pedro Hispano was a famous Portuguese physician from the XIII century who later became Pope John XXI.
References
Armitage GD, Suter E, Oelke ND, Adair CE (2009) Health systems integration: state of the evidence. Int J Integr Care 9:17
Braithwaite J, Vining RF, Lazarus L (1994) The boundaryless hospital. Aust NZ J Med 24(5):565–571
Berg M (2001) Implementing information systems in health care organizations: myths and challenges. Int J Med Inform 64(2):143–156
Bodenheimer T (2008) Coordinating care—a perilous journey through the health care system. N Engl J Med 358(10):1064
Canastra MA, Ferreira MA (2014) Perspetiva histórica da informação na ULSM. ICHI—International Congress on Health Information. ULS Matosinhos 39
Cardoso S, Lima G and Santos S (2014) Avoidable hospital admissions for ambulatory care sensitive conditions, ULS Matosinhos, 2008–2012
Enthoven AC, Tollen LA (2005) Competition in health care: it takes systems to pursue quality and efficiency. Health Aff 24(5):1383
Ferlie EB, Shortell SM (2001) Improving the quality of health care in the United Kingdom and the United States: a framework for change. Milbank Q 79(2):281–315
Grol R, Grimshaw J (2003) From best evidence to best practice: effective implementation of change in patients’ care. Lancet 362(9391):1225–1230
Kingdon JW (1995) Agenda, alternatives, and public policies, 2nd edn. HarperCollins College, New York
Kuhn KA, Giuse D, Lapão L et al (2007) Expanding the scope of health information systems. Methods Inf Med 46(4):500–502
Lapão LV (Coordination) (2014) AVALACES: primary-care management models and integration with secondary-care. Project report. Instituto de Higiene e Medicina Tropical, Lisbon
Lapão LV, Dussault G (2011) PACES: a national leadership program in support of primary-care reform in Portugal. Leadersh Health Serv 24(4):295–307
Lapão LV, Dussault G (2012) From policy to reality: clinical managers’ views of the organizational challenges of primary care reform in Portugal. Int J Health Plann Manage 27(4):295–307
McKee M (2004) Reducing hospital beds: what are the lessons to be learned? vol 6. WHO Regional Office for Europe, Copenhagen
Orlikowski WJ (1996) Improvising organizational transformation over time: a situated change perspective. Inf Sys Res 7(1):63–92
Pauly MV, Burns LR (2002) Integrated delivery networks: a detour on the road to integrated health care? Health Aff 21(4):128–143
Perkins J (2010) Digital school transformation. http://www.slideshare.net/joseph.perkins/digital-school-transformation-managing-change-with-effective-strategies. Accessed 20 Jul 2015
Portugal (1999a) Decree-Law 156/99. The definition of local health system. http://www.sindicatomedicosnorte.pt/portal/index.php/destaques/item/443-decreto-lei-156-99-de-10-de-maio. Accessed 20 Jul 2015
Portugal (1999b) Decree-Law 207/1999. The creation of the ULS Matosinhos. http://www.base-geral.com/pt/dr1/diploma-apresentar.asp?diploma=207___Decreto-Lei%5EDecreto-Lei&ano=1999. Accessed 20 Jul 2015
Portugal (2002a) Decree-Law 27/2002. The definition of the new legal regime of hospital management. http://www.acss.min-saude.pt/Portals/0/Circulares/Lei%2027%20-%2002.pdf. Accessed 20 Jul 2015
Portugal (2002b) Decree-Law 283/2002. The definition of limited company owned exclusively by public funds. http://dre.tretas.org/dre/158694/. Accessed 20 Jul 2015
Portugal (2005a) Decree-Law 93/2005. The actualization of the definition of limited company owned exclusively by public funds. http://www.sg.min-saude.pt/NR/rdonlyres/4D921E90-4382-4E9E-B682-3FE85F261D87/17862/36363637.pdf. Accessed 20 Jul 2015
Portugal (2005b) Decree-Law 233/2005. The definition of public enterprise entities. http://www.acss.min-saude.pt/Portals/0/DL%20n.°%20233.2005,%20de%2012-29%20(Consolidado).pdf. Accessed 20 Jul 2015
Portugal (2005c) Resolution from the Council of Ministers 102/2005. The creation of the “Public Administration Restructuring Program” (PRACE). http://www.dgaep.gov.pt/media/0701020000/Cap%C3%ADtulos%201%20a%204/cap1_3/cap%20I.pdf. Accessed 20 Jul 2015
Portugal (2008) Decree-Law 28/2008. The creation of new health centers groups (ACES). http://www.smzc.pt/attachments/132_DL_28_2008_ACES.pdf. Accessed 20 Jul 2015
Portugal (2009) Decree-Law No 127/2009. Definition of the National Health Regulatory Agency. http://www.sindicatomedicosnorte.pt/portal/index.php/legislacao/outra-legislacao/item/547-decreto-lei-n-127-2009-de-27-de-maio. Accessed 20 Jul 2015
Ramsay A, Fullop N, Edwards N (2009) The evidence base for vertical integration in health care. J Integr Care 17(2):3–12
Singh D, Ham C (2005) Transforming chronic care: evidence about improving care for people with long-term conditions. http://www.download.bham.ac.uk/hsmc/pdf/transforming_chronic_care.pdf. Accessed 20 Jul 2015
Starfield B (1998) Primary care: balancing health needs, services, and technology. Oxford University Press, Oxford
Starfield B, Shi L, Macinko J (2005) Contribution of primary care to health systems and health. Milbank Q 83(3):457–502
Suter E, Oelke ND, Adair CE et al (2009) Ten key principles for successful health systems integration. Healthc Q 13:16–23
ULSM (2014) Relatório de Actividade da Unidade Local de Saúde de Matosinhos ULSM, Matosinhos
Walshe K, Rundall TG (2001) Evidence‐based management: from theory to practice in health care. Milbank Q 79(3):429–457
Weick KE (1995) Sensemaking in organizations. Sage, London
Weick KE, Quinn RE (1999) Organizational change and development. Annu Rev Psychol 50(1):361–386
Yin RK (2001) Case studies—planning and methods, 2nd edn. Bookman, New York
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Lapão, L.V. (2016). The Importance of Time in Developing a Boundaryless Hospital: An Example from Northern Portugal. In: Albach, H., Meffert, H., Pinkwart, A., Reichwald, R., von Eiff, W. (eds) Boundaryless Hospital. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-49012-9_5
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