Governance of Integrated Delivery Systems/Networks: A Stakeholder Approach

Savage, Grant T.; Taylor, Rosemary L.; Rotarius, Timothy; Buesseler, John A.

doi:10.1097/00004010-199702210-00002

Cited by 24 publications

(23 citation statements)

References 18 publications

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“…CCOs are working to solve fundamental problems within the financing, delivery, and organization of health and health care services for a specified population. Results of this study suggest that collaborative governance offers a new and innovative approach for local communities to collaborate through new partnerships to set priorities, make The results of the study support existing theory and literature Savage, Taylor, Rotarius, & Buesseler, 1997), which suggest that four broad dimensions influence the model of collaborative governance within a CCO:…”

Section: Chapter 5: Discussion Conclusion and Recommendations For supporting

confidence: 72%

“…In the health administration literature, four dimensions of governance are often cited for integrated delivery systems or networks: control, structure, composition, and functioning Savage, Taylor, Rotarius, & Buesseler, 1997). The results of this study provide an understanding of whether the four governance dimensions affect an organization's ability to effectively manage issues and challenges faced by a CCO (Savage et al, 1997, p. 12).…”

Section: Collaborative Governance and Ccosmentioning

confidence: 87%

“…control, structure, composition, and functioning Savage, Taylor, Rotarius, & Buesseler, 1997). These were adopted with some modification as the key constructs for examining the governance structure of a CCO.…”

Section: Dimensions Of Governancementioning

confidence: 99%

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A Case Study of Collaborative Governance: Oregon Health Reform and Coordinated Care Organizations

Droppers

John²

2000

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The complexity of issues in health care in the United States-specifically insurance coverage, access, affordability, quality of care, and financing-requires effective new models for governing, in which governmental and non-governmental organizations seek to solve problems collaboratively rather than independently. This research explores collaborative governance as a model to form new partnerships among for-profit, nonprofit, and public organizations in an effort to create community-based, locally governed health care entities in Oregon through coordinated care organizations (CCOs). A key question is whether collaboration, through CCOs, brings together government and non-governmental organizations to solve "intractable problems" by establishing new public-private partnerships in Medicaid. The research focuses on the formation of CCOs, including the influence of local, political, institutional, and historical contexts, planning processes, and governance structures. The hypothesis is that conditions, norms, governance structures and processes, and the presence or absence of a combination of these factors, facilitate or impede participation and decision-making, and over time, successful system integration by these new complex organizations.This study developed insights into similarities and differences among CCO governance structures by investigating three CCOs. Findings from the case study suggest that the following key factors influence the collaborative governance process among government and non-governmental organizations within CCOs: prior history of conflict or cooperation; open, transparent, and inclusive processes for stakeholders; face-to-face OREGON HEALTH REFORM AND COORDINATED CARE ORGANIZATIONS ii dialogue, trust building, and shared understanding; and high-functioning governing boards. Results also indicate that maintaining stakeholder participation can be challenging due to time and cost, power imbalances and competing interests among stakeholders, and mistrust and lack of facilitative leadership. The results suggest that collaborative governance is a strategic approach for the allocation of limited resources across public, private, and nonprofit organizations to deliver services to Oregon's Medicaid population.

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Section: Chapter 5: Discussion Conclusion and Recommendations For supporting

confidence: 72%

Section: Collaborative Governance and Ccosmentioning

confidence: 87%

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A Case Study of Collaborative Governance: Oregon Health Reform and Coordinated Care Organizations

Droppers

John²

2000

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“…mandated and voluntary coordination), and to the kinds of governance of network integration. Governance is defined as the distribution of authority or regulation power and the overseeing of networks activities and decisions (Park, 1996;Savage et al, 1997).…”

Section: Analytic Model Of Pros Implementation and Of Its Impact On Nmentioning

confidence: 99%

Regional planning implementation and its impact on integration of a mental health care network

Fleury¹,

Mercier²,

Denis³

2002

Health Planning & Management

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This article questions the effectiveness of a managerial tool in changing a health-care system. The process of implementing regional planning and its impact on creating integrated service networks is examined, using a case study and a multi-dimensional analytic model. This model highlights the influence of contextual, structural, cultural and dynamic factors on forming networks. The regional planning developed in the province of Québec (Canada), aimed at a major transformation of the mental health-care system. In each district, organizations working with people who have serious mental disorders were mobilized to plan and implement a more coordinated, continuous and diversified supply of services, under the direction of a regional health body. This study outlines the limitations of regional planning as a tactic for transforming the system. It recommends instead developing more diversified integration strategies to further the process of forming integrated service networks within a complex system. In conclusion, a brief discussion deals with the difficulties related to the study of systemic change implementation.

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“…” [1, p. 3]. An integrated care system provides “ a coordinated continuum of health services for a defined population ” [5, p. 7]. Integrated care systems are based on a collaborative arrangement approach [4].…”

Section: Theoretical Framework Structuring Innovation and Diversitymentioning

confidence: 99%

Structuring an integrated care system: interpreted through the enacted diversity of the actors involved – the case of a French healthcare network

Grenier¹

2011

Int J Integr Care

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Research question: We are looking at the process of structuring an integrated care system as an innovative process that swings back and forth between the diversity of the actors involved, local aspirations and national and regional regulations. We believe that innovation is enriched by the variety of the actors involved, but may also be blocked or disrupted by that diversity. Our research aims to add to other research, which, when questioning these integrated systems, analyses how the actors involved deal with diversity without really questioning it.Case study: The empirical basis of the paper is provided by case study analysis. The studied integrated care system is a French healthcare network that brings together healthcare professionals and various organisations in order to improve the way in which interventions are coordinated and formalised, in order to promote better detection and diagnosis procedures and the implementation of a care protocol. We consider this case as instrumental in developing theoretical proposals for structuring an integrated care system in light of the diversity of the actors involved. Results and discussion:We are proposing a model for structuring an integrated care system in light of the enacted diversity of the actors involved. This model is based on three factors: the diversity enacted by the leaders, three stances for considering the contribution made by diversity in the structuring process and the specific leading role played by those in charge of the structuring process. Through this process, they determined how the actors involved in the project were differentiated, and on what basis those actors were involved. By mobilising enacted diversity, the leaders are seeking to channel the emergence of a network in light of their own representation of that network. This model adds to published research on the structuring of integrated care systems.

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Governance of Integrated Delivery Systems/Networks: A Stakeholder Approach

Cited by 24 publications

References 18 publications

A Case Study of Collaborative Governance: Oregon Health Reform and Coordinated Care Organizations

A Case Study of Collaborative Governance: Oregon Health Reform and Coordinated Care Organizations

Regional planning implementation and its impact on integration of a mental health care network

Structuring an integrated care system: interpreted through the enacted diversity of the actors involved – the case of a French healthcare network

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