Unravelling collaborative governance dynamics within healthcare networks: a scoping review.

IF 2.9 3区 医学 Q2 HEALTH CARE SCIENCES & SERVICES
Zakaria Belrhiti, Maryam Bigdeli, Aniss Lakhal, Dib Kaoutar, Saad Zbiri, Sanaa Belabbes
{"title":"Unravelling collaborative governance dynamics within healthcare networks: a scoping review.","authors":"Zakaria Belrhiti, Maryam Bigdeli, Aniss Lakhal, Dib Kaoutar, Saad Zbiri, Sanaa Belabbes","doi":"10.1093/heapol/czae005","DOIUrl":null,"url":null,"abstract":"<p><p>In many countries, healthcare systems suffer from fragmentation between hospitals and primary care. In response, many governments institutionalized healthcare networks (HN) to facilitate integration and efficient healthcare delivery. Despite potential benefits, the implementation of HN is often challenged by inefficient collaborative dynamics that result in delayed decision-making, lack of strategic alignment and lack of reciprocal trust between network members. Yet, limited attention has been paid to the collective dynamics, challenges and enablers for effective inter-organizational collaborations. To consider these issues, we carried out a scoping review to identify the underlying processes for effective inter-organizational collaboration and the contextual conditions within which these processes are triggered. Following appropriate methodological guidance for scoping reviews, we searched four databases [PubMed (n = 114), Web of Science (n = 171), Google Scholar (n = 153) and Scopus (n = 52)] and used snowballing (n = 22). A total of 37 papers addressing HN including hospitals were included. We used a framework synthesis informed by the collaborative governance framework to guide data extraction and analysis, while being sensitive to emergent themes. Our review showed the prominence of balancing between top-down and bottom-up decision-making (e.g. strategic vs steering committees), formal procedural arrangements and strategic governing bodies in stimulating participative decision-making, collaboration and sense of ownership. In a highly institutionalized context, the inter-organizational partnership is facilitated by pre-existing legal frameworks. HN are suitable for tackling wicked healthcare issues by mutualizing resources, staff pooling and improved coordination. Overall performance depends on the capacity of partners for joint action, principled engagement and a closeness culture, trust relationships, shared commitment, distributed leadership, power sharing and interoperability of information systems To promote the effectiveness of HN, more bottom-up participative decision-making, formalization of governance arrangement and building trust relationships are needed. Yet, there is still inconsistent evidence on the effectiveness of HN in improving health outcomes and quality of care.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":"412-428"},"PeriodicalIF":2.9000,"publicationDate":"2024-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11005841/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Health policy and planning","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1093/heapol/czae005","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"HEALTH CARE SCIENCES & SERVICES","Score":null,"Total":0}
引用次数: 0

Abstract

In many countries, healthcare systems suffer from fragmentation between hospitals and primary care. In response, many governments institutionalized healthcare networks (HN) to facilitate integration and efficient healthcare delivery. Despite potential benefits, the implementation of HN is often challenged by inefficient collaborative dynamics that result in delayed decision-making, lack of strategic alignment and lack of reciprocal trust between network members. Yet, limited attention has been paid to the collective dynamics, challenges and enablers for effective inter-organizational collaborations. To consider these issues, we carried out a scoping review to identify the underlying processes for effective inter-organizational collaboration and the contextual conditions within which these processes are triggered. Following appropriate methodological guidance for scoping reviews, we searched four databases [PubMed (n = 114), Web of Science (n = 171), Google Scholar (n = 153) and Scopus (n = 52)] and used snowballing (n = 22). A total of 37 papers addressing HN including hospitals were included. We used a framework synthesis informed by the collaborative governance framework to guide data extraction and analysis, while being sensitive to emergent themes. Our review showed the prominence of balancing between top-down and bottom-up decision-making (e.g. strategic vs steering committees), formal procedural arrangements and strategic governing bodies in stimulating participative decision-making, collaboration and sense of ownership. In a highly institutionalized context, the inter-organizational partnership is facilitated by pre-existing legal frameworks. HN are suitable for tackling wicked healthcare issues by mutualizing resources, staff pooling and improved coordination. Overall performance depends on the capacity of partners for joint action, principled engagement and a closeness culture, trust relationships, shared commitment, distributed leadership, power sharing and interoperability of information systems To promote the effectiveness of HN, more bottom-up participative decision-making, formalization of governance arrangement and building trust relationships are needed. Yet, there is still inconsistent evidence on the effectiveness of HN in improving health outcomes and quality of care.

揭示医疗保健网络中的合作治理动态:范围界定审查。
在许多国家,医疗保健系统都存在医院和初级保健之间各自为政的问题。为此,许多国家的政府将医疗保健网络(HN)制度化,以促进整合和高效的医疗保健服务。尽管医疗保健网络具有潜在的好处,但其实施往往受到低效合作动力的挑战,这些动力导致决策延迟、缺乏战略协调以及网络成员之间缺乏互信。然而,人们对组织间有效合作的集体动力、挑战和促进因素的关注却很有限。为了研究这些问题,我们进行了一次范围界定研究,以确定有效组织间合作的基本过程以及引发这些过程的背景条件。根据范围界定综述的适当方法指导(Arksey 和 O Malley,2005 年),我们检索了四个数据库(PubMed(114 篇)、Web of Science(171 篇)、Google Scholar(153 篇)、Scopus(52 篇)和 snowballing(22 篇))。其中包括医院在内的 37 篇论文涉及 HN。我们根据(Emerson,2011 年)合作治理框架,采用框架综合法指导数据提取和分析,同时对新出现的主题保持敏感。我们的综述表明,平衡自上而下和自下而上的决策(如战略委员会和指导委员会)、正式的程序安排和战略管理机构在激励参与式决策、协作和主人翁意识方面的作用十分突出。在高度制度化的背景下,组织间的伙伴关系可以通过已有的法律框架得到促进。保健网适合通过资源共享、人员共用和加强协调来解决棘手的保健问题。整体绩效取决于合作伙伴采取联合行动的能力、有原则的参与和亲密文化、信任关系、共同承诺、分布式领导、权力共享和信息系统的互操作性。为提高人道主义网络的有效性,需要更多自下而上的参与式决策、治理安排的正规化以及建立信任关系。然而,关于保健网在改善医疗效果和护理质量方面的有效性,目前仍没有一致的证据。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
Health policy and planning
Health policy and planning 医学-卫生保健
CiteScore
6.00
自引率
3.10%
发文量
98
审稿时长
6 months
期刊介绍: Health Policy and Planning publishes health policy and systems research focusing on low- and middle-income countries. Our journal provides an international forum for publishing original and high-quality research that addresses questions pertinent to policy-makers, public health researchers and practitioners. Health Policy and Planning is published 10 times a year.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信