Supporting self-managing care teams: A structural diagnosis of the support of self-managing care teams in a healthcare organisation
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2022-07-15
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en
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The development of self-managing care teams at HCO is under pressure. Improvement opportunities appear to be related to the way in which support activities are designed in the organisational structure. The goal of this research is to contribute to improving the support of self-managing care teams at HCO by means of a structural diagnosis of the support of self-managing care teams.
Three support processes at HCO are analysed, which are the intake of clients, ICT support, and the scheduling of workers. It is desirable that support activities are relevant, accurate, timely, and complete (Kuipers, Van Amelsvoort & Kramer, 2020). Gaps in the support of self-managing care teams were identified by means of interviews and observations. De Sitter’s sociotechnical design theory (De Sitter, 1994; Achterbergh & Vriens, 2010; 2019; n.d.; Kuipers, Van Amelsvoort & Kramer, 2020) was used to find structure related causes of identified gaps.
With regard to the intake process at HCO, gaps in the relevance, accuracy, timeliness, completeness, and understanding of other task groups of activities were identified. Furthermore, it appears that members of care teams do not always know where or from whom to request support. The degree of functional concentration, differentiation of operational activities, specialisation of operational activities, and separation of operational and regulatory activities appear to be structure related causes for the identified gaps. The need for integration of the intake process into the primary care process appears to be high, and there appear to be few contextual constraints for low parameter values. The intake process at HCO can be improved by integrating the intake process with the primary care process, integrating activities currently divided between the care mediation team and the care administration team, and integrating activities which are currently performed by the planning and control department with the primary care process.
With regard to ICT support at HCO, gaps in the relevance, accuracy, timeliness, completeness, and understanding of other task groups were identified. Furthermore, it appears that users do not always know how to formulate an ICT related question or problem. The degree of separation of operational and regulatory activities, and specialisation of regulatory activities appear to be structure related causes for the identified gaps. The need for integration of ICT support activities into the primary care process is relatively high, but there are pressing contextual constraints for low parameter values, such as the required knowledge and skills, and professional identity. Activities which do not require specialised knowledge and skills, and which are often performed, can be insourced or decentralised. Resetting passwords and stewardship of home and care automation devices are examples of activities which appear to be able to be insourced and decentralised.
With regard to the scheduling of workers at HCO, gaps in the relevance, accuracy, timeliness, and completeness were identified. It appears that most gaps are not related to design parameters. The values
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of design parameters are relatively low, except for separation of operational and regulatory activities. The scheduling of workers at HCO can be improved by integrating activities which are currently performed by the planning and control department with the primary care process.
Only structure related causes are analysed in this research. Gaps in the support of self-managing care teams can also be related to other causes, which can be considered in future research for a holistic approach to improving the support of self-managing care teams at HCO (Bleijenbergh et al., 2011).
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Faculteit der Managementwetenschappen