Towards Process-Oriented Hospital Structures; Drivers behind the Development of Hospital Designs

Jeroen D. H. van Wijngaarden, Anoek Braam (), Martina Buljac-Samardžić and Carina G. J. M. Hilders
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Jeroen D. H. van Wijngaarden: Health Services Management & Organisation, Erasmus School of Health Policy and Management, Erasmus University Rotterdam, 3062 PA Rotterdam, The Netherlands
Anoek Braam: Health Services Management & Organisation, Erasmus School of Health Policy and Management, Erasmus University Rotterdam, 3062 PA Rotterdam, The Netherlands
Martina Buljac-Samardžić: Health Services Management & Organisation, Erasmus School of Health Policy and Management, Erasmus University Rotterdam, 3062 PA Rotterdam, The Netherlands
Carina G. J. M. Hilders: Health Services Management & Organisation, Erasmus School of Health Policy and Management, Erasmus University Rotterdam, 3062 PA Rotterdam, The Netherlands

IJERPH, 2023, vol. 20, issue 3, 1-12

Abstract: Hospitals have been encouraged to develop more process-oriented designs, structured around patient needs, to better deal with patients suffering from multi-morbidity. However, most hospitals still have traditional designs built around medical specialties. We aimed to understand how hospital designs are currently developing and what the important drivers are. We built a typology to categorize all Dutch general hospitals (61), and we interviewed hospital managers and staff. The inventory showed three types of hospital building blocks: units built around specific medical specialties, clusters housing different medical specialty units, and centers; multi-specialty entities provide the most suitable structure for a process-oriented approach. Only some Dutch hospitals (5) are mainly designed around centers. However, most hospitals are slowly developing towards hybrid designs. Competitive drivers are not important for stimulating these redesigns. Institutional pressures from within the health care sector and institutional ‘mimicking’ are the main drivers, but the specific path they take is dependent on their ‘heritage’. We found that hospital structures are more the result of incremental, path-dependent choices than ‘grand-designs’. Although the majority of the Dutch general hospitals still have a general design built around medical specialties, most hospitals are moving towards a more process-oriented design.

Keywords: hospital design; multi-disciplinary cooperation; integrated care; multi-morbidity (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2023
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