Types of integration described in case study 1
Horizontal or virtual integration has been described in case 1. The three hospitals got into partnership to improve on their functioning capacity. This type of health system integration involves firms coming together to form a partnership which is extended to central functions of each firm. The functions that the partnership supports include human resource management, information technology management, financial management, quality improvement and strategic planning. According to this nature of health system integration, all the key functions have to be coordinated across each of the parties involved in the partnership so as to increase the overall value of the system. The case involves a partnership or integration of three hospitals that were going through similar problems. These problems could best be solved through an integrated health system as explained by the hospital’s finance committee chair, Brain.
The main features of this type of integration involve aligned financial incentives. This helps the parties in the partnership to facilitate their use of financial resources wisely. It can be noted that after the partnership in case one, the finance committee of the hospital perceived a flexibility to respond to funding formulas inadequacies. The finance committee was also able to coordinate response from the three hospitals so that financial performance target set in the partnership agreement can be met. The aligned financial incentives are also able to eliminate any wasteful practices that neither benefits the hospitals nor the patients.
The other major feature of this form of integration is medicine management. Both the patients and the doctors became happy after the three hospitals integrated. Despite the small complaint that existed among the patients in relation to travel times for selective services, the patients became generally happy because delivery of service was quick and they were not forced to wait.
Benefits involved with virtual integration
Health system integration is generally known to have benefits to all the parties involved. The healthcare system has for a long time now been focused on improving quality of care. However on the other hand the cost of operation keeps on going up. The underlying cause for this growing problem in the healthcare system is the manner in which it has been structured. Health systems are generally structured to treat diseases and not improve or maintain wellness. Integrated systems are a good measure for cost reduction. They offer supporting ground for ideas that enable healthcare delivery to be of quality and provided at a lower cost. They also provide good supportive ground that support technological innovations.
The main focus of virtual integration is to ensure that the health needs of the community are met. It can be noted from the case being referenced to here that the three hospitals were under the same problems. They had to engage in service cuts so that they reduce their cost of operation. However, this was not a panacea for the problem since the communities’ most pressing need was not met. For instance, the government emphasized that the wait times for hip and knee replacement be reduced but according to the assessment of the situation, cardiac care is what required a reduced wait time compared to knee replacement. Individually, the hospitals became more accountable but however, they lacked the ability to meet the most pressing needs of the community.
The capacity to meet the needs of the population is achieved through a combined effort and matching of services. One center or facility can offer a particular service and develop specialties in the field while another center can offer a different service. In this way, waiting time for patients is reduced and quality delivery of service is improved. At the same time the needs of the community are met effectively. For instance, according to case 1, it can be noted that a patient was very happy with the cardiac program he received. He categorically termed it as effective and fast. He came to the hospital complaining of chest pains and immediately admitted. Within a day, he was already taken to the cardiac center for test and angiogram. Soon after a surgery was done and placed on a cardiac rehab program. It is noted that in this whole process, his doctor could easily follow him and the patient’s records were readily accessible. This case illustrates the effectiveness integrated health system.
There are also other desired outcomes that can be achieved through integration of healthcare system. There is increased capacity to control cost and regulate expenditure. The government used to provide for the hospitals a multiyear funding to boost their operation cost. But soon this money became very little to sustain the hospitals. It was only a short term boost for growth and soon this money became insufficient to cater for the needs of the hospital. However, after the partnership deal was done, the three hospitals began to experience control over finances. The finance committee, for instance developed a perspective of flexibility to respond to financial inadequacies. The three hospitals could make a financial performance target and be able to respond effectively.
Key issues involved in successful implementation of health system integration
The first major issue necessary for successful implementation of integration is strategic dimension. This simply means maintaining focus on key issues that affect a health system and not looking at the peripheral activities of each party involved in the partnership. The underlying idea behind integration systems is to solve problems affecting the system. Therefore, this must always be the center of emphasis in any integration. In the case being referred to here, the board chairs of the three hospitals met to device a partnership plan. In the meeting, each of them agreed that the big picture is beyond the needs and plans of each hospital. They were looking at introducing services such as geriatric, and rehabilitation apart from the acute care services.
The other key success factor for health system integration has to do with structural dimension. The organizational structure of a system has to be in such a way that it supports efforts of different hospitals integrating. The structure includes from the top, the management, board of directors, work force, and any other structural arrangement that would cause a smooth implementation of integration efforts. According to the case being referred to, the three hospitals agreed to form an organizational structure that will ensure each of the individual entities maintain their corporate existence while still being able to honor the terms of the agreement. They had proposed a unified board of management which serves the purpose of an advisory body without interfering with the individual plans of each hospital. This form of governance was just but one of the two that were proposed to lead the way forward for the integration. The other form of governance was an amalgamation of the three hospitals to form a single corporate entity.
Cultural dimension is one of the main key determining factors for the success of integration. This dimension involves issues such as organizational behavior, and organizational values, norms and beliefs. If these issues are in line with or support clinical integration, then most likely the integration effort will succeed. However, organizational culture, values and belief system can inhibit success of integration effort. Operation efficiency is supported by good organizational culture. This was reported in the case under reference. Every department, food, health, human resource, IT proved to be very efficient in their operations after the formation of the partnership.
In terms of technical dimension, the integration will be successful if the work force has all the training for technical operations. This may not only involve concerns of information technology, but it also involves expertise in the various relevant fields of medicine. The objectives of health system integration can be achieved with the help of a highly skilled and trained workforce. Capabilities of information technology help to improve the operations of the newly formed integrated system. According to the case under reference the human resource department of the hospitals became more effective in recruitment of highly skilled workers with knowledge and experience of the field. The work force was even more motivated since there were greater opportunities for improved compensation packages and job security. Before the three hospitals decided to go into partnership, they were all facing the same kind of problems. They were unable to perform certain services because of the funding problem that directly came from the ministry of health. They knew the most pressing need of the community around them but however, the service cuts meant that they could not solve the pressing communal problem but instead focus on services directed by the ministry.
Making approaches to health systems a reality
Making an improved health system a reality will require that the entire senseless predicament affecting the system is bypassed. Healthcare systems therefore can overcome these predicaments by developing an integrated health care system. There is still a lot to be accomplished with the integrated health system in order to maintain it and to sustain it for longer periods. Strategic planning is of the essence and this will support the system to have an improvement as it is implemented. The merging parties need to come up with a clearly defined and well articulated plan of implementation in order to make strategic planning a central focus for the integration. Planning also needs to be done based on the population.
The human resource management is also essential. The work force needs to be productive and yield results. Therefore, human resource best practices such as performance appraisals and employee reward systems needs to be put in place in order to get the best out of the human resource.
In terms of organizational structure, there is need for a comprehensive assessment of the appropriate governance structure that will cause a smooth way forwards for the integration. Assessment is done at both macro and micro level. This means that the overall management, the management at different facilities and sites, and management in terms of delivery of care to patients are all considered in the overall assessment. The process of workflow is important to be subjected under assessment. This will help identify areas within the workflow that needs to be changed or sustained in line with the organizational strategic goals. Redesigning the work flow to meet the objectives of an integration effort will ensure that this approach to healthcare system be a reality.
Culturally, there is need for a result, learning and change oriented cultures in the health systems. Development of new technologies should a priority for the hospitals in their integration objectives. Technologies will pave the way for the partnership to perceive population needs in a different way and come up with new strategies for solving meeting these needs. The integration has to be able to provide different levels of service to patients so that to improve quality of care.
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