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Effectiveness of Interorganizational Service Delivery Networks in Health Care: A Scoping Review

Author:

Christine Gordon

University of Toronto, CA
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Abstract

Introduction:

Interorganizational networks (IONs) are increasingly being used in healthcare, particularly to deliver integrated patient care services.  We define IONs in this context as cooperative relationships among three or more types of service providers that each maintain their autonomy but also work together to coordinate patient care across organizational boundaries.  This review sought to answer the question, “What is known from the existing theoretical and empirical literature about effectiveness of interorganizational service delivery networks within health care systems?” The extent, range and nature of ION effectiveness research in health care were examined and gaps in the literature identified.  

Methods:

A scoping review following the Arksey and O’Malley framework was conducted.  Peer-reviewed and grey literature were identified through database searches (Health Star, Scopus, Social Sciences Citation Index and Applied SS Index and Abstracts), hand searches of reference lists and consultation with experts. Data from included studies were extracted into a template for analysis.     

Results:

Twenty-nine studies met the inclusion criteria.  The literature was divided into four categories:  theories of network effectiveness; factors associated with effectiveness; developing frameworks to evaluate effectiveness; and evaluation of integrated care models. The results indicated that a comprehensive theory of ION effectiveness does not yet exist. A number of factors have been associated with effectiveness, including network development processes (e.g. managing divergent viewpoints), governance choices (e.g. different governance models), network structures (e.g. number of ties) and environment (e.g. political environment).   

Discussion:

The ION effectiveness literature examining health systems is small.  The initial work was conducted in mental health systems and focused on network structural characteristics and stability as they relate to effectiveness.  Frameworks that evaluate the effectiveness of IONs have involved a number of factors. Recently, intervening variables (e.g. leadership, network management, communication strategies and inter-professionalism) have been added to evaluation frameworks.  Effectiveness has been evaluated from the perspective of multiple stakeholders, including the network, organization and community.  Future work should focus on incorporating different methods (e.g. longitudinal studies) and types of networks (e.g. networks of various sizes and comprised of various organizations) to answer more sophisticated questions.  Further examination of the cost of IONs is needed, particularly in determining if IONs are more or less costly than traditional models of care. 

Conclusion and Lessons Learned:

There is an opportunity to advance the application of ION effectiveness literature to health care systems with an objective of better understanding effectiveness of integrated care initiatives. This may provide new insights into why some integrated care initiatives perform well while others do not.

Limitations:

Many included studies are from the United States.  The health care system of that country differs significantly to that of Canada and others, potentially limiting applicability.  The search strategy may have excluded relevant studies.  

 

How to Cite: Gordon C. Effectiveness of Interorganizational Service Delivery Networks in Health Care: A Scoping Review. International Journal of Integrated Care. 2021;21(S1):190. DOI: http://doi.org/10.5334/ijic.ICIC20101
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Published on 01 Sep 2021.

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