Abstract
Inter-municipal cooperation (IMC) has gained widespread recognition as a beneficial strategy for improving efficiency and quality in the provision of out-of-hours emergency care services (OOH services). Little attention, however, has been given to the additional costs of cooperation and the relational processes through which benefits and costs are likely to result. Based on survey data from 266 (77%) Norwegian municipalities involved in IMC in OOH services in 2015, this study aimed to investigate how the structure (governance form, complexity and stability) and quality (trust and consensus) of cooperation processes interact to influence the perceived outcomes (benefits and costs) of IMC in OOH services. Using Structural equation modeling, we found trust and consensus fully mediated the association between the structure and outcomes of IMC. More specifically, the results suggest that cooperation structures characterized by centralized governance, stability over time, and reduced complexity were likely to enhance the benefits and reduce the costs of IMC through trust and consensus.
Highlights
Looking first at the relationship between the quality of the cooperation processes and the perceived outcomes, the overall results from our analysis suggest that the level of trust and consensus among the participants seems to be crucial in determining the perceived outcomes of Inter-municipal cooperation (IMC) in OOH services
Based on what we believe to be some of the limitations in the literature on inter-organizational cooperation in OOH services, this study aimed to investigate how the structure and quality of cooperation processes interact to influence the perceived benefits and costs associated with IMC in OOH services
In an effort to address what we believe to be some of the limitations in the literature on inter-organizational cooperation in health services, this study set out to investigate how the structure and quality of cooperation processes interact to influence the perceived benefits and costs of being involved in IMC in OOH services
Summary
Throughout Europe, the provision of out-of-hours emergency care services (OOH services) are increasingly being organized through various forms of cooperative arrangements that are expected to help service providers cope with steadily rising pressure in terms of increased efficiency and service quality (Grol et al, 2006; Huibers et al, 2009; Huibers et al, 2014; Leibowitz et al, 2003; Leutgeb et al, 2014; Philips et al, 2010; Smits et al, 2012). As many as 80% of all Norwegian municipalities provided these types of services through voluntary IMC in 2015 (Norwegian Ministry of Health and Care Services, 2015) Given this widespread recognition of scaling up OOH services through cooperation, it seems that most of the literature has primarily been focusing on assessing the expected benefits, such as reduced service costs (Broekman et al, 2017; Brogan et al, 1998; Grol et al, 2006; Hansen and Munck, 1998; Smits et al, 2017), enhanced service quality (Giesen et al, 2011; Hansen and Munck, 1998; Shipman et al, 2000; Smits et al, 2012; Tranberg et al, 2018) and reduced workloads for GPs (Giesen et al, 2011; Grol et al, 2006; van Uden and Crebolder, 2004)
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