Abstract
Introduction:Previous studies have suggested that telecare can improve interorganisational collaboration within fragmented health care systems, yet this outcome has not been examined in a large-scale setting. This study explores the effects of a large-scale interorganisational telecare programme in Denmark based on home-monitoring on collaboration in a telecare network between municipalities, hospitals, and general practitioners.Methodology:Semi-structured interviews and observations of collaborating health professionals from the municipalities, hospitals, and general practitioners were undertaken and then repeated a year later. Collaboration was analysed both at the interorganisational network level and within each part of the network, including its interrelations.Results:Collaboration between municipalities and general practitioners was initially intensified as a result of implementing telecare, though this changed over time as the first start-up obstacles were overcome and the patients became more active in their treatment. Conversely, collaboration between hospitals and municipalities and hospitals and general practitioners was unaffected by telecare.Discussion:Changes in collaboration among municipal nurses, general practitioners, and hospital staff were related to dependency structures and municipalities’ newly gained central role in a telecare network. While the telecare network was initially characterised by asymmetrical dependency structures, these were partially equalised over time because of the municipalities’ new position in the network.
Highlights
Previous studies have suggested that telecare can improve interorganisational collaboration within fragmented health care systems, yet this outcome has not been examined in a large-scale setting
Collaboration among Municipal Nurses and general practitioners (GPs) in the Primary Health Sector The analysis of each organisational part of the telecare network revealed that only municipal nurses experienced significant changes in their work after the implementation of telecare, which in turn affected their collaboration with GPs
The changes identified in this study with regard to interorganisational relations were related to structural properties, power, and dependency structures in the telecare network
Summary
Previous studies have suggested that telecare can improve interorganisational collaboration within fragmented health care systems, yet this outcome has not been examined in a large-scale setting. This study explores the effects of a large-scale interorganisational telecare programme in Denmark based on home-monitoring on collaboration in a telecare network between municipalities, hospitals, and general practitioners. Methodology: Semi-structured interviews and observations of collaborating health professionals from the municipalities, hospitals, and general practitioners were undertaken and repeated a year later Collaboration was analysed both at the interorganisational network level and within each part of the network, including its interrelations. This study examines a large-scale, cross-sector Danish telecare programme involving more than 1,200 patients with chronic obstructive pulmonary disease (COPD) who receive remote home monitoring from an interorganisational telecare network of eleven municipalities, four hospitals, and 225 general practitioners (GPs). It deepens our empirical knowledge of telecare in a complex, large-scale setting with multiple health care organisations. It provides a nuanced understanding of how telecare reconfigures interorganisational networks in terms of interorganisational collaboration, dependency, and power structures
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