Evaluating organizational change in health care: the patient-centered hospital model

Carlo V Fiorio,Stefano Verzillo,Mara Gorli

doi:10.1186/s12913-018-2877-4

Abstract

BackgroundAn increasing number of hospitals react to recent demographic, epidemiological and managerial challenges moving from a traditional organizational model to a Patient-Centered (PC) hospital model. Although the theoretical managerial literature on the PC hospital model is vast, quantitative evaluations of the performance of hospitals that moved from the traditional to the PC organizational structure is scarce. However, quantitative analysis of effects of managerial changes is important and can provide additional argument in support of innovation.MethodsWe take advantage of a quasi-experimental setting and of a unique administrative data set on the population of hospital discharge charts (HDCs) over a period of 9 years of Lombardy, the richest and one of the most populated region of Italy. During this period three important hospitals switched to the PC model in 2010, whereas all the others remained with the functional organizational model. This allowed us to develop a difference-in-difference analysis of some selected measures of efficiency and effectiveness for PC hospitals focusing on the “between-variability” of the 25 major diagnostic categories (MDCs) in each hospital and estimating a difference-in-difference model.ResultsWe contribute to the literature that addresses the evaluation of healthcare and hospital change by providing a quantitative estimation of efficiency and effectiveness changes following to the implementation of the PC hospital model. Results show that both efficiency and effectiveness have significantly increased in the average MDC of PC hospitals, thus confirming the need for policy makers to invest in new organizational models close to the principles of PC hospital structures.ConclusionsAlthough an organizational change towards the PC model can be a costly process, implying a rebalancing of responsibilities and power among hospital personnel (e.g. medical and nursing staff), our results suggest that changing towards a PC model can be worthwhile in terms of both efficacy and efficiency. This evidence can be used to inform and sustain hospital managers and policy makers in their hospital design efforts and to communicate the innovation advantages within the hospital organizations, among the personnel and in the public debate.

Highlights

An increasing number of hospitals react to recent demographic, epidemiological and managerial challenges moving from a traditional organizational model to a Patient-Centered (PC) hospital model
The decision to move from a functionally organized to a PC hospital model is typically taken at the hospital level; its implementation might differ greatly depending on each major diagnostic category1, as some MDCs are more influenced by the organization, whereas others follow very strict protocols regardless of the organizational model adopted
For such an organizational change, there is no need for high-frequency data, as it is likely to have an impact on the hospital performance over months or years, or for individual data, as the focus is on the average efficiency and effectiveness in MDCs of treated hospital units versus those in untreated ones

Summary

Introduction

An increasing number of hospitals react to recent demographic, epidemiological and managerial challenges moving from a traditional organizational model to a Patient-Centered (PC) hospital model. New demands and needs are emerging, connected with the growth of chronic pathologies, the ageing of the population, the development of technologies, the scarcity of economic resources and people’s emerging awareness of their care and cure rights. With respect to this demographic, epidemiological and social context, health care and hospital systems overall must innovate to respond to the new care needs. An increasing literature ([10,11,12,13]) suggests that innovation in health care should evolve towards a patient-centered ( PC) model, reshaping hospitals with the aim of moving from functional towards process-oriented organizational forms, focusing on the process of care instead of on functional, self-referential departments within the hospital. To innovate towards the PC model, hospitals usually undergo a process of redesign that encompasses several restructuring actions, both in the organizational structure and in the physical building ([14])

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