Hospitals Within Ecosystems: Designing a University Hospital as Part of an Integrated Care Ecosystem

Abstract

This chapter explores how design of a single organization can improve larger ecosystem functioning. An underlying assumption was that a hospital organization model based on sociotechnical system principles would in fact enable enhanced forms of cooperation and coordination between eco-system actors both within the hospital and in its relationship with actors external to the hospital. The chapter describes how the merger of two University Hospitals and their physical move into one new building was used as an ideal opportunity for building the organizational conditions necessary for enhanced collaboration and coordination among key ecosystem actors both within the hospital (i.e., the staff, clinicians and administrators) and in the relationships between the hospital and its external partners—i.e. General Practitioners connected to the hospital and other independent healthcare providers. Internally a customized version of the sociotechnical systems design approach created cross-functional, high performance teams. To improve cross organizational relationships, rather than using the usual institutional cooperation agreements between the Board of the Hospital, the Boards of the Associations of Regional/local GPs and other care providers these actors were involved in designing the modes of cooperation between the hospital teams and their connections with the world outside the hospital. Internally, the self-managing multi-disciplinary teams turned out to be very flexible and very effective in developing their ‘own’ networks both within the hospital and with the General Practitioners and other independent healthcare practitioners in the region. Additional outcomes of this redesign process included delivery of very high quality patient care and also a very flexible organization and a good quality of working life for all people working in the hospital. An important conclusion is that in order to be an effective participant in an integrated healthcare ecosystem, an organization must itself be designed as a flexible cooperative network of relatively independent multi-disciplinary units, serving a specific group of patients.