Use Of Coordination Mechanisms Research Articles

Has cross-level clinical coordination changed in the Catalan health system after the pandemic?

Abstract Background The COVID-19 pandemic triggered several changes in the organization of health services, such as the acceleration of the introduction of digital tools to improve cross-level clinical coordination and, therefore, the quality of care. The aim is to analyse changes in the experience, perception of cross-level clinical coordination and related factors of primary care (PC) and secondary care (SC) doctors in the Catalan health system between 2017 and 2022. Methods Comparison of two cross-sectional studies based on the online surveys COORDENA-CAT (2017) and COORDENA-TICs (2022) to PC and SC doctors. Sample 2017 n = 3308 (participation: 20.9%); 2022 n = 2277 (participation: 17.5%). Outcome variables: experience and perception of cross-level clinical coordination, and related factors, knowledge, and use of digital coordination mechanisms. Descriptive and multivariate analyses were performed to detect changes between years. Results Compared to 2017, there was a worse experience of clinical management coordination, particularly in cross-level care consistency and accessibility, and of the perception. Regarding related factors there was a worsening in some organizational factors (time available for coordination, institutional support), attitudinal factors (satisfaction with the job) and interactional factors (knowledge between doctors). The use of some coordination mechanisms such as electronic medical records and virtual consultations between PC and SC increased, while the use of virtual joint clinical sessions was limited. Conclusions Results show that after the pandemic there was a worsening in some items of the experience and in the perception of cross-level clinical coordination, despite the increased use of some digital coordination mechanisms. There is a need to explore in depth the factors associated with this worsening to identify and promote more effective strategies to improve cross-level clinical coordination in Catalonia. Key messages • Cross-level clinical coordination in Catalonia has worsened despite the increase in implementation and use of some digital coordination mechanisms. • It is necessary to explore in depth the factors related to this worsening to develop more effective strategies to improve cross-level clinical coordination.

Preconditions of coordination in regional public organizations

ABSTRACT Involving several levels ranging from policy-making to service delivery, the coordination of regional public organizations is a complex matter. This paper explores how relational preconditions affect regional public organizations’ coordination activities and outcomes. A model is developed that links relational preconditions to coordination outcomes. Even though the coordination mechanisms and instruments are used, the coordination outcome might vary based on the individuals and the relationships among individuals. This study suggests that the use of coordination mechanisms and in turn coordination outcome, is affected by the individuals’ personal beliefs and personal relationships as well as trust in the vertical organization.

Метод оценки сбалансированности партнёрства участников закупочного процесса на основе применения координационных механизмов

The proposed article presents the results of the author's study of the indicator of partnership balance in relation to the use of coordination mechanisms in procurement activities of supply chain participants.
 Based on a series of expert surveys, the author proposed an approach to defining this parameter, taking into account the assessment of the benefits and losses of partnership participants based on the results of the use of coordination mechanisms.
 The study was based on a comparative analysis of retrospective data from companies participating in the questionnaire between July and December 2021. Among them are production, freight forwarding enterprises, warehouse operators, wholesale and retail trading companies.
 In conclusion, the author made conclusions about the different influence of mechanisms of joint planning, motivation, resource integration on the dynamics of the indicator of balance of partnership in relations between companies and strategic and tactical suppliers.

Command and Control in a Fifth Generation Air Force: Coordination Requirements of Air Operations with F-35 and the Command and Control-System of the Norwegian Armed Forces

This article discusses the ways in which the F-35 Lightning aircraft might affect the command and control (C2) of the Royal Norwegian Air Force. It emphasises the importance of coordination answering questions regarding the effect of the implementation of the F-35 on interdependencies with other capabilities. This foundation is further used to discuss possible implications for elements central to C2 such as procedures, personnel, and communication and information systems. Based on the capabilities of the F-35 system, we find a development of interdependencies across domains and C2 levels in the Norwegian armed forces; the complexity of these interdependencies, influenced both by the execution of air operations and by environmental contingencies, means that the organisation needs to be flexible in its use of coordination mechanisms. We find that interdependence, and the coordination necessary if it is to be successful, have implications for command and control of air operations involving F-35 aircraft. We suggest the organisation should adopt a more active use of both hierarchical and horizontal structures to accommodate the sharing of knowledge and information across domains and C2 levels. Procedures need to include methods and systems for the delegation of authority, and personnel require knowledge of interdependencies and multi-domain operations. Finally, communication and information systems need to be available, interoperable, and robust.

¿La integración de la gestión de servicios sanitarios mejora la coordinación clínica? Experiencia en Cataluña

ObjectiveTo analyze the experience and perception of clinical coordination across care levels and doctor's organizational and interactional related factors, according to the type of management integration of the healthcare services of the area, in Catalonia. MethodCross-sectional study based on an online survey by self-administration of the questionnaire COORDENA-CAT. Data collection: October–December 2017. Study population: primary and secondary care (acute and long-term care) doctors of the public Catalan health system. Sample: 3308 doctors. Outcome variables: experience and perception of clinical coordination, knowledge and use of coordination mechanisms and organizational and interactional factors; explanatory variables: area according to type of management (integrated, semi-integrated, non-integrated), socio-demographic, employment characteristics and attitude toward work. Descriptive analysis by type of area and multivariate analysis by robust Poisson regression. ResultsBetter clinical coordination was observed in integrated areas compared to those semi-integrated, mainly in relation to information transfer, adequate follow-up and perception of coordination in the area. No differences were found between integrated and non-integrated areas in the clinical coordination experience, although there were differences in perception and some related factors. There are common problems across areas, such as accessibility to secondary care. ConclusionsFew differences were found between integrated and non-integrated areas, revealing that management integration may facilitate clinical coordination but is not enough. Differences with semi-integrated areas indicate the need to promote cooperation formulas between all the providers of the territory, with common objectives and coordination mechanisms, in order to avoid inequalities in quality of care.

The study of the procurement complex cost indicator in relation to using coordination mechanisms in supply chains

The purpose of this article was to study the indicator of the complex cost of procurement in relation to the use of coordination mechanisms in supply chains. Based on the analysis of various types of costs associated both directly with purchases and with the subsequent use and operation of the purchased products, the author proposed an approach to determining this parameter, taking into account the assessment of «complex proposals» of suppliers per unit of purchased products. The study was conducted on the basis of a comparative analysis of retrospective data from a group of enterprises that took part in the survey from February to May 2021. The enterprises included manufacturing and trading companies, freight forwarding companies, and warehouse operators working at different levels of procurement maturity. Based on the results of the work carried out, the author made a conclusion about the different influence of the mechanisms of joint planning, motivation, and resource integration on the dynamics of the indicator of the complex cost of procurement in organizations of different fields of activity. In the course of the study, the methods of expert assessments, statistical and comparative analysis, comparison by analogy, and questionnaires were used. The theoretical and methodological basis of the study was the scientific works of Russian and foreign authors on procurement and supply management, logistics management, and the development of partnerships with suppliers in supply chains.

Barriers and factors associated with the use of coordination mechanisms between levels of care in Mexico

The aim was to analyze the level and characterize the use of clinical coordination mechanisms between levels of care, and their associated factors, in two public networks of health services in Mexico. A cross-sectional study was carried out using the COORDENA questionnaire to primary and specialized care physicians in the state of Veracruz. Differences were found between networks and levels of care, according to the mechanism. In both, the referral/counter-referral is mostly used to channel the patient to another level, mainly by primary care physicians. A high reception of referrals by specialists was identified, but few counterreferences in primary care. Being a man and recognizing the primary care physician, as responsible for monitoring the patient in his/her healthcare career, were factors associated with the frequent sending of the counter-referral by specialists. The discharge report is used in both networks to send clinical information to the other level, with more sending by specialist doctors, but with less reception in primary care. In both networks, the follow-up to the recommendations of the mechanisms to standardize clinical care was greater by primary care physicians than specialized ones. The use of coordination mechanisms between levels of care is deficient and limited, with greater use of mechanisms to transfer information than for clinical management. The need to implement strategies that consider the participation of professionals is evident, to favor local adaptation, appropriation and improve their use.

Innovative solutions for effective conflict resolution in higher education institutions

The article discusses innovative solutions for effective conflict resolution in higher education institutions. In the analysis of conflict situations, the predominance of two methods of conflict resolution in the organization, the method of adaptation and conciliation. The results of the use of coordination mechanisms as a method of managing an acute conflict situation are described.

A coordination perspective on dialogue processes between planners and developers in a sustainable urban development project

Several of Sweden’s Local Planning Authorities (LPAs) use developer dialogue processes between them and building actors to aid in the implementation of urban development projects. The idea is often to achieve ambitious local sustainability and to encourage a generally appreciated collaborative culture; however, processes of planners/developers interactions are challenging to manage in practice. In this study, we aim to depict and analyse a developer dialogue process used by a Swedish LPA in an on-going sustainable urban development project through the theoretical lens of organizational coordination mechanisms. Particular focus is placed on exploring how planners and develops interact while negotiating and implementing locally defined sustainability priorities. Empirical material was collected through document analysis, workshops and interviews with LPA representatives. Findings from the ongoing study indicates that the LPA manage a mixture of formal and informal interdependencies throughout in an attempt to achieve a greater fulfilment of their sustainability goals, and better outcomes in terms of product compliance. Furthermore, the use of coordination mechanisms for analysing the project seems to represent an important instrumental knowledge gap for better understanding sustainable urban development projects’ implementation and outcomes.

Does management integration improve cross-level clinical coordination? Experience of Catalonia

Abstract Background Cross-level clinical coordination is a priority for health systems. Evidence suggests that management integration may improve clinical coordination. This study aims to evaluate clinical coordination according to the type of management integration of the area in the Catalan health system. Methods Cross-sectional study based on the online questionnaire COORDENA-CAT (October-December 2017). Study population: primary and secondary care (acute and long term) doctors of the public Catalan health system. Sample: 3.308 doctors. Outcome variables: experience and perception of clinical coordination across care levels, knowledge and use of coordination mechanisms and related factors. Explanatory variables: area according to type of management (integrated, semi-integrated and non-integrated), demographic, employment characteristics and attitude towards work. Descriptive and multivariate analysis by robust Poisson regression. Results Better clinical coordination was observed in integrated areas compared to those semi-integrated, mostly in information transfer (PR 0.80 (95%CI 0.74-0.87)) and adequate follow-up of the patient (PR 0.89 (95%IC 0.82-0.97)). No differences were observed between integrated and non-integrated areas. General perception of coordination was higher in integrated areas than in semi-integrated and non-integrated areas (PR 0.73 (95%CI 0.63-0.84) and PR 0.85 (95%CI 0.75-0.97) respectively). Some organizational and interactional factors and the knowledge and use of coordination mechanisms showed also better results in integrated areas. There were common fields for improvement like accessibility between care levels. Conclusions No differences between integrated and non-integrated areas reveal that management integration is not enough condition to improve clinical coordination. Differences with semi-integrated areas suggest that coordination efforts should be equitable among all the providers of the territory to avoid inequalities in quality of care. Key messages Management integration does not determine clinical coordination. Cooperation formulas are needed between all territory providers that allow to fix common strategies to improve clinical coordination.

Clinical coordination across care levels according to medical specialty in the Catalan health system

Abstract Background In primary care-based national health systems, cross-level clinical coordination is a priority, as it contributes to quality of care and efficiency. Studies show that clinical coordination may vary depending on doctoŕs specialty. The study's aim was to determine the differences in experience and perception of clinical coordination and their related factors according to the doctor's specialty in the Catalan health system Methods Cross-sectional study, based on an on-line survey applying the COORDENA-CAT questionnaire to 1666 secondary care doctors. Descriptive and multivariate analysis were used to compare five groups of specialties (potentially decentralised, hospital-based, internal-medicine/geriatrics, gynaecology, and paediatrics), for experience, perception and factors related to clinical coordination. Results Clinical coordination experience was relatively high in all groups, with differences when comparing with decentralised specialties; hospital-based specialties and internal medicine/geriatrics presented lower care consistency and follow up across levels, while gynaecology and paediatrics showed higher accessibility. General perception of coordination was low, being worse in hospital-based specialties (PR:0.80,95%CI0.72-0.89) and better in gynaecology (PR:1.36,95%CI1.18-1.56). Moreover, hospital-based specialties reported lower use of coordination mechanisms and less interaction with doctors from the other level (PR:0.42,95%CI0.23-0.72), than gynaecology (PR:2.04, 95%CI1.22-3.45). Conclusions Doctors' experience and perception of clinical coordination was lower among hospital-based specialties and internal medicine/geriatrics and higher in gynaecology and paediatrics. These differences may be explained by complexity, coordination needs, level of specialty decentralisation or related factors. Further research is needed to understand such differences and consider the coordination needs of each specialty to improve cross-level clinical coordination. Key messages Differences between specialities might be explain by the complexity, level of specialty decentralisation or factors related to clinical coordination. Clinical coordination needs of each specialty should be deeply explored to improve cross-level clinical coordination.

Conocimiento y uso de mecanismos de coordinación clínica de servicios de salud de Latinoamérica

ObjectiveTo analyze the level of knowledge and use, and the characteristics of use, of care coordination mechanisms in public healthcare networks of six Latin America countries. MethodCross-sectional study based on a survey using the COORDENA® questionnaire with primary and secondary care doctors (348 doctors/country) of public healthcare networks in Argentina, Brazil, Chile, Colombia, Mexico and Uruguay (May-October 2015). Analyzed variables: degree of knowledge and use of information coordination (referral/reply letter, discharge report, phone, e-mail) and of clinical management coordination (shared clinical guidelines, joint meetings) mechanisms. Descriptive analyses were conducted. ResultsKnowledge of clinical information coordination mechanisms was high in both care levels and analyzed networks as was the use of referral/reply letter. There was greater variability in the use of discharge reports (from 40.0% in Brazil to 79.4% in Mexico) and, except for Argentina, a low reception reported by primary care doctors stands out (12.3% in Colombia and 55.1% in Uruguay). In contrast, knowledge of clinical management coordination mechanisms was limited, especially among secondary care doctors. It is noteworthy, however, that adherence to clinical guidelines was high (from 83.1% in Mexico to 96.8% in Brazil), while participation in joint meetings varied widely (from 23.7% in Chile to 76.2% in Brazil). The difficulties reported in the use of the mechanisms are related to structural and organizational factors. ConclusionsThe limited knowledge and use of coordination mechanisms shows insufficient diffusion and implementation. Strategies to increase its use are needed, including the related factors.

COORDINATION MECHANISMS OF COLLABORATIVE R&D PROJECTS IN SMALL AND MEDIUM ENTERPRISES

ABSTRACT Purpose: To analyze how small and medium enterprises (SMEs) coordinate collaborative research and development (R&D) projects through an open innovation strategy. Originality/value: This research was motivated by a theoretical gap in the management of collaborative R&D projects in open innovation strategies. The originality of the paper is to advance the understanding of coordination mechanisms that SMEs can use to manage open innovation and obtain more effective results. Design/methodology/approach: The research followed a qualitative approach, through three case studies of collaborative projects. Data were collected by means of in-depth interviews with eleven managers directly involved in collaborative R&D projects. Findings: Results demonstrate that the use of coordination mechanisms depends on the applicability of each project’s results, i.e., the higher the chances of a certain R&D project becoming a real product, the higher the importance given to the coordination mechanisms. On the cases observed, the coordination mechanisms were defined by the enterprise, not by external partners. In addition, it was observed that open innovation projects that the enterprise seeks for external knowledge to complement internal resources (outside-in) were considered more important than transferring internal knowledge to external partners (inside-out). The paper contributes to organizational theory by highlighting the relation between the characteristics of collaborative R&D projects and the coordination mechanisms used. Regarding the managerial contribution, results serve as a guide for entrepreneurs and managers of SMEs interested in coordinating collaborative projects based on open innovation processes.

Coordination within medical neighborhoods: Insights from the early experiences of Colorado patient-centered medical homes.

The term "medical neighborhood" refers to relationships that patient-centered medical homes (PCMHs) seek to establish with other providers to facilitate coordinated patient care. Yet, how PCMHs can accomplish this coordination is not well understood. Drawing upon organizational theory (; ; ), we explored how PCMHs use coordination mechanisms to build and optimize their medical neighborhoods. We used mixed methods, blending data collected via interviews and surveys with practice leaders and care coordinators at 30 months after a PCMH collaborative intervention in Colorado as well as surveys from all providers from 13 PCMHs before and 30 months after the intervention. We used thematic analysis to understand the role and use of coordination mechanisms by PCMHs and changes in the ability to coordinate and deliver care continuity. PCMHs drew on four coordination mechanisms to build relationships with their medical neighbors: interorganizational routines to improve reliability of information flow; information connectivity to facilitate continuity and safe care; boundary spanners to integrate care across silos; and communication, negotiation, and decision mechanisms to introduce shared accountability. When providers were fairly confident of the patient's diagnosis and management required sequential interactions (such as tests or procedures), PCMHs tended to coordinate care through interorganizational routines and information connectivity. When a diagnosis was less certain and required reciprocal interaction (i.e., consultation), PCMHs employed boundary spanners and communication, negotiation, and decision mechanisms. Use of coordination mechanisms by PCMHs can help to improve care coordination in medical neighborhoods. All four mechanisms appear to be useful. The optimal mix of coordination mechanisms requires attention to patient context. Successfully building medical neighborhoods also requires meta-leaders, collaboration competencies, and high-quality relationships between providers in primary care, specialty care, and hospitals.

Barriers to healthcare coordination in market-based and decentralized public health systems: a qualitative study in healthcare networks of Colombia and Brazil.

Although integrated healthcare networks (IHNs) are promoted in Latin America in response to health system fragmentation, few analyses on the coordination of care across levels in these networks have been conducted in the region. The aim is to analyse the existence of healthcare coordination across levels of care and the factors influencing it from the health personnel’ perspective in healthcare networks of two countries with different health systems: Colombia, with a social security system based on managed competition and Brazil, with a decentralized national health system. A qualitative, exploratory and descriptive–interpretative study was conducted, based on a case study of healthcare networks in four municipalities. Individual semi-structured interviews were conducted with a three stage theoretical sample of (a) health (112) and administrative (66) professionals of different care levels, and (b) managers of providers (42) and insurers (14). A thematic content analysis was conducted, segmented by cases, informant groups and themes. The results reveal poor clinical information transfer between healthcare levels in all networks analysed, with added deficiencies in Brazil in the coordination of access and clinical management. The obstacles to care coordination are related to the organization of both the health system and the healthcare networks. In the health system, there is the existence of economic incentives to compete (exacerbated in Brazil by partisan political interests), the fragmentation and instability of networks in Colombia and weak planning and evaluation in Brazil. In the healthcare networks, there are inadequate working conditions (temporary and/or part-time contracts) which hinder the use of coordination mechanisms, and inadequate professional training for implementing a healthcare model in which primary care should act as coordinator in patient care. Reforms are needed in these health systems and networks in order to modify incentives, strengthen the state planning and supervision functions and improve professional working conditions and skills.

Do existing mechanisms contribute to improvements in care coordination across levels of care in health services networks? Opinions of the health personnel in Colombia and Brazil.

BackgroundThe fragmentation of healthcare provision has given rise to a wide range of interventions within organizations to improve coordination across levels of care, primarily in high income countries but also in some middle and low-income countries. The aim is to analyze the use of coordination mechanisms in healthcare networks and its implications for the delivery of health care. This is studied from the perspective of health personnel in two countries with different health systems, Colombia and Brazil.MethodsA qualitative, exploratory and descriptive-interpretative study was conducted, based on a case study of healthcare networks in two municipalities in each country. Individual semi-structured interviews were conducted with a three stage theoretical sample of a) health (112) and administrative (66) professionals of different care levels, and b) managers of providers (42) and insurers (14). A thematic content analysis was conducted, segmented by cases, informant groups and themes.ResultsThe results show that care coordination mechanisms are poorly implemented in general. However, the results are marginally better in certain segments of the Colombian networks analyzed (ambulatory centres with primary and secondary care co-location owned by or tied to the contributory scheme insurers, and public providers of the subsidized scheme); and in the network of the state capital in Brazil. Professionals point to numerous problems in the use of existing mechanisms, such as the insufficient recording of information in referral forms, low frequency and level of participation in shared clinical sessions, low adherence to the few available clinical guidelines and the lack of or inadequate referral of patients by the patient referral centres, particularly in the Brazilian networks. The absence or limited use of care coordination mechanisms leads, according to informants, to the inadequate follow-up of patients, interruptions in care and duplication of tests. Professionals use informal strategies to try to overcome these limitations.ConclusionsThe results indicate not only the limited implementation of mechanisms for coordination across care levels, but also a limited use of existing mechanisms in the healthcare networks analyzed. This has a negative impact on coordination, efficiency and quality of care. Organizational changes are required in the networks and healthcare systems to address these problems.

How do companies achieve mix flexibility?

PurposeThe purpose of this paper is to address a research gap relating to the understanding of how one type of manufacturing flexibility – mix flexibility – is achieved during day‐to‐day operations.Design/methodology/approachConstructs from coordination theory are used in order to understand the way in which physical manufacturing resources are coordinated during daily operations to produce a company's product mix. A multiple case study methodology is used to investigate the applicability of these constructs in the flour milling industry. Subsequently, a conceptual framework is proposed which captures the coordination mechanisms used in the achievement of mix flexibility.FindingsThe paper finds that mix flexibility requirements influence how a company achieves mix flexibility. Further, the findings indicate that, at an operational level, mix flexibility is achieved via the use of coordination mechanisms to manage specific dependencies relating to mix flexibility requirements.Research limitations/implicationsMix flexibility achievement was studied in a single industry. Future research can test the applicability of the conceptual framework in other manufacturing settings.Originality/valueAn empirical contribution to the study of manufacturing flexibility achievement has been made, where the application of constructs from coordination theory presents a novel approach to the study of manufacturing flexibility achievement.

Generic Advertising, Brand Advertising and Price Competition: An Analysis of Free-Riding Effects and Coordination Mechanisms

The main purpose of generic advertising is to enlarge the total market demand rather than capturing further slices from competitors. Several studies point out emergence of free-riding behavior under independent contribution and suggest use of coordination mechanism. However, existing literature does not shed light on the conditions under which generic advertising can be detrimental (beneficial) to stronger firms weakening (strengthening) their competitive advantage. Also, under a setting including both price and brand advertising competition, coordination in generic advertising has not been unraveled. In order to deal with such issues, we consider a one-stage duopoly game in which two firms jointly spend in generic advertising and, simultaneously, compete by setting price and brand advertising. Under independent contribution, we show that when generic advertising effectiveness is high or differences between firms are overall small, weaker firm’s free-riding lowers the profit difference between the two firms and, sometimes, leads the stronger firm to make even lower profit. On the other hand, in presence of low generic advertising effectiveness or high asymmetries between firms, the stronger firm takes more advantage from generic advertising and increases the profit gap. Under coordination we consider two commonly used mechanisms to share generic advertising expenditure, i.e. fixed percentage (FP) mechanism and sales-proportional (SP) mechanism. We discover that neither mechanism is always dominant in terms of industry profit. In fact, under symmetry, SP mechanism always drives firms to spend more in generic advertising. However, this will result in a higher industry profit if either price or brand advertising competition is fierce or generic advertising effectiveness is low. On the other hand, FP mechanism can guarantee a bigger pie when both price and brand advertising competition is mild and generic advertising is highly effective. Numerical analysis under asymmetry seems to confirm our findings.

Improving interface congruence between manufacturing and marketing in industrial-product manufacturers

Volatile market conditions force managers to make strategic decisions concerning new product development, process innovation and capacity planning within more limited time than ever. This time pressure on strategic decisions inevitably calls for a higher degree of consensus between related functional areas on cross-departmental decision problems which occur at their interface. This consensus is termed interface congruence. An interface congruence model based on five integration facilitating factors was proposed and tested through an empirical survey. Consistent understanding of corporate strategic objectives, extensive use of coordination mechanisms and manufacturing flexibility showed significant direct relationships with interface congruence. A closer customer relationship was also related to higher interface congruence if there was extensive use of coordination mechanisms. Vendor relationships, however, did not show a significant relationship with interface congruence. They did show a significant direct relationship with manufacturing flexibility and thus seemed to indirectly influence interface congruence through the relationship with manufacturing flexibility. Many practical ideas for implementing these factors for facilitating integration were also found through case studies on two selected manufacturers with high interface congruence. These abundant practical ideas ranging from organizational structure to information technology will help practitioners to improve interface congruence in real business settings.