How to achieve care coordination inside health care organizations: Insights from organization theory on coordination in theory and in action

Abstract

Understanding how health care organizations can achieve care coordination internally is essential because it is difficult to achieve, but essential for high-quality and efficient health care delivery. This article offers an answer by providing a synthesis of knowledge about coordination from organization theory, where coordination is a central research topic. The article focuses on intra-organizational coordination, which is challenging especially across boundaries such as departments or professions. It provides an overview of the classic coordination mechanisms, e.g., standardization of work processes, but also of recent insights that have identified the conditions that are required to achieve coordination, and how these conditions can be provided by formal mechanisms, such as standardization, but also informally by drawing on features of the emerging situation. Such research highlights the contribution of, e.g., routines like those guided by care pathways or of artifacts like displays. The coordination insights are also discussed as regards inter-organizational care coordination.

Keywords

Care coordination coordination intra-organizational coordination organization theory

The challenge of providing care coordination

Understanding how health care organizations can achieve care coordination internally is essential because care coordination is difficult to achieve^1,2—especially across boundaries such as departments or occupations—but is essential for high-quality and efficient health care delivery^3–6 and continuously learning health care organizations.⁷

To advance knowledge about how health care organizations can achieve care coordination, this article offers a synthesis of knowledge about coordination from organization theory,⁸ where one of the central challenges is how to provide coordination.⁹ Organization theory thus has accumulated a comprehensive body of knowledge about the coordination challenge and different coordination mechanisms.^10–12

By synthesizing insights about how health care organizations can coordinate care, this article adds an important operational layer to the understanding of what care coordination is.¹³ The article is structured in three parts that represent different organization theory perspectives on coordination^12,14–17: (1) traditional coordination mechanisms from classic organization theory; (2) insights from a more recent stream of studies of how coordination emerges and gets achieved in practice, which has identified the conditions that are required for coordination to be achieved, and how these conditions can be provided by the classic coordination mechanisms but also in informal ways that draw on features of the emerging situation; and (3) an overview of Okhuysen and Bechky’s¹² integrative framework of coordination which combines the two perspectives and offers a cutting-edge framework of coordination mechanisms.

The article focuses on intra-organizational coordination. Coordination is especially difficult across boundaries such as departments, roles and professions, features that are particularly strong in health care organizations^18–20 with high functional specialization² and strong professional cultures.^7,21,22

Traditional perspectives on how to achieve coordination

Coordination refers to the alignment of actions.⁹ It becomes non-trivial when the actions to be aligned are interdependent.¹⁰ In a classic and influential conceptualization, March and Simon²³ distinguished coordination by plan and coordination by feedback. Coordination by plan (e.g., through plans or programs) achieves the alignment of actions beforehand, by prescribing behaviors to the different parties involved that will be coordinated if everyone follows the plan. In the context of health care, clinical pathways²⁴ and lean processes,²⁵ for example, represent coordination by plan. Coordination by feedback, on the other hand, aligns actions of different individuals by them adapting through communication (feedback) as action unfolds, for example, during a surgery.

Mintzberg¹¹ identified specific coordination mechanisms within these two categories (see Table 1).

Table 1.

Five traditional coordination mechanisms (Based on Mintzberg, 1979).¹¹

Coordination mechanism	Description and example from health care	Usefulness on a rough continuum of work complexity
Mutual adjustment	Relies on informal communication between people.	Low- and high-work complexity
Mutual adjustment	Verbal communication during surgery or when people communicate in the hallway to update each other.	Low- and high-work complexity
Direct supervision	Refers to a situation in which a supervisor, who has the authority to direct the work of subordinates, provides instructions to them and monitors their actions, thereby assuring alignment of their actions.	Low- to medium-work complexity
	Authority roles like resident doctors or team leaders during a trauma call rely on this mechanism.
Standardization of processes	Refers to instances where decision making build on fixed responses to predefined stimuli.	Low- to medium-work complexity
Standardization of processes	Clinical pathways and lean processes in health care resemble this mechanism.	Low- to medium-work complexity
Standardization of outputs	Coordinates by specifying what the outcomes of work should be, but not the means to achieve it.	Medium-work complexity
Standardization of outputs	A priori specification by hospital managers of performance measures (like a quality indicator) that a hospital department has to achieve within a given timeframe illustrates this mechanism.	Medium-work complexity
Standardization of skills	Refers to the standardization of the training needed to perform the task. It is determined by the education, training, and professional norm the professional receives primarily outside the control of the organization in which he/she works.	Medium- to high-work complexity
	Medical schools, e.g., determine the repertoire of skills doctors use to deliver care.

Mutual adjustment brings about the alignment of action by informal communication, for instance, verbal communication during a surgery or when people communicate in the hallway to update each other. Direct supervision achieves coordination as a supervisor, who has the authority to direct the work of subordinates, provides instructions to them, or monitors their actions, thereby assuring that their actions are aligned. In a hospital, the authority of hierarchical roles such as team leader of a trauma team can bring about coordination through direct supervision.

Standardization of work processes achieves coordination by making everyone accomplish work in a standardized process, which is designed in such a way as to align the actions of the different actors involved. It mirrors what March and Simon,²³ see above, call programs. Standardization of outputs achieves coordination by specifying what the outcomes of work should be (e.g., a production or quality target), but not how to achieve it.

Standardization of skills, finally, aligns actions as everyone with a standardized skill set will accomplish a task in a similar way. It is different from the other coordination mechanisms because the skills are determined by the education, training, and professional norms professionals receive primarily outside the control of the organization¹¹; e.g., medical schools determine the repertoire of skills doctors use to deliver care. As the skills reside in the professional, standardization of skills is consistent with delegation of decision-making autonomy to professionals. Traditionally, standardization of skills represents an important coordination mechanism in hospitals, due to the unique character of health care work.

A fundamental rule for deciding which coordination mechanism to use is that coordination challenges involving high degrees of interdependence require more powerful coordination mechanisms.^5,10 Traditionally, coordination by standardization of process or output are better suited for situations of weaker interdependence (lower work complexity), while coordination by mutual adjustment is required in situations characterized by strong interdependence, e.g., where all other involved parties need to adapt when one party changes the way she carries out her work,¹¹ such as during surgery. Mutual adjustment is also sufficient when work complexity is low and there is no need for more expensive coordination mechanisms, e.g., to develop plans or standardized processes.

In general, the attraction of programmed coordination mechanisms over coordination by feedback is that they are considered efficient and controllable and reduce the need for personal interactions and information processing.^26–28 However, recent research insights about how coordination is realized in action have added nuance and new possibilities.

Coordination in action: Recent research on how coordination is achieved in practice

A recent stream of research has studied the process how coordination is actually brought about in practice by people as work progresses, noting the emergent nature of coordination as opposed to simply applying certain coordination mechanisms.¹⁷ This emergent perspective offers a more fine-grained understanding of how coordination mechanisms bring about aligned actions.¹² Three hospital examples about clinical protocols, care pathways, and displays illustrate insights from the emergent perspective on coordination.

Studying trauma centers, Faraj and Xiao¹⁴ find that dialogic coordination (e.g., interventions across professional boundaries and protocol breaking) is used by actors when clinical protocols (an instance of a standardized procedure) are insufficient to coordinate the work, which in this case is saving patients’ lives. Relatedly, Gittell⁶ finds that hospital care pathways (instances of standardized work processes that function as process maps) in practice provide visibility into the connections between tasks and actions. This visibility facilitates emergent forms of coordination among interrelated workers because it develops frequent, timely, accurate, and problem-solving communication as well as relationships of shared knowledge, shared goals, and mutual respect. Xiao et al.,²⁹ in the context of a trauma operating suite and an emergency department, also identify how a traditional whiteboard (an instance of an object and representation) serves as a versatile information mechanism to support communication in rapid-paced, highly dynamic collaborative work, which plays an important role in coordination in this context.

Factoring in the emergent perspective on coordination provides a more differentiated understanding of how different coordination mechanisms (can) help to achieve (care) coordination.

An integrative perspective on coordination: Combining the traditional and emergent perspectives

Okhuysen and Bechky¹² synthesize traditional and emergent perspectives on coordination mechanisms into an integrative framework (Table 2) which extends the set of coordination mechanisms considered in the classic perspective, and identifies ways in which they can be employed and lead to coordination. The framework contains five categories of coordination mechanisms—plans and rules, objects and representations, roles, routines, and proximity—that foster coordination among interdependent people “through formal, planned mechanisms and by emergent interactions in an organization.”¹² The additional contribution of the framework is to identify three integrating conditions required to achieve coordination, i.e., accountability, predictability, and/or common understanding. As Okhuysen and Bechky¹² argue, coordination mechanisms lead to coordination when they provide at least one of these integrating conditions. They also point out that these integrating conditions can be provided in formal ways—such as by formal coordination mechanisms such as plans or authority—but also in informal ways that use what is available in an emergent situation.

Table 2.

An integrative perspective on coordination (based on Okhuysen & Bechky, 2009).¹²

Coordinates by providing	Accountability	Predictability	Common understanding	Health care examples
Coordination mechanism	Coordinates through establishing who is responsible for particular aspects of the task	Coordinates through providing information to interdependent parties about what the elements of the task are, how and when they happen and who performs them.	Coordinates through developing a shared conception of the activities interdependent parties are performing
Plans and rules	Defining responsibilities for tasks	Defining responsibilities for tasks Resource allocation	Developing agreement	Clinical pathways; lean processes; clinical guidelines; resource allocation agreements
Objects and representations	Scaffolding Acknowledging and aligning work	Scaffolding	Direct information sharing Creating a common perspective	Whiteboards; Kaizen boards; monitors; bedside records; electronic patient record systems
Roles	Monitoring and updating	–	Substitution Creating a common perspective	Assigned roles, e.g., specific roles during surgery or care coordinators.
				Specialization roles, e.g., cardiologist or oncology nurse.
				Authority roles like manager versus staff.
				Emergent roles, e.g., learning about each other’s work role by working together.
Routines	Hand-off work	Task completion/stability	Bringing groups together	Refers to patterns of how work is carried out in practice.
			Developing agreement	Brought about tacitly (when actors gain knowledge of other’s behavior involved in solving a task) or explicitly (e.g., clinical pathways).
Proximity	Visibility: monitoring and updating Familiarity: developing trust	Familiarity: anticipating and responding	Familiarity: store of knowledge	Co-location, e.g., of interdependent departments; Joint meeting spaces like huddles and Kaizen meetings; Informal interaction

Different ways for leveraging coordination mechanisms: Programmed and emergent

Two of the central insights summarized by Okhuysen and Bechky¹² are that an extended range of mechanisms can bring about coordination, and that the classic coordination mechanisms can also be triggered in emergent ways that had not previously be considered.

Objects and representations refer, among other things, to documents (like bedside records, admission and discharge forms, or clinical guidelines³⁰), displays (such as hospital whiteboards²⁹ or Kaizen boards used as part of lean health care³¹), or monitors which act as boundary spanners that can provide information about task status and progress, etc. Such objects and representations provide workers with mechanisms to acknowledge and align work, offer a scaffold that provides a structure for activities, make the progress of a task obvious, create a common perspective, and allow information to be shared directly.

Plans and rules refer to what was above called programs or standardized work processes. This type of coordination mechanism realizes its coordination potential by defining ex ante responsibilities for tasks, allocating resources, and developing agreements among the people involved.

Roles coordinate through the associated expectations people have of the roles, thereby offering the possibility to monitor and provide updates on activities. Roles also make it possible for people to substitute for each other and open for creating a common understanding about the task that needs to be coordinated. Roles can be established formally (e.g., managerial positions, team leader roles, or specialized roles based on job function such as cardiologist) or informally (emergent) when learning about each other’s work role by working together in, for instance, a hospital department.

Routines—stable ways of accomplishing a task^32,33—coordinate in programmed or emergent ways “by providing a template for task completion, by bringing people together, and by creating a common perspective across groups.”¹² Routines can be brought about tacitly (e.g., when actors gain knowledge of others’ behavior when solving a task together) or explicitly (e.g., when routines are guided by clinical pathways). The coordination potential gets realized because routines provide a backdrop for handing off work (handoffs in hospitals are crucial to ensure patient safety and care quality^34,35) and they foster task completion and stability. Routines also help to develop agreement among people. Interestingly, Greenhalgh³⁶ argues that organizational routines in the context of health care represent a hitherto untapped research area, that, if addressed, can provide insights about care coordination.

Proximity influences the amount of interaction and communication among people. Proximity can be achieved through co-location³⁷ or by organizing for interdependent process management by using “process mapping, brainstorming, participatory meeting management, and multi-stakeholder decision-making”³⁸ or having joint meeting spaces like huddles³⁹ in the hospital. Proximity aids coordination by providing visibility, which in turn makes it possible to monitor and update each other. Proximity also develops familiarity that builds trust and stores knowledge. Such familiarity also makes it possible for people to anticipate and respond to each other as needed in the situation.

Accountability, predictability, and common understanding: Three integrating conditions

The five types of coordination mechanisms (plans and rules, objects and representations, roles, routines, or proximity that can be brought about in programmed or emergent ways) can lead to three integrating conditions (accountability, predictability, and common understanding) which foster coordination among interdependent people (see Table 2). Accountability coordinates through establishing who is responsible for particular parts of the task. Contrary to traditional perspectives on coordination, accountability “is not only attained through hierarchical authority […] but can also be achieved in other ways, such as lateral interactions in meetings”¹² through which it emerges and becomes clear to people who is accountable for what.

Predictability coordinates through providing information to interdependent people about what the elements of the task are, how and when they happen and who performs them, thereby opening for anticipating subsequent steps. Predictability can be formally established through formal means like hierarchy and top-down plans. However, predictability can also be brought about in emergent ways using, for example, simulations and briefings because “a consequence of building knowledge of one another through emergent interaction is an enhanced level of predictability in the execution of the task.”¹²

Common understanding coordinates through developing a shared conception of the activities interdependent parties are performing. This can occur in formal ways when activities are “embodied in assembly drawings, schedules, or other plans drawn up by the organization […] and handed down a hierarchy” or as a lateral process when “members of the groups themselves through an iterative process [interact] to create these plans.”¹²

Discussion and conclusion

Improving intra-organizational care coordination and addressing the trends of reorganizing around care processes and delivering patient-centered care

Adding to a well-established classic body of knowledge, organization theory has recently generated important new insights on how coordination is provided inside organizations,¹² opening the door to new developments in organization theory but also offering new possibilities for achieving intra-organizational (care) coordination in practice.

Specifically, recent research in organization theory emphasizes the conditions under which coordination mechanisms bring about intra-organizational coordination—by providing accountability, predictability, and common understanding. It also points out that these conditions can be provided by classic coordination mechanisms such as plans and direct supervision but also by other means such as inter-relational and lateral mechanisms. By establishing this argument, it sheds light on the micro-foundations for coordination and, especially, identifies new possibilities for intra-organizational coordination by directing attention to the question how the processes by which interdependent actors accomplish tasks together offers possibilities for providing accountability, predictability, and common understanding. Identifying such possibilities then provides the potential to strengthen those conditions, thereby leveraging the mechanisms that foster coordination in the specific situation, which might well go beyond the classic set of coordination mechanisms.⁴⁰

These new possibilities from organization theory offer useful and novel ways of providing care coordination in hospitals, at a time when hospitals are facing increased coordination challenges brought about by new developments. Hospitals are undergoing a fundamental reorganization from being organized around departments (also known as professional silos)⁴¹ to process-oriented organizations where the focus is on the whole care process.^42–44 This process-orientation accentuates the need for finding ways to align the actions of health care staff in order to achieve care coordination throughout the hospital.⁴⁵ Similarly, mergers of hospitals into very large hospitals, with the aim of reaping economies of scale and scope,^46–48 require a stronger focus on internal care coordination to connect the different organizational parts into an integrated whole.

Another challenge these new possibilities of coordination can help address is the aim of providing patient-centered care⁴⁹ and making patients active participants.⁷ Gittell et al.⁵⁰ have emphasized the relational side of hospital work in which shared goals, shared knowledge, and mutual respect is decisive. Gittell and Douglass⁵¹ highlight relational coproduction between workers (health care professionals) and customers (patients), and the Institute of Medicine⁷ highlights the role of patient coaching and question checklists.

The insights from organization theory synthesized here thus offer a structured perspective that allows identifying possibilities for bringing about and strengthening coordination in hospitals as well as meeting current health care challenges.

Inter-organizational care coordination: Applicability of the traditional, emergent, and integrative perspectives on intra-organizational coordination

Intra-organizational coordination is challenging to achieve, but achieving it across organizations is often even more tricky.⁵² Coordination across health care organizations and/or care sectors today is an increasing health care challenge that calls for tighter inter-organizational care coordination.^53–55 One factor is that more and more “persons with continuous complex care needs frequently require care in multiple settings.”⁵⁶ A widely used health care solution to that end is chronic care models/disease management programs.^57,58

The integrative perspective on intra-organizational coordination offers potentially valuable insights when it comes to organizing for accountability, predictability, and common understanding across organizations, although it remains largely unexplored.¹² At first, the traditional perspective on coordination (like plans and rules and defined roles) looks more likely to improve inter-organizational care coordination. One reason being that emergent forms of coordination across organizations face greater challenges because working in separate organizations typically provides far fewer opportunities (such as meeting spaces and proximity) to, for example, (a) learn about each other’s work role or (b) gain knowledge of other’s behavior involved in solving a common task.

However, using traditional, formal coordination mechanisms purposefully across organizations (like institutionalizing opportunities for dialogue³⁸) could help to achieve inter-organizational care coordination and potentially serve as a step towards developing emergent forms of coordination across organizations that bring about accountability, responsibility, and common understanding. The latter, for example, by “transforming outsiders into insiders by sharing information about operational aspects or making the project a joint endeavour.”¹² The former, for example, through display practices such as “internal and external networks, electronic mail system, online calendaring tool, and project management system.”⁵⁹

Relatedly, Gulati et al.’s⁵² review of inter-organizational collaboration (such as alliances and joint ventures) are of interest to the health care sector because it considers not only the role of coordination mechanisms where the challenge is how to manage task interdependencies and uncertainties in alliances but also factors in the importance of cooperation/governance mechanisms such as “legal or private sanctions; social sanctions” (p. 534), which are needed to solve the challenge of how to manage resource dependencies and share investment risk.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research benefited from financial support by the Danish Council for Independent Research.

References

Ramanujam

Rousseau

. The challenges are organizational not just clinical. J Organ Behav 2006; 27: 811–827.

Mintzberg

Glouberman

. Managing the care of health and the cure of disease—part I: differentiation. Health Care Manage Rev 2001; 26: 56–69.

McDonald

. Care coordination, Rockville, MD: Agency for Healthcare Research and Quality, 2007.

Ovretveit

. Does clinical coordination improve quality and save money; A detailed review of the evidence, Volume 2, London: The Health Foundation, 2011.

Argote

. Input uncertainty and organizational coordination in hospital emergency units. Adm Sci Q 1982; 27: 420–434.

Gittell

. Coordinating mechanisms in care provider groups: relational coordination as a mediator and input uncertainty as a moderator of performance effects. Manage Sci 2002; 48: 1408–1426.

Institute of Medicine

Smith

. Best care at lower cost: the path to continuously learning health care in America, Washington, DC: The National Academies Press, 2013.

Scott

Davis

. Organizations and organizing: rational, natural and open systems perspectives, Harlow: Pearson/Prentice Hall, 2007.

Heath

Staudenmayer

. Coordination neglect: how lay theories of organizing complicate coordination in organizations. Res Organ Behav 2000; 22: 153–192.

10.

Thompson

. Organizations in action: social science bases of administrative theory, New Brunswick, NJ: Transaction Pub, 1967.

11.

Mintzberg

. The structuring of organizations: a synthesis of the research, Englewood Cliffs, NJ: Prentice-Hall, 1979.

12.

Okhuysen

Bechky

. Coordination in organizations: an integrative perspective. Acad Manage Ann 2009; 3: 463–502.

13.

Schultz

McDonald

. What is care coordination? Int J Care Coord 2014; 17: 5–25.

14.

Faraj

Xiao

. Coordination in fast-response organizations. Manage Sci 2006; 52: 1155–1169.

15.

Grant

. Toward a knowledge-based theory of the firm. Strategic Manage J 1996; 17: 109–122.

16.

Valentine

Edmondson

. Team scaffolds: how mesolevel structures enable role-based coordination in temporary groups. Organ Sci 2015; 26: 405–422.

17.

Jarzabkowski

Lê

Feldman

. Toward a theory of coordinating: creating coordinating mechanisms in practice. Organ Sci 2012; 23: 907–927.

18.

Gosselin

. Probing into task interdependencies: the case of physicians in a teaching hospital. J Manage Stud 1985; 22: 466–497.

19.

Young

. Best practices for managing surgical services: the role of coordination. Health Care Manage Rev 1997; 22: 72–81.

20.

Strauss

. Social organization of medical work, New Brunswick: Transaction, 1997.

21.

Macdonald

. The sociology of the professions, London, England: SAGE Publications, 1995.

22.

Currie

White

. Inter-professional barriers and knowledge brokering in an organizational context: the case of healthcare. Organ Stud 2012; 33: 1333–1361.

23.

March

Simon

. Organizations, Cambridge, MA: Blackwell, 1958.

24.

Pearson

Goulart-Fisher

Lee

. Critical pathways as a strategy for improving care: problems and potential. Ann Intern Med 1995; 123: 941–948.

25.

Poksinska

. The current state of Lean implementation in health care: literature review. Qual Manage Health Care 2010; 19: 319–329.

26.

Van de Ven

Delbecq

Koenig

Jr . Determinants of coordination modes within organizations. Am Sociol Rev 1976; 41: 322–338.

27.

Tushman

Nadler

. Information processing as an integrating concept in organizational design. Acad Manage Rev 1978; 3: 613–624.

28.

Galbraith

. Organization design: an information processing view. Interfaces 1974; 4: 28–36.

29.

Xiao

. What whiteboards in a trauma center operating suite can teach us about emergency department communication. Ann Emerg Med 2007; 50: 387–395.

30.

Field

Lohr

. Clinical practice guidelines: directions for a new program, Washington, DC: National Academy Press, 1990.

31.

Institute for Healthcare Improvement. Going lean in health care, Cambridge, MA: Institute for Healthcare Improvement, 2005.

32.

Becker

. Organizational routines: a review of the literature. Indus Corporate Change 2004; 13: 643–677.

33.

Becker

Organizational routines. In: Teece

Augier

(eds). The Palgrave Dictionary of strategic management, London: Palgrave MacMillan, 2014.

34.

Cohen

Hilligoss

. The published literature on handoffs in hospitals: deficiencies identified in an extensive review. Qual Saf Health Care 2010; 19: 493–497.

35.

Solet

. Lost in translation: challenges and opportunities in physician-to-physician communication during patient handoffs. Acad Med 2005; 80: 1094–1099.

36.

Greenhalgh

. Role of routines in collaborative work in healthcare organisations. Br Med J 2008; 337: 1269–1271.

37.

Allen

. Managing the flow of technology, Cambridge, MA: MIT Press, 1977.

38.

Adler

Heckscher

. The collaborative, ambidextrous enterprise. Universia Bus Rev 2013; 40: 34–51.

39.

Provost

. Health care huddles: managing complexity to achieve high reliability. Health Care Manage Rev 2015; 40: 1–12.

40.

Bechky

. Sharing meaning across occupational communities: the transformation of understanding on a production floor. Organ Sci 2003; 14: 312–330.

41.

Mintzberg, H. On management: Inside our strange world of organizations. In: The professional organization, ch. 10. New York: The Free Press, 1989, pp.173–195.

42.

Vos

. Towards an organisation-wide process-oriented organisation of care: a literature review. Implement Sci 2011; 6: 8–8.

43.

Lega

DePietro

. Converging patterns in hospital organization: beyond the professional bureaucracy. Health Pol 2005; 74: 261–281.

44.

Villa

Barbieri

Lega

. Restructuring patient flow logistics around patient care needs: implications and practicalities from three critical cases. Health Care Manage Sci 2009; 12: 155–165.

45.

Prætorius

Towards the collaborative hospital – harnessing the potential of enabling care processes and structures. In: Elg

(ed). Sustainable development in organizations, Cheltenham: Edward Elgar Publishing, 2015, pp. 57–76.

46.

Kristensen

Bogetoft

Pedersen

. Potential gains from hospital mergers in Denmark. Health Care Manage Sci 2010; 13: 334–345.

47.

Posnett

. Is bigger better? Concentration in the provision of secondary care. Br Med J 1999; 319: 1063–1065.

48.

Preyra

Pink

. Scale and scope efficiencies through hospital consolidations. J Health Econ 2006; 25: 1049–1068.

49.

Institute of Medicine. Crossing the quality chasm: a new health system for the 21st century, Washington, DC: The National Academies Press, 2001.

50.

Gittell

Seidner

Wimbush

. A relational model of how high-performance work systems work. Organ Sci 2010; 21: 490–506.

51.

Gittell

Douglass

. Relational bureaucracy: structuring reciprocal relationships into roles. Acad Manage Rev 2012; 37: 709–733.

52.

Gulati

Wohlgezogen

Zhelyazkov

. The two facets of collaboration: cooperation and coordination in strategic alliances. Acad Manage Ann 2012; 6: 531–583.

53.

Hofmarcher

Oxley

Rusticelli

. Improved health system performance through better care coordination: OECD health working papers, Paris: Organisation for Economic Co-operation and Development, 2007.

54.

Bodenheimer

. Coordinating care: a perilous journey through the health care system. N Engl J Med 2008; 358: 1064–1071.

55.

Coleman

Berenson

. Lost in transition: challenges and opportunities for improving the quality of transitional care. Ann Intern Med 2004; 140: 533–536.

56.

Coleman

. Falling through the cracks: challenges and opportunities for improving transitional care for persons with continuous complex care needs. J Am Geriatr Soc 2003; 51: 549–555.

57.

Wagner

Austin

Von Korff

. Organizing care for patients with chronic illness. Millbank Q 1996; 74: 511–543.

58.

Wagner

. What will it take to improve care for chronic illness? Eff Clin Pract 1998; 1: 2–4.

59.

Kellogg

Orlikowski

Yates

. Life in the trading zone: structuring coordination across boundaries in postbureaucratic organizations. Organ Sci 2006; 17: 22–44.