背景:医疗保健中的组织间网络并不总是达到他们的目标。现有模型概述了可以解释网络绩效不佳的因素:治理;结构;以及专业,组织和网络层面。然而,这些模型是非常通用的,并假设一种功能方法。我们调查了有关网络结构和治理如何相互关联以及在多层次背景下与网络性能相关的可用经验知识,为了获得更深入的洞察力,有经验的支持,为什么网络(未能)实现他们的目标。
方法:基于WebofScience搜索的系统文献综述,BusinessSourceComplete和PubMed于2021年5月执行,并于2022年1月重复执行。如果全文是用英语撰写的,并在医疗保健组织间环境中报告了经验数据,则包括全文。包含的论文被编码为治理主题,结构,性能和多级网络。科学管理领域的论文,比较了管理和医疗保健。使用Vosviewer可视化文档引用和书目耦合网络,并使用UCINET计算网络测量值。
结果:总体而言,184篇论文被纳入审查,其中大部分来自医疗保健期刊。医疗保健期刊的研究主要对护理质量感兴趣,而管理和行政期刊的研究往往集中在效率和财务方面。交叉引用在不同的领域是有限的。具有经纪治理形式的网络是最普遍的。网络性能主要在社区级别进行衡量。只有少数研究采用了多层次的视角,和交互效应通常不测量水平之间。
结论:医疗保健网络的研究分散在不同的科学领域。目前的审查显示了一系列积极的,负面影响和混合效应,并指出需要更多的实证研究来确定这些结果的根本原因。关于不同网络结构和治理模式对不同级别医疗网络绩效的影响,几乎没有任何实证研究。我们发现需要更多的实证研究来研究多层次的医疗保健网络,同时承认可能适用于不同层次的混合治理模型。
BACKGROUND: Interorganizational networks in healthcare do not always attain their goals. Existing models outline the factors that could explain poor network performance: governance; structure; and the alignment of professional, organizational and network levels. However, these models are very generic and assume a functional approach. We investigate available empirical knowledge on how network structure and governance relate to each other and to network performance in a multilevel context, to get deeper insight, supported with empirics, of why networks (fail to) achieve their goals.
METHODS: A systematic literature
review based on a search of Web of Science, Business Source Complete and PubMed was executed in May 2021 and repeated in January 2022. Full papers were included if they were written in English and reported empirical data in a healthcare interorganizational setting. Included papers were coded for the topics of governance, structure, performance and multilevel networks. Papers from the scientific fields of management, administration and healthcare were compared. Document citation and bibliographic coupling networks were visualized using Vosviewer, and network measures were calculated with UCINET.
RESULTS: Overall, 184 papers were included in the
review, most of which were from healthcare journals. Research in healthcare journals is primarily interested in the quality of care, while research in management and administration journals tend to focus on efficiency and financial aspects. Cross-citation is limited across different fields. Networks with a brokered form of governance are the most prevalent. Network performance is mostly measured at the community level. Only a few studies employed a multilevel perspective, and interaction effects were not usually measured between levels.
CONCLUSIONS: Research on healthcare networks is fragmented across different scientific fields. The current
review revealed a range of positive, negative and mixed effects and points to the need for more empirical research to identify the underlying reasons for these outcomes. Hardly any empirical research is available on the effects of different network structures and governance modes on healthcare network performance at different levels. We find a need for more empirical research to study healthcare networks at multiple levels while acknowledging hybrid governance models that may apply across different levels.