Towards Process-Oriented Hospital Structures: Drivers behind the Development of Hospital Designs

Jeroen van Wijngaarden, Anoek Braam*, Martina Buljac, Carina Hilders

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

1 Citation (Scopus)
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Hospitals have been encouraged to develop more process-oriented designs, structured around patient needs, to better deal with patients suffering from multi-morbidity. However, most hospitals still have traditional designs built around medical specialties. We aimed to understand how hospital designs are currently developing and what the important drivers are. We built a typology to categorize all Dutch general hospitals (61), and we interviewed hospital managers and staff. The inventory showed three types of hospital building blocks: units built around specific medical specialties, clusters housing different medical specialty units, and centers; multi-specialty entities provide the most suitable structure for a process-oriented approach. Only some Dutch hospitals (5) are mainly designed around centers. However, most hospitals are slowly developing towards hybrid designs. Competitive drivers are not important for stimulating these redesigns. Institutional pressures from within the health care sector and institutional ‘mimicking’ are the main drivers, but the specific path they take is dependent on their ‘heritage’. We found that hospital structures are more the result of incremental, path-dependent choices than ‘grand-designs’. Although the majority of the Dutch general hospitals still have a general design built around medical specialties, most hospitals are moving towards a more process-oriented design.
Original languageEnglish
Article number1993
JournalInternational Journal of Environmental Research and Public Health
Issue number3
Publication statusPublished - 21 Jan 2023

Bibliographical note

Funding Information:
This research is (indirectly) funded by the Academy for medical specialists (NL). They initiated a chair in medical management and leadership at the Erasmus School of Health Policy and Management, which is held by endowed professor Carina Hilders. In the context of this chair, they also fund a Ph.D. position, filled in by Anoek Braam. The aim of the Academy for medical specialists is to help healthcare professionals acquire knowledge and expertise in the six non-medical competence areas of the internationally recognized CanMeds model: communication, collaboration, knowledge and science, social action, organization, and professionalism. They played no further role in the research design or any other part of the conducted study.

Publisher Copyright:
© 2023 by the authors.


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