Management Barriers to Inter-Organizational Collaboration in Preoperative Treatment of Patients with Hip or Knee Osteoarthritis
Abstract
:1. Introduction
2. Materials and Methods
2.1. Quantitative Approach
2.2. Qualitative Study
2.3. Ethical Issues
3. Results
3.1. Results of Quantitative Study
3.2. Results of Qualitative Study
3.2.1. Macro-Level Barriers
“Our healthcare system does not work well because not enough money is provided and at the same time too much bureaucratic work has been imposed on doctors and nurses. There is a lack of funds for sufficient medical personnel, for sufficient treatments, for investments. … Of course, some people are making big profits. But for us all this is not enough, and then they ordered the doctors and nurses to fill in meaningless administration. Yes, I can see while I am waiting for treatment. So, there is lack of money, no time for patients, and no will to introduce something as good as this preoperative treatment.”
“In my opinion, the general problem is the indecision of the main players. Why? Because they are afraid of being replaced if they do not play the way others want them to. So, the main problem is that public healthcare in general is inefficient and disorganized, with politicians, the insurance company, and some other institutions such as the medical association and the unions taking the lead, each defending its own interests. I know that we have many cases where good innovations are ready, but these people are afraid of being replaced if they do not make the decision expected of them, so they leave the documents in the drawer embark on this integrated path, and last but not least, to make all the essential changes, it is an imperative to change the system of organization, management, and administration.” (Stakeholder 2).
3.2.2. Meso-Level Barriers
“The main problem is poor management. I can say that out loud, even though I am the director of a healthcare center. Because of the politicization of healthcare, I do not have the autonomy to make decisions. And the losers of all of this are the citizens who years ago had difficulty accessing specialists, but today they have difficulty accessing a general practitioner, which has never existed before. This is a violation of constitutional and human rights. It is necessary to change the management of public healthcare facilities and give them the necessary autonomy in administration by appointing appropriate experts with knowledge in healthcare and healthcare management. The facilities also need effective supervisory boards, which must be composed of healthcare professionals and not be politically motivated. Again, a depoliticization of the healthcare system is needed. The role of politics is simply to create the conditions for the optimal functioning of the healthcare system. The healthcare system should be managed by experts who are most knowledgeable in this area.” (Stakeholder 3)
3.2.3. Micro-Level Barriers
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Demographic Parameter | Category | No. of Respondents n (%) |
---|---|---|
Gender | Female Male | 87 (64.4%) 48 (35.6%) |
Age | <30 years | 17 (12.6%) |
31–40 years | 22 (16.3%) | |
41–50 years | 44 (32.6%) | |
51–60 years | 32 (23.7%) | |
61 years < | 20 (14.8%) | |
Profession | MD–general | 55 (40.7%) |
MD–specialist | 39 (28.9%) | |
Physiotherapist | 41 (30.4%) | |
Type of organization | Public sector Private sector | 84 (62.2%) 51 (37.8%) |
Organizational Level | Median | Mean | SD |
---|---|---|---|
Macro level | 2.00 | 2.14 | 0.61 |
Meso level | 2.50 | 2.50 | 0.54 |
Micro level | 3.00 | 2.82 | 0.70 |
Related-Samples Wilcoxon Signed Rank Test | Sig. (P) | ||
Macro vs. meso | <0.001 | ||
Meso vs. micro | <0.001 | ||
Macro vs. micro | <0.001 |
All Responders | Group of Professional | Type of Organization | |||||||
---|---|---|---|---|---|---|---|---|---|
Estimation of the Influence of the Following Factors on Interorganizational Collaboration for Integrated Approach: | Median | Mean (SD) | MD–General (Mean) | MD–Specialist (Mean) | PHT (Mean) | Kruskal–Wallis H Test (P) | PUB (Mean) | PRIV (Mean) | Mann–Whitney U Test (P) |
n | 135 | 55 | 39 | 41 | 93 | 52 | |||
Macro level—average | 2.00 | 2.14 (1.04) | 2.15 | 2.05 | 2.09 | 0.793 | 2.09 | 2.12 | 0.701 |
The culture of (non)cooperation in Slovenia | 2.00 | 2.22 (0.87) | 2.22 | 2.21 | 2.24 | 0.969 | 2.24 | 2.20 | 0.901 |
Legislation in the field of healthcare | 2.00 | 2.31 (0.77) | 2.38 | 2.33 | 2.20 | 0.295 | 2.27 | 2.37 | 0.620 |
Healthcare financing (e.g., standardization of services and salaries) | 2.00 | 1.83 (0.77) | 1.93 | 1.64 | 1.88 | 0.522 | 1.80 | 1.88 | 0.531 |
Control of work by the insurance agency (ZZZS) | 2.00 | 2.13 (0.84) | 2.15 | 2.26 | 2.03 | 0.309 | 2.14 | 2.11 | 0.884 |
Meso level—average | 2.50 | 2.55 (0.54) | 2.50 | 2.44 | 2.74 | 0.008 * | 2.55 | 2.57 | 0.949 |
Management (coordination of work by management) | 3.00 | 3.24 (0.90) | 3.40 | 3.18 | 3.10 | 0.241 | 3.05 | 3.57 | 0.01 * |
Differences in the understanding of cooperation and cooperation goals | 3.00 | 2.75 (0.69) | 2.75 | 2.56 | 2.93 | 0.042 * | 2.73 | 2.78 | 0.708 |
Different organization of institutions (different working hours, hierarchy, etc.) | 3.00 | 2.54 (0.67) | 2.56 | 2.41 | 2.63 | 0.299 | 2.55 | 2.53 | 0.854 |
Power positions and conflicts among institutions | 2.00 | 2.37 (0.72) | 2.29 | 2.26 | 2.59 | 0.025 * | 2.38 | 2.35 | 0.868 |
Staff size/number | 2.00 | 2.21 (0.99) | 2.04 | 2.00 | 2.66 | <0.001 ** | 2.14 | 2.33 | 0.398 |
Experience from previous collaborations | 3.00 | 3.14 (0.97) | 3.05 | 3.08 | 3.32 | 0.204 | 3.18 | 3.08 | 0.477 |
Differences in organizational culture (way of working norms, values) | 3.00 | 2.59 (0.83) | 2.49 | 2.56 | 2.76 | 0.099 | 2.54 | 2.69 | 0.486 |
Different interests and goals of individual institutions (public/private) | 2.00 | 2.49 (0.84) | 2.40 | 2.33 | 2.76 | 0.012 * | 2.51 | 2.45 | 0.749 |
(Mis)understanding the role of other organizations | 2.00 | 2.33 (0.66) | 2.29 | 2.33 | 2.39 | 0.620 | 2.36 | 2.29 | 0.607 |
Technical standards | 3.00 | 2.71 (0.75) | 2.64 | 2.69 | 2.83 | 0.218 | 2.75 | 2.65 | 0.443 |
(Dis)trust among actors | 2.00 | 2.41 (0.80) | 2.40 | 2.26 | 2.59 | 0.084 | 2.51 | 2.25 | 0.085 |
(Non)communication among actors | 2.00 | 2.11 (0.94) | 1.89 | 2.15 | 2.37 | 0.031 * | 2.15 | 2.04 | 0.686 |
Different profession or professionalization | 3.00 | 2.70 (0.99) | 2.71 | 2.38 | 3.00 | 0.015 * | 2.65 | 2.78 | 0.368 |
(Un)acceptance of changes/innovations in the organization | 2.00 | 2.41 (0.95) | 2.38 | 2.18 | 2.66 | 0.054 | 2.36 | 2.49 | 0.377 |
Micro level—average | 3.00 | 2.82 (0.69) | 2.72 | 2.57 | 3.18 | <0.001 ** | 2.81 | 2.83 | 0.728 |
Documentation (e.g., scope, content, and technology) | 2.00 | 2.41 (0.99) | 2.35 | 2.03 | 2.85 | 0.001 * | 2.31 | 2.57 | 0.107 |
Confidentiality between healthcare professional and patient | 3.00 | 3.40 (0.85) | 3.49 | 3.08 | 3.59 | 0.120 | 3.44 | 3.33 | 0.330 |
Patient requests for additional treatment/referral | 3.00 | 2.77 (0.86) | 2.38 | 2.96 | 3.13 | 0.001 * | 2.83 | 2.68 | 0.551 |
Barriers | Patients | Health Professionals | Other Stakeholders |
---|---|---|---|
Macro level (system) Insufficiently efficient system due to culture of non-collaboration | |||
Insufficiently efficient system | |||
Power imbalance and conflicts: overpowering politicians and financier Indecision of key actors | Power imbalance and conflicts: overpowering politicians and financier Indecision of key actors | ||
Administrative barriers Funding barriers | Too much administration | Too much administration | |
Lack of resources | Unpaid inter-organizational collaboration | Lack of resources | |
Meso level (healthcare setting) Poor management Lack of technological standards Lack of staff | |||
Disorganization | Power imbalance and conflicts: overpowering politicians and financier Indecision of key actors | Power imbalance and conflicts: overpowering politicians and financier Indecision of key actors | |
- | Incompatible IT infrastructure | Incompatible IT infrastructure | |
Shortage of GPs | Shortage of nurses and GPs | Shortage of nurses and GPs | |
Micro level (service delivery) Lack of communication | |||
Lack of time for communication | Lack of time for communication, incompetence, or personal characteristics | Lack of time and willingness for communication |
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Hussein, M.; Erjavec, K.; Velikonja, N.K. Management Barriers to Inter-Organizational Collaboration in Preoperative Treatment of Patients with Hip or Knee Osteoarthritis. Healthcare 2023, 11, 1280. https://doi.org/10.3390/healthcare11091280
Hussein M, Erjavec K, Velikonja NK. Management Barriers to Inter-Organizational Collaboration in Preoperative Treatment of Patients with Hip or Knee Osteoarthritis. Healthcare. 2023; 11(9):1280. https://doi.org/10.3390/healthcare11091280
Chicago/Turabian StyleHussein, Mohsen, Karmen Erjavec, and Nevenka Kregar Velikonja. 2023. "Management Barriers to Inter-Organizational Collaboration in Preoperative Treatment of Patients with Hip or Knee Osteoarthritis" Healthcare 11, no. 9: 1280. https://doi.org/10.3390/healthcare11091280