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The purpose of this paper is to systematically apply theory of organisational routines to standardised care pathways. The explanatory power of routines is used to address open questions in the care pathway literature about their coordinating and organising role, the way they change and can be replicated, the way they are influenced by the organisation and the way they influence health care professionals.

Theory of routines is systematically applied to care pathways in order to develop theoretically derived propositions.

Care pathways mirror routines by being recurrent, collective and embedded and specific to an organisation. In particular, care pathways resemble standard operating procedures that can give rise to recurrent collective action patterns. In all, 11 propositions related to five categories are proposed by building on these insights: care pathways and coordination, change, replication, the organisation and health care professionals.

The paper is conceptual and uses care pathways as illustrative instances of hospital routines. The propositions provide a starting point for empirical research.

The analysis highlights implications that health care professionals and managers have to consider in relation to coordination, change, replication, the way the organisation influences care pathways and the way care pathways influence health care professionals.

Theory on organisational routines offers fundamental, yet unexplored, insights into hospital processes, including in particular care coordination.

The purpose of this study is to assess the relationship between patient-centricity, care coordination and delivery of quality care for older people with multiple chronic conditions. Care coordination is defined as a process where physicians, nurses and allied professionals work together to clarify responsibilities, care objectives, treatment plans and discharge plans for delivery of unified care. Patient-centricity is defined as an approach of delivering quality care to patients that focuses on creating a positive experience for them.

A literature review was used to identify measures of care coordination and then partial least square structural equation modeling was used to assess interrelationship among patient-centricity, measures of care coordination and delivery of quality care.

Results reveal that care coordinated pathways consist of IT-enabled coordination, interprofessional teamwork, information sharing and facilitative infrastructure requirements and are influenced by patient-centricity. These are deliberate requisites for delivering of quality care. Results of this study present a validated model of care coordination for older people, which may be further explored to refine the concept of care coordination.

Based on these results, practitioners may develop an overarching strategy to deliver seamless care and to achieve better health outcomes. Measures of care coordination may be used as a performance benchmarking tool and will also help in the process mapping of hospitals.

This paper highlights how patient-centricity may be achieved by focusing on coordinated care processes. This understanding may help in designing processes, which in turn deliver health as a social good in an effective manner.

Results of this study present such a validated model for care coordination, which can be used by researchers.

New organization theory posits that coordination mechanisms work by generating three integrating conditions: accountability (clarity about task responsibilities), predictability (clarity about which, when, and how tasks will be accomplished), and common understanding (shared perspectives about tasks). We apply this new theory to health care to improve understanding of how accountable care organizations (ACOs) are attempting to reduce the fragmentation that characterizes the US health care system. Drawing on four organizational case studies, we find that ACOs rely on a wide variety of coordination mechanisms that have been designed to leverage existing organizational capabilities, accommodate local contingencies. and, in some instances, interact strategically. We conclude that producing integrating conditions across the care continuum requires suites of interacting coordination mechanisms. Our findings provide a conceptual foundation for future research and improvements.

The purpose is to analyse the relationship between democratic accountability and how sustainable governance is achieved by horizontally integrating care services for older people through collaboration in a coordination body of key leaders from across the health and social care system.

The data and measures come from two surveys with coordination body members in Sweden (politicians, administrators, professionals) from a sample of 73 bodies in 2015 (n = 549) and the same/corresponding 59 bodies in 2019 (n = 389).

The governance of integrating care scale and the accountability scales repeatedly show consistency among individual members. Systematic progress is found among large coordination bodies: the greater the average perception of governance of horizontally integrating care in 2015, the greater it was in 2019 – and regardless of the period, the stronger the internal administrative or political monitoring and reviewing of the coordination body, the greater its governance (while the relationship to the external monitoring and reviewing is weak). However, the growing importance of external accountability is indirect, shown by stronger correlations between the internal political and external monitoring and reviewing, regardless of size.

The scales are based on self-reported perceptions that cannot be objectively verified, but they can be linked to changes in outcomes and user experiences in the later stages of the research.

Repeatedly verified scales of internal and external accountability for analysing and evaluating governance of integrating care services horizontally, which is useful for improving strategic coordination of integrated care.

The purpose of this paper is to present a framework for examining variation in care coordination arrangements for older people.

A multi-method approach was adopted combining analysis of secondary data and primary data. There were two stages: the development of the framework and its constituent attributes and indicators; and its validation from two perspectives: a meeting with managers and focus groups with practitioners. It was informed by an existing generic framework; subsequent policy guidance; data from an English national survey; previous research; and international literature.

The framework comprises 19 attributes each with indicators measuring performance relating to: organisational arrangements influencing service delivery; the performance of core tasks of care coordination; and differentiation within the process to distinguish between responses to different levels of need.

Care coordination arrangements in England are characterised by diversity. This paper provides a framework for evaluating local arrangements thereby highlighting strengths and where improvements are needed. It offers a means to promote programme fidelity. As such it has utility for both service commissioners and providers.

Academic healthcare systems face great challenges in coordinating services across a continuum of care that spans hospital, community providers, home and chronic care facilities. The Johns Hopkins Community Health Partnership (J-CHiP) was created to improve coordination of acute, sub-acute and ambulatory care for patients, and improve the health of high-risk patients in surrounding neighborhoods. The paper aims to discuss this issue.

J-CHiP targeted adults admitted to the Johns Hopkins Hospital and Johns Hopkins Bayview Medical Center, patients discharged to participating skilled nursing facilities (SNFs), and high-risk Medicare and Medicaid patients receiving primary care in eight nearby outpatient sites. The primary drivers of the program were redesigned acute care delivery, seamless transitions of care and deployment of community care teams.

Acute care interventions included risk screening, multidisciplinary care planning, pharmacist-driven medication management, patient/family education, communication with next provider and care coordination protocols for common conditions. Transition interventions included post-discharge health plans, hand-offs and follow-up with primary care providers, Transition Guides, a patient access line and collaboration with SNFs. Community interventions involved forming multidisciplinary care coordination teams, integrated behavioral care and new partnerships with community-based organizations.

This paper offers a detailed description of the design and implementation of a complex program to improve care coordination for high-risk patients in an urban setting. The case studies feature findings from each intervention that promoted patient engagement, strengthened collaboration with community-based organizations and improved coordination of care.

The purpose of this paper is to investigate frontline meetings in hospitals and how they are used for coordination of daily operations across organizational and occupational boundaries.

An in-depth multiple-case study of four purposefully selected departments from four different hospitals is conducted. The selected cases had actively developed and embedded scheduled meetings as structural means to achieve coordination of daily operations.

Health care professionals and managers, next to their traditional mono-professional meetings (e.g. doctors or nurses), develop additional operational, daily meetings such as work-shift meetings, huddles and hand-off meetings to solve concrete care tasks. These new types of meetings are typically short, task focussed, led by a chair and often inter-disciplinary. The meetings secure a personal proximity which the increased dependency on hospital-wide IT solutions cannot. During meetings, objects and representations (e.g. monitors, whiteboards or paper cards) create a needed gathering point to span across boundaries. As regards embedding meetings, local engagement helps contextualizing meetings and solving concrete care tasks, thereby making health care professionals more likely to value these daily meeting spaces.

Health care professionals and managers can use formal meeting spaces aided by objects and representations to support solving daily and interdependent health care tasks in ways that IT solutions in hospitals do not offer today. Implementation requires local engagement and contextualization.

This research paper shows the importance of daily, operational hospital meetings for frontline coordination. Organizational meetings are a prevalent collaborative activity, yet scarcely researched organizational phenomenon.

Autistic youth face higher risks for experiencing mental health crises. To develop and test a county-level social network measure of care coordination between police departments and other systems that support autistic youth experiencing suicidal crisis.

To measure the structure of care coordination for autistic youth experiencing suicidal crisis, the authors created a roster of all police departments and youth servicing organizations in two East Coast counties in the United States. They met or exceeded the whole network recruitment threshold of 70% completion in both counties. From the data, the authors created a directed matrix for each county of all reported connections, which they used to create sociograms and calculate standard network measures, including indegree, outdegree and total degree for each organization in the network. Data management and processing were done using R-programming and ORA.

Social network findings indicated that about half of all police departments surveyed coordinate care for autistic youth in suicidal crisis. Coordination varied by county, with nonpolice organizations acting as connectors between police and other nonpolice organizations. Two structural configurations were found, including a nonpolice organizational hub structure and a lead police structure. More research is needed to determine how different police integration structures shape care coordination for autistic youth.

Limitations include the small number of counties included in the study. A larger sample of counties is required for generalizable results.

This article introduces new tools and approaches to assist police in building their capacity to measure and improve their coordination of care with other community systems during crisis situations for youth on the autism spectrum. Network science (e.g. matrix and graph theoretic algebra methods) can be used to measure the configuration of relationships police departments have with complex multi-level healthcare systems.

Implications for findings include the consideration of police integration across systems in ways that produce new collaboration possibilities to support autistic youth experiencing suicidal crisis.

While police departments play a critical role in coordinating care for youth in suicidal crisis, little is known if or how police departments collaborate with other systems to provide assistance for autistic youth during a suicidal crisis. Improving care continuity within and between systems could potentially address clinical and structural challenges and reduce risk for autistic youth experiencing a suicidal crisis.

The aim of this paper is to empirically describe and analyze factors deemed to be relevant for the successful provision of coordinated paediatric oncology care by physicians and nurses involved.

A qualitative case study primarily consisting of interviews.

The paper's findings indicate that certain factors (i.e. distinct mission, clear treatment protocols and support from external stakeholders) relevant for the provision of coordinated paediatric oncology care have not received sufficient attention in previous research. In addition, emphasis is placed on the necessity of facilitating constructive working relationships and a bottom-up perspective when pursuing improved care coordination.

The factors described and analyzed may act as insights for how paediatric oncology might be improved in terms of care coordination and thus facilitate care integration. In addition, the paper's findings identify factors relevant for further empirical studies in order to delineate their generalizability.

The authors aim to present findings from their research on the implementation of Unified Assessment (UA) policy and the work of care coordinators who oversee the delivery of support to older people with complex needs.

A mixed methods approach included staff interviews (n=95) and focus groups (n=3).

The care coordinator role is controversial and the lack of common terminology across health and social care obscures its importance. It is seen as a social care responsibility. Limited ownership amongst healthcare professionals leads to tensions in practice. The challenges of breaking down silo thinking embedded in established professional practices are highlighted as are infrastructural and capacity deficits. Disparities between policy intentions and practice means that UA is failing to meet core objectives relating to the delivery of seamless support.

Further research is needed to develop and evaluate evidence‐informed interventions that test solutions to the problems faced in practice and support the delivery of more effective arrangements.

Practice development may be supported by: guidelines that are more prescriptive and include a formal role definition; joint training to promote shared understanding of key concepts; investment in administrative and IT infrastructures; and more coordinated direction at strategic level.

Over a decade has elapsed since the publication of UA Policy Guidance; however, there is limited published evidence on the effectiveness of UA policy and its translation into practice.