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Introduction: Healthcare today is characterized at the same time by increasing specialization and by an increasing number of patients with multi-morbidity. To cope with this contrast, inter-physician collaboration is inevitable. Different initiatives are taken in practice to improve care for complex multimorbid patients. Among others we see many hospitals in Western countries trying to reorganize their structures to stimulate inter-physician collaboration by changing from more traditional hospitals organized around medical specialties, to more process-based hospitals organized around patient needs. Our focus is to provide insight in how hospital restructuring influences inter-physician collaboration.Methods: To research hospital restructuring and the effects on inter-physician collaboration we used multiple methods. First, we performed a systematic review on inter-physician collaboration in hospitals, which included 63 studies, to understand what factors affect inter-physician collaboration, how inter-physician collaboration is measured, and what the effects of inter-physician collaboration are. Second, a qualitative study to understand the rationale behind hospital-designs. In the first phase of this study annual reports and organization charts of all Dutch general hospitals (n= 61) were collected and in the second phase hospital management and staff were interviewed (n= 26). of a selected number of hospitals (N=13) Third, a quantitative survey study among physicians (n = 103) and nurses (n = 316) in a hospital that redesigned its structure based on patient themes. In the survey medical leadership and relational coordination have a central role.Results: From the review we learned that multiple tools are developed to measure inter-physician collaboration. However, most of these tools are not validated in the hospital setting. Despite limited evidence, there are promising results that collaborative practice between physicians increased satisfaction of patients and staff, while also reducing length of stay, error rates, and hospitalization costs. Strongest evidence indicated that physicians believe that their collaboration will lead to better patient care. We denoted that personal factors, professional factors, preconditions and tools, organizational elements and contextual characteristics can influence inter-physician collaboration. From the qualitative study we learned that most hospitals are aiming to move towards more process- oriented structures however primarily through incremental changes. The hospitals that dare to radically change the structure have a stable basis and a strong visionary board of management together with doctors. The quantitative study has preliminary results; data has been collected from October till December 2020. We hypothesize that medical leaders will be more prone to work together with physicians from other specialties; and that the restructuring of the hospital will result in better connections between physicians from different medical specialties that work together around a patient theme. Discussion: Studies on inter-physician collaboration in hospitals increased, but the quality of the studies remains limited. Strongest evidence indicates that physicians believe that their collaboration will lead to better patient care. Hospital management tries to support inter-physician collaboration by redesigning structures, although in most cases with incremental steps and not radical changes. In inter-physician collaboration reciprocal dependencies, overlapping professional domains, professional heritage, and medical leadership are important factors to consider. |
