Background
Motivation and purpose
Theoretical underpinnings
IT-based inter-organizational cooperation
A temporal perspective on frailty-related information sharing
Methods
Selection of research site
Participatory modelling
Feedback loop diagramming
Results
Treatment process and stakeholder network
Benefit / Stakeholder | 1 | 2 | 3 | 4 | Overview of perceived benefits | ||
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…through identifying frailty-related complications | x | x | x | The identification of frail patients implies potential determination of related diseases and complications. The practitioners in private practice are primarily not affected by this benefit. Their role as the starting point in the process is to generate the data and detect further diseases in order for the subsequent stakeholders to adapt the patient treatment. The health insurance companies benefit through a more comprehensive information base on the insured patients. | |||
Treatment quality and time | Treatment quality | … through implementing standardized decision processes | x | x | The alignment of the involved stakeholders with respect to the processes and database could enhance the treatment and decision-making processes. Standardization of the heterogenic database will cause high costs and effort for the practitioners in private practice. Being in the early stage of the process, they face the least potential benefit. From the current perspective, the healthcare providers are not concerned by the increase in data standardization, as it constitutes mainly a benefit for the operative stakeholders. | ||
Treatment time | … through avoiding repetitious procedures | x | x | Data sharing and the implementation of standardized data sets could reduce the number of medical tests. Repetitious procedures concern subsequent process steps and stakeholders, therefore not the practitioners in private practice and the geriatric center. The health insurance benefits financially from the elimination of repetitions. | |||
… through reducing waiting times for patients | x | The enhancement of the processes and data sets would ultimately have an impact on the waiting times between treatment steps. This mainly concerns the patient and partially the health insurance, as it might result in financial benefits. | |||||
Costs saving | Pre-operative | … through stratifying patients | x | x | Stratification enables the grouping of patients (e.g. high risk) and enables individual treatment processes. The geriatric center could be systematically integrated in the patient treatment, which is currently still not the case. Also, it increases process reliability for the surgeon / anesthesiologist, as they could base the treatment planning on differentiated information on the patients. | ||
Operative | … through avoiding operation cancellations | x | This leads to financial damages for the clinic (mainly surgery) and the health insurance. The early stratification of the patient enables the surgeons to consider a more comprehensive view on the patients and their resilience to overcome an operation. | ||||
Post-op. | … through avoiding intensive care treatments | x | x | Intensive care treatments are related to uncertainty of the treatment planning, personnel expenditures (clinic) and high financial effort (health insurance). In relation to the stratification of patients, intensive care treatments could ultimately be avoided. |
Barrier / Stakeholder | 1 | 2 | 3 | 4 | Overview of perceived barriers | ||
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Pressures of costs and efficiency
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Time constraints
| Individual time constraints | x | x | On the operational level, the stakeholders face time constraints due to various reasons, which leads to a focus on the day-to-day activities, hindering systemic collaborations. Supposedly, this concerns mainly the referring practitioners in private practice and the surgeon/anesthetist at the hospital. It might be reasonable to take the geriatric center into account, but due to a lack of integration in the perioperative treatment, it is not concerned at this point. | ||
Other resource constraints
| Lack of funding | x | x | Reimbursement concerns the re-payment for the conducted patient treatments. The geriatric center is not systematically included in the pre-operative patient treatment, raising reimbursement issues. Referring to the standardization of data sets and of processes, the alignment of the information systems and communication tools, it is apparent that data sharing requires a great amount of financial effort. Notably, the decentralized structure of ambulant sector (e.g. practitioners in private practice) requires early-stage financing to mount the innovation. | |||
Non-aligned/non-adapted action frames
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Incompatible goals
| Incompatible organizational goals and time horizons | x | x | x | This refers to the divergent operational speed and the difficulties caused by these in the attempt of a cooperation. In this regard, this concerns primarily the stakeholders and cooperation between the practitioner in private practice, geriatric center, and hospital. | |
Legitimation and interpretation frames
| No legitimate action frame for preoperative treatment | (x) | x | x | (x) | The stakeholders face uncertainty regarding their action frame, due to a missing systemic perioperative process, the separation of the ambulant and clinical sector and the lack of financial support. | |
Unclear interpretation of rules and responsibilities | x | x | (x) | x | Data security and the responsibility for the handling and exchanges of patient data remain unclear for the concerned stakeholders. Notably, by looking at the role of the practitioners in private practice in the treatment process (early stage, data generation and transfer) and their resources, it becomes apparent that this group of stakeholders faces the greatest challenges in understanding, interpreting and acting on the data protection guidelines. |