Integrative practices in hospitals and their impact on patient flow

Purpose - The aim of this paper is to investigate which integrative planning and control practices are used in hospitals and what their effects are on patient flow. Design/methodology/approach - The study is based on a three-hospital multi-case study carried out in The Netherlands. The main findings are based on over 40 in-depth interviews and the analysis of detailed patient flow data. The analysis of the flow data is used to explore the effects of integrative practices on lead times and patient flow. Findings - Based on the various patient groups examined in the different hospitals, four integrative practices stand out: sharing waiting list information, sharing planning information, cross-departmental planning, and combining appointments. In line with earlier studies, the overall level of integration in hospitals was found to be low. However, patient flow performance is significantly better in those hospitals that employ more of the above-mentioned integrative practices. Research limitations/implications - The study was limited to three major patient groups within the orthopedic supply chain. The deliberate choice for these patients groups was based on the expectations that integration in hospitals is relatively low and that the highest levels of integration would be found in high volume low variety patient groups. Further research should include patient groups with less favorable characteristics such as lower volumes and/or greater variety. Practical implications - This study provides clear support for the value of integration initiatives in healthcare operations. The performance of hospitals, in terms of patient flows, benefits from cooperation between the various members of an internal supply chain. Hospital administrators and medical professionals could learn from these results and attempt to abandon their silo mentality and start integrating for and their patients' and their own benefit. Originality/value - Despite the importance of integration in hospitals, little is known about the integrative practices hospitals actually employ. Most existing studies on patient flows are confined to a single stage in the care process. In this study, the effects of integration in the internal supply chain from the first visit to the end of treatment are examined.