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The Role of Micro and Macro Level Organizational Coordination in Accountable Care Organizations

  • Author(s): Huber, Thomas Patrick
  • Advisor(s): Shortell, Stephen M
  • et al.
Abstract

The aim of this dissertation is to explore both micro and macro level healthcare coordination constructs and to explore associated concepts to better understand what enables or impedes coordination in the delivery system. Given the significance and importance of coordinating mechanisms, my studies examine types of coordination at the micro (Relational Coordination), and macro (Care Transition Management) levels, to contribute to the literature in healthcare coordination and to support healthcare transformation toward a safer, higher quality, and more cost-effective delivery system.

The growing literature on team level coordination has not explored how facilitative leadership supports or hinders coordination, nor have studies examined how team member participation and solidarity culture are associated with team level coordination. At the organizational level, studies have explored healthcare care coordination, accountability, and electronic health records as individual constructs, but no studies have looked at all three together and explored the association between them.

Study 1 and 2 examine micro-organizational coordination in two accountable care organizations with quantitative and qualitative investigations of Relational Coordination and teamwork factors including; Leadership Facilitation, Team Participation, Solidarity Culture. Study 3 explores macro-organizational coordination to see if physician group Accountable Care Organization (ACO) affiliation and greater EHR functionality are positively associated with more robust Care Transition Management (CTM) capabilities.

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