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“Chains, shops, networks” – Organizing efficient patient flows in hospitals


Catharina Bjørkquist ,

Østfold University College, NO
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Helge Ramsdal

Østfold University College, NO
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Introduction: This paper addresses the challenges of organizing health work based upon principles of “patient flows” – as a contrast to the structure of hospital organizations based upon functional principles. We ask how new approaches to work process organization principles are adopted in hospitals, and to which extent, and how, “process perspectives” will address the complexities of health work in hospitals.

Theoretical considerations: “Process perspectives”, referred to as clinical pathways, patient pathways or value chains are basically related to linear approaches to work flows.  The linear value chain approach has been criticized for being too simple to structure complex organizations in general - but still has a major impact on our understanding of hospital work organizations.  Here, we discuss how alternative models – based upon “chain”, “network” and “shop” models as organizing principles might be reflected in work organization studies.

Methodology: The study referred to here is based upon research in one modern hospital in Norway – opened during end 2015. In the public presentations of the new hospital, references to “value chain”, “value network” and “value shop” concepts are focused.  During the autumn 2015, we conducted 20 semi-structured interviews with managers and leaders, including union representatives in the “old” hospital, followed by interviewing these managers one year later.  The interviews focused upon several themes relating to the contrasts between organizing the two hospitals, including to which extent and how new work organization principles – based upon the concepts of chain, network and shop, actually could be identified within the new hospital.  We asked how these principles materialized and worked as guidelines for organizing, and the experiences for professional work and management within the context of these models.  

Findings: Still at a preliminary phase of the analysis, the interviews indicate that most managers did not – as a contrast to top level managers – generally know about the theoretical background/conceptualizations of the three models upon which the hospital is organized. Still, these models were reflected in the design of departments and activities at different locations in the hospital: the “chain model” was a major issue for efficient workflows related to clinical pathways for different diagnoses.  The network model was referring to the generic approach to information technology at different levels in the organization. The workshop model was identified with 3 – 4 organizational innovations in particular. These were mainly   multi-professional teams were specialists in somatic and psychiatric medicine coordinated treatment strategies towards elderly with mental health/somatic diseases, patients with obesity diagnoses, and plans for a new admission center.

Implications for future research: From a theoretical perspective, these efforts to identify different approaches to “value” based work organization has a potential to increase our knowledge on the rather abstract models on “chain”, “network” and “shop” respectively. The identification of these models at different locations in the hospital structure will be followed by case studies addressing implications for professional work and challenges for management.

Limitations: There are certain limitations to the generalizability of this study given it is designed as a single case study. 

How to Cite: Bjørkquist C, Ramsdal H. “Chains, shops, networks” – Organizing efficient patient flows in hospitals. International Journal of Integrated Care. 2017;17(5):A73. DOI:
Published on 17 Oct 2017.


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