Keywords Healthcare organisations - organisational behaviour - organisational research - health services research - interdisciplinary - international network
Background
Healthcare organisations are a building block of healthcare systems, providing a
variety of healthcare services spanning from prevention to palliative care. They
range from small office-based practices to large-scale hospitals and play a vital
role in shaping the way healthcare is delivered to patients. Healthcare
organisations can be defined as organisations that provide personal services in
interaction with patients with the aim of prevention and health promotion, curation,
rehabilitation, palliation or nursing care [1 ]
. While healthcare services are predominantly provided by healthcare organisations,
they are also offered in companies and institutions outside of the healthcare sector
(e. g. in occupational health).
Understanding the organisation and delivery of healthcare services, as well as the
functioning of healthcare organisations, is a central task of health services
research (HSR). HSR is a crucial research field that investigates the organisation,
management, financing, professional arrangement and delivery of healthcare services
to patients and the population. It aims to identify effective and efficient
approaches to enhance patient-centred care and patient safety, as well as the
conditions under which safe patient-centred healthcare can be delivered [2 ] . HSR places the complexity of healthcare
systems, organisations and institutions at the centre of its investigation, thereby
acknowledging the critical role of interrelations between micro-, meso- and macro
level factors. These factors include individuals and teams, organisations, and
health care systems and their institutions (e. g. regulations and governing bodies).
In Germany, HSR has emerged as a rapidly growing interdisciplinary field, first
established as a subfield within the broader health sciences in the late 1990s. Over
the past decade, HSR has increasingly gained recognition as a critical pillar of
health research in Germany, striving to enhance the understanding and improvement of
routine healthcare practices. The significance of organisations in HSR was
acknowledged early on in the fieldʼs development in Germany. The working group
‘Organisational Health Services Research’ was established as one of the first
working groups within the German Network Health Services Research (DNVF). In 2009,
the working group published the first consensus paper (‘Memorandum’) on the
conceptual and methodological foundations of organisational health services research
(OHSR) [3 ] . A more elaborated consensus
paper, comprising three parts, was published ten years later in 2019 [1 ]
[4 ]
[5 ] . To further promote OHSR in Germany, a
scientific network initiative entitled ‘Network on Organisational Behaviour in
Healthcare’ was funded by the German Research Foundation (DFG) between 2014 and
2018. In the resulting book publication, researchers from Germany contributed 15
chapters with original work covering various OHSR themes, such as work organisation,
leadership and patient safety, interprofessional teamwork, promotion of hand hygiene
in hospitals and integrated care networks [6 ]
. The origins of the network can be traced back to the ‘Health Services Research’
working group founded in 2004 within the German Society of Medical Sociology (DGMS).
The experience of the aforementioned two working groups suggests that HSR in Germany
often perceives healthcare organisations merely as empirical study settings [7 ]
[8 ] . This perspective overlooks the
theoretical and methodological importance of treating the ‘organisation’ as a
distinct entity in its own right, including the activities and practices conducted
within the entity as well as the collective agency. In order to rectify this
omission, the two working groups jointly organised an online symposium in September
2021 to discuss the current state and future perspectives of OHSR with national and
international experts. The participants concluded that the following objectives are
necessary for the future development of OHSR in Germany: refinement of the concept,
the inclusion of related scientific disciplines, and international collaboration.
Due to its origins in HSR, OHSR in Germany operates somewhat detached rather than
synergistically with its parent disciplines [9 ] , e. g., organisational sociology and psychology, economics and
management, and sociology of health and medicine. At the same time, organisational
research in healthcare is conducted in disciplinary silos within these parent
disciplines as well, and this runs the risk of preventing the exchange of knowledge
and interaction with the HSR community. A scoping review was conducted to capture
the range and scope of OHSR within the HSR community in Germany [7 ]
[8 ] . An analysis of the abstracts submitted
to the annual conference on HSR in Germany in 2020 revealed that many studies engage
with both teams and individuals in organisations as well as with organisational
behaviour. However, explicitly formulated research questions dealing specifically
with the organisation as a research object, as well as in reference to relevant
organisational theory, were rare.
The observations described above imply that healthcare organisations are generally
regarded as a marginal phenomenon in HSR in Germany, despite the fact that they are
fundamental to HSR. They serve as a context for healthcare rather than a
constitutive element of healthcare to be analysed [10 ] . Against this background, the idea for a scoping workshop was born
in order to develop the field of OHSR in a systematic and targeted way.
Aims
In order to navigate the direction of future research activities and increase the
attractiveness of the discipline for (early-career) researchers, a sustainable
establishment and consolidation of OHSR in Germany is crucial. However, there are
several challenges for OHSR in Germany. Firstly, a research agenda that pinpoints
relevant research questions in the field is missing. Furthermore, there is a need to
address the lack of theoretical underpinning and application of existing
organisational theory. Similarly, the application and adaptation of the broad range
of methodologies for OHSR is limited, and truly interdisciplinary and international
collaboration is rare. The aim of the scoping workshop was therefore to address
these gaps and create a conceptual foundation via an interdisciplinary scientific
community. In this position paper, insights from the scoping workshop are summarized
and integrated. These insights were revealed through the involvement of experts from
the interdisciplinary and international scientific community. The aim of this paper
is to present a strategic framework and road map for German OHSR to guide future
efforts in the field. This position paper is addressed to researchers and funding
organisations connected to OHSR and its parent disciplines.
Methods of the scoping workshop
Methods of the scoping workshop
The scoping workshop was funded by the Volkswagen Foundation and took place at
Schloss Herrenhausen, Hanover, Germany, in July 2023. Over the course of three days,
32 (inter)national experts discussed the current state of OHSR in Germany and its
potential for development. To build bridges to neighboring and parent disciplines,
experts from various research fields were invited in addition to health services
researchers (e. g., sociology of health and medicine, implementation science,
nursing science, occupational health, public health, organisational sociology,
psychology, economics and management, health policy). In addition to participants
from Germany, experts from Australia, Norway, UK, Austria and the Netherlands
attended the workshop. [Table 1 ] displays
the topics and interactive formats applied in the workshop.
Table 1 Overview of the scoping workshop topics and formats
Workshop days
Topics and formats
Day 1: Where are we at?
Living statistics: Getting to know each other
Four Pitches: Development of Organisational Research in
Healthcare from various disciplines and countries
World Café: What is needed for interdisciplinary
collaboration in the field of OHSR?
Day 2: What are the main challenges?
Group discussions: How to move Organisational Research in
Healthcare forward?
Four Pitches: Key challenges for healthcare organisations
within different healthcare systems: Different Country –
Same Challenge?
Panel discussion: International collaboration – Why and
How?
Presentation: funding opportunities for international
collaboration from the DFG and Volkswagen-Foundation
Day 3: Where do we go from here?
The interactive workshop concluded on Day 3 with an interactive summarising session,
where participants aimed to formulate positions based on discussion results from
Days 1 and 2. Participants were asked to state what is needed to strengthen the
field of OHSR in Germany and beyond. Following the workshop, these central positions
were condensed, prioritised, and approved by the participants.
Results
In the following, key positions derived from the scoping workshop are presented (see
[Fig. 1 ] ). These positions and their
arguments should not be seen as independent from each other but rather as highly
intertwined.
Fig. 1 Central positions that can guide the development of German
OHSR.
1. Developing a research agenda
Many discussions within the workshop hinted towards one central requirement: a
systematically developed research agenda for OHSR in Germany and beyond is
necessary. A research agenda can guide future research efforts by highlighting
relevant research questions and suitable theory and methods. Additionally, a
research agenda can be used to monitor OHSR’s achievements in subsequent years.
Previous reviews of OHSR in Germany [3 ]
[8 ]
[11 ] indicate that a large share of
research work engages with healthcare organisations solely as study settings,
without fully appreciating the fundamental organisational nature of many
behaviours and phenomena in healthcare. Additionally, current OHSR research
efforts focus mostly on the hospital acute care setting, neglecting many other
relevant settings and adjacent fields in the realm [11 ] such as outpatient care, prevention,
occupational health and rehabilitation. Moreover, many OHSR studies in Germany
lack a theoretical underpinning (see position 4), which in turn limits their
explanatory power. Current efforts leading to this scoping workshop also
indicate that the German OHSR field requires conceptual sharpening. These
central shortcomings need to be informed by a comprehensive research agenda. The
following positions are closely linked to a research agenda but emphasize
specific shortcomings related to content and strategy.
2. Clarifying the interdisciplinary field of OHSR and its terminology
Due to our finding that the organisational nature of many HSR studies is being
disregarded, it is crucial to clarify what organisational research in healthcare
entails, what it contributes to HSR, and which (inter)disciplinary theoretical
and methodological perspectives are most interesting, relevant, useful and
feasible. First of all, there is a need to reconsider terminology in
communicating OHSR research. A consensus is needed on what to call our field
(our suggestion: OHSR) within the German research landscape and internationally,
in order to be able to use clear and consistent language, promote the field, and
gain visibility. Research results and publications should be labelled
accordingly.
A clarification is needed of which disciplines or research fields beyond HSR
should actively be included in order to foster interdisciplinary research and
mutual inspiration (as an illustration see [12 ] ). In order to turn the interdisciplinary character of OHSR
research to advantage, research efforts need be oriented towards the research
problem under study, rather than being limited by disciplinary boundaries and
academic traditions. In the context of interdisciplinarity, questions arise
regarding the self-conception and role of researchers in the field of OHSR. A
discussion is pending about whether researchers in OHSR should aim to (1)
understand and explain organisational phenomena from an observer perspective to
gain basic knowledge and/or, going further (2) to contribute and facilitate
change (e. g., in intervention studies). It will be important to strike an
adequate balance between the two aims and shape the translation from basic to
applied research (and back). A consensus in the understanding of science and the
role of researchers in OHSR is not central to that discussion; however,
achieving clarity about the different disciplinary self-conceptions will help to
reduce barriers in interdisciplinary cooperation.
3. Putting organisation at the centre of our research and making use of
international comparative studies
Currently, organisational aspects in German HSR are often studied as a side
project or sub-question within larger HSR studies and thus tend to be reduced to
a “nice-to-have” add-on. This practice fails to acknowledge the clear relevance
that organisational characteristics have in shaping and delivering healthcare.
Although these add-on projects, which are often of an applied nature, can still
produce relevant knowledge for OHSR, researchers should put organisational
phenomena at the centre of their studies and develop convincing, theory-informed
and relevant research questions. Drawing from the international character of the
scoping workshop, comparative research between different countries and
healthcare systems as well as jointly coordinated research projects could
contribute greatly to developing such research questions. To date, researchers
in German HSR have tended to focus on national collaboration and are less
visible to potential international partners. Since strengthening
internationalisation is of central importance for HSR, the OHSR field could
strive to become a leading example.
4. Utilising the range of organisational theories and promoting theory
development
To increase the explanatory power and reach of the knowledge produced from OHSR
studies, OHSR researchers need to become better in using organisational theory.
Theory application should become a crucial part of OHSR studies and should help
direct and inform research questions, study design(s) and interpretation of
results, particularly in regard to complex organisational phenomena. Current
organisation and management theory, for example, offers a broad spectrum of
well-tested approaches - such as New Institutionalism [13 ] , the Behavioural Theory of the Firm
[14 ] , Network Theory [15 ] or Systems Theory [16 ] . Among other things, these theories
help unpack hidden agendas of collective action underlying a given healthcare
arrangement, such as barriers to effective collaboration of physicians and
nurses or hospitals and general physician practices. At the same time, empirical
research results can inform theory refinement and theory development in OHSR and
thereby contribute to knowledge building that goes beyond single specific
research questions and healthcare settings.
5. Institutionalising the teaching of OHSR
Since many studies in German HSR do not acknowledge the organisational character
of their research or underestimate its relevance, it is particularly important
to integrate organisational theory and research into existing study programs
that qualify for OHSR. Several recently-developed master-level programs in HSR
in Germany do incorporate the respective content; however, this remains the
exception rather than the norm [17 ]
[18 ] . Developing learning goals, central
competencies and a curriculum on OHSR that can be integrated into existing
curricula could strengthen the field and attract future OHSR researchers. The
integration of such curricula could be equally beneficial for study programmes
in medicine, nursing, management, health policy etc. Teaching healthcare
professionals and managers about the functioning of healthcare organisations and
about the difficulties and opportunities of stimulating change in organisations
could contribute to professional development, interdisciplinary collaboration
and innovation in healthcare. In order to deal with these specific competencies,
an orientation, such as the set of core competencies in HSR published by Burgess
et al. [19 ] or on implementation science
could be valuable [20 ] .
6. Promoting international and interdisciplinary exchange and
cooperation
International and interdisciplinary exchange and cooperation in OHSR is
beneficial for the development of the field and for individual academic careers.
Therefore, the research community as well as the academic system need to promote
and incentivise international as well as interdisciplinary research. Since OHSR
is a highly interdisciplinary field, funding opportunities for interdisciplinary
research projects and an openness towards interdisciplinary approaches are
needed. Furthermore, committees that determine academic promotion should be
encouraged to value research outputs that are grounded in interdisciplinary
collaboration rather than focus on disciplinary rankings. In terms of
international collaboration, instruments such as international honorary
professorships and research visits can be established. This would enable the
building of long-term collaborative relationships and would attract renowned
academics and researchers from other countries to collaborate with research
institutions in Germany. In addition, opportunities for international mobility
are essential for early-career researchers. Once long-term international
networks are established, the prospects for acquiring funding from the EU and
other international funding organisations will grow. Besides the demand for
suitable funding opportunities, researchers should make use of existing funding
opportunities and promote them among colleagues.
7. Tailoring research funding for OHSR and strengthening participatory
research approaches
In Germany, the Federal Ministry of Education and Research (BMBF), the Federal
Ministry of Health (BMG) – including the Innovation Fund - and the German
Research Foundation (DFG) are the main funding institutions that HSR can
exploit. Although funding opportunities for HSR in Germany have clearly
increased over the last decade, it is oftentimes challenging to acquire funding
for OHSR research that is not necessarily of a highly applied nature.
Fundamental OHSR is essential to better understand the complexities and
realities of healthcare organisations. It follows that explicit funding calls
for OHSR are desired, particularly funding opportunities that go beyond the
three-year corridor, as this timeframe is largely insufficient when trying to
understand complex organisational change processes [5 ] . Besides funding opportunities for
individual OHSR projects, funding programmes bringing together interdisciplinary
and international networks as well as connecting researchers from traditional
universities and universities of applied sciences (such as the scoping workshop
format by Volkswagen Foundation) can be highly effective formats that fields
such as OHSR require for fruitful development. Funding formats like these have
the potential to build capacity for larger joint applications on OHSR with an
interdisciplinary and international character. As indicated above, it is vital
that funding institutions become more open to truly interdisciplinary research,
since, in our experience, a highly interdisciplinary project idea often has a
lower chance of approval due to widespread mono-disciplinary thinking and
reviewing. Furthermore, to promote academic careers in OHSR, funding formats for
early-career researchers are crucial. Public and patient involvement (PPI) and
particularly co-design of complex interventions is essential in many OHSR
studies [21 ]
[22 ]
[23 ] . Funding institutions increasingly
expect applicants to include strategies for PPI. Besides the involvement of
patients, relatives and the public, OHSR often requires the involvement of other
stakeholders in healthcare organisations (e. g., healthcare professionals,
managers), especially when research deals with organisational change. Thus,
funding institutions should broaden their definition of PPI. OHSR researchers
should also make use of the potential of PPI by systematically planning and
conducting PPI when it is relevant for the research aim.
Conclusions
The position paper has two main claims: First, a research agenda placing
organisations and their core activities at the centre of OHSR is needed. This
requires conceptual sharpening and clarifying the OHSR field and its
interdisciplinary nature. Questions on the potential and methods of PPI and on the
application of organisational theory are closely linked to this claim. Second,
research communities and funding institutions need to work on conditions that are
conducive to developing OHSR in Germany. This entails educating the next generation
of researchers by teaching OHSR in study programs, but also valuing, enabling, and
making use of opportunities for international mobility as well as international and
interdisciplinary collaboration.
The workshop revealed that some of the challenges discussed for German OHSR are
equally present in other countries. Thus, we hope that this position paper can
initiate fruitful discussions in those countries as well and possibly within
international academic societies such as the Society for Studies in Organizing
Healthcare (SHOC).
This position paper seeks to serve as a guide for researchers and funding
organisations on how to bring OHSR forward. In addition, the scoping workshop
contributed to forging international networks and to expanding disciplinary
boundaries. The ultimate goal is to further cultivate and develop the newly-formed
network.
This article is part of the DNVF supplement “Health
Care Research and Implementation”
Hinweis
Dieser Artikel wurde gemäß des Erratums vom 19.08.2024
geändert.
Erratum
Im oben genannten Artikel wurde der deutsche Titel korrigiert.
Korrekt ist: Die Zukunft der organisationsbezogenen
Versorgungsforschung in Deutschland und darüber hinaus –
ein Positionspapier.
