Organizing for the Collaborative Hospital

To meet demands for high quality and efficient care, hospitals increasingly organize horizontally around standardized processes (like lean and care pathways) and/or set-up formal structural arrangements such as using performance boards, having daily huddles or assigning specific roles. This trend highlights a management paradox that calls for balancing a both/and approach to bureaucratization and collaboration in hospitals. Through a qualitative multiple, embedded case study of four hospitals, the paper investigates how standardized processes and structural arrangements—instances of organizational design—facilitate collaboration in hospitals. This is important as the literature on formal organization is disconnected from the informal aspects of the organization, thereby limiting the understanding of how hospitals function. Findings suggest that hospitals use many different types of organizational design to foster and maintain collaboration, thereby pointing towards mechanisms for developing the collaborative hospital. The findings also provide insights to managers which can be utilized for the further development of hospitals.