Application of a modified, double-moderated, model of relational coordination in performance measurement of lung cancer multi-level trajectory vs. Isolated, single-level clinical pathways

Resumen

INTRODUCTION This doctoral dissertation is a synthesis of three articles that explore the organization of health systems and their levels around a pathology of great relevance, such as lung cancer, from the point of view of the Resource-Based View integrating for this purpose Relational Coordination and Dialogic Practices models. OBJECTIVES The main objective of this research is to explore the organizational factors that may be influencing the lengthening of symptom-diagnosis, diagnosis-treatment and treatment-treatment intervals between the two levels of healthcare (Primary/ Specialized) and among clinical services, for the treatment of patients affected by lung cancer from the perspective of Business Organization through a combined approach that integrates Relational Coordination and Dialogic Practices models. According to the accessed available evidence, no research has been yet carried out to apply a combined model for the implementation of an intra and inter-level coordinative strategy for early detection and treatment of this pathology, which could provide significant returns such as a higher survival rate, hospitalization costs decrease and a potential decrease of costs incurred by productivity losses . METHODOLOGY Methodology has consisted in the design of two phases of analysis (qualitative and quantitative), complemented by a panel of experts that provides a real vision of the degree of development of coordination practices applied in the healthcare corporation for the treatment of the outstanding pathology. RESULTS There is an intricate organizational structure that, although it places the patient at the center of the system, frequently moves him to more peripheral positions due to the abundance of concurrent processes and subprocesses that are not always intertwined and can lead to additional connecting subprocesses, which generate delays in key intervals for diagnosis and treatment. CONCLUSIONS There are very significant gaps in the transfer of intra- and inter - level knowledge: The lack of an adequate relational component causes ignorance about precise resources allocation and clinical possibilities. The organizational factors related to RC and DP models have a medium degree of implementation and for some issues this degree turns to a low one. All of this leads to a reflection about the need to reconfigure current care processes to accommodate them to a real continuity of care and to a managed efficiency. For these reasons, the RC model enriched by the contributions of DP is an excellent tool to identify the root causes for this series of gaps in the continuum of care and design alternative circuits tailored to fit the real needs of agents and organizations.