RESUMO
Effective healthcare coordination is vital when such care is provided as a collaborative effort by many individuals and their task activities are interdependent. Coordination is necessary to ensure that care not only meets the needs of patients, but also avoids negative consequences for them due to omitted, inefficient, unnecessary, or even incorrect treatments. It also helps conserve resources. This has contributed to a rapid increase in articles on this subject. Still, while care coordination topics are gaining the attention of researchers, there are a number of issues experienced, including the delineation of limitations, inconsistent definitions, and problems with measurement. Therefore, the aim of this article is to refine the concept of homecare coordination and provide a comprehensive theoretical framework, illustrated with examples from practice. Focusing on this goal, we have reviewed the extant literature on the subject to develop a theoretical homecare coordination framework. The first intermediary goal was to integrate relevant concepts across multiple theories and frameworks into a unified synthesis. We do so in two parts: (1) analysis of extant coordination frameworks and theories; and (2) the presentation of our newly developed theoretical framework for homecare coordination. The new framework differentiates clearly between coordination as a process-i.e., what people do to coordinate and coordination as an outcome-i.e., the state of coordination. Applying this distinction to both, measurement and interpretation of results helps avoid misleading conclusions. As a research outcome, our framework builds upon the extant coordination literature, considers the complex relationships among the various coordination-related factors and, while focusing on homecare, is applicable to various healthcare settings in general. A nuanced differentiation and explanation of the elements involved enable a more consistent operationalization of the coordination concept. Additionally, as they explicitly address the healthcare system's micro, meso, and macro levels, they can be applied across diverse healthcare settings to investigate homecare coordination.
RESUMO
OBJECTIVE: We propose a network perspective of team knowledge that offers both conceptual and methodological advantages, expanding explanatory value through representation and measurement of component structure and content. BACKGROUND: Team knowledge has typically been conceptualized and measured with relatively simple aggregates, without fully accounting for differing knowledge configurations among team members. Teams with similar aggregate values of team knowledge may have very different team dynamics depending on how knowledge isolates, cliques, and densities are distributed across the team; which members are the most knowledgeable; who shares knowledge with whom; and how knowledge clusters are distributed. METHOD: We illustrate our proposed network approach through a sample of 57 teams, including how to compute, analyze, and visually represent team knowledge. RESULTS: Team knowledge network structures (isolation, centrality) are associated with outcomes of, respectively, task coordination, strategy coordination, and the proportion of team knowledge cliques, all after controlling for shared team knowledge. CONCLUSION: Network analysis helps to represent, measure, and understand the relationship of team knowledge to outcomes of interest to team researchers, members, and managers. Our approach complements existing team knowledge measures. APPLICATION: Researchers and managers can apply network concepts and measures to help understand where team knowledge is held within a team and how this relational structure may influence team coordination, cohesion, and performance.
