The Paradoxes of Leading and Managing Healthcare Professionals: Toward the Integration of Healthcare Services

Abstract

Fragmentation and differentiation in healthcare unavoidably calls for corresponding integration. The more fragmentation, the more we long for integration. This paradox explains recent efforts to promote coordination programs, clinical microsystems of care, integrated delivery networks, and accountable care organizations. However, these integrative and collaborative mechanisms are largely organizational in nature. We argue that collaborative capacity may be more important than “collaborative structures,” to foster quality interactions and collaborative influence among team members. Collaborative capacity is defined as the routines and work processes—often embedded in work cultures, decision-making styles, shared commitments, and team dynamics—that foster coordinated behavior among professionals and stakeholders. This chapter reviews provider efforts to deploy structural mechanisms to promote collaboration and recent efforts to develop collaborative routines and processes. We also explore leadership and management implications, aimed at adapting healthcare institutions and their values, as well as coordinating workers and workforces.