Care management in complex organizations: Intraorganizational relationships and the legitimization of integrated healthcare delivery systems

The objective of this research was to document and analyze the factors that contribute to the formation of intraorganizational relationships and their influence on the parent organization's care management mission, strategy and goals. This study was a cross case analysis of three flagship hospitals, from three separate integrated healthcare delivery organizations (IHO).;The methods included interviews using a semi-structured interview guide and a structured Barriers Identification worksheet conducted during three one week-long site visits. Interviews were conducted with members of IHO corporate center leaders and flagship hospital leaders. Transcribed interview tapes and the Barriers Identification worksheet data from thirty-nine (39) leaders were analyzed to determine factors/barriers that influenced how strategic choices were made between the IHO and flagship hospital leaders and what impact their choices were on the care management mission, strategy and goals of the IHO.;The results of this analysis indicate that a number of factors to an effective intraorganizational relationship between IHO leaders and flagship hospital leaders were identified. Organizational identity factors related to internal boundary buffering, belonging and autonomy resulted in identity conflict. Organizational legitimacy factors related to power, goal setting, decision-making and trust resulted in internal conflicts around the means to achieving the care management mission and goals. And, environmental factors such as limited market forces for care management, internal culture supporting independence, and parallelism of market-institutional forces on IHO strategic choices resulted in ineffective and uncoordinated efforts around the care management mission, strategy and goals.;The intraorganizational relationship between the IHO corporate center leaders and the flagship hospital leaders had a significant influence on the lack of success of the IHO's care management mission, strategy and goals. None of the IHO's in this analysis had demonstrated any significant improvement in the health of the community members they served. The lack of success was influenced by the organizational identity, legitimization and environmental issues on the intraorganizational relationship between the IHO corporate center and flagship hospital leaders. Though the stated care management mission of the IHO's in this study was to improve the health of the people in the communities they served, the real goal was for the IHO's to present themselves as an integrated organization to differentiate themselves from other IHO's in the market. Care management was used to legitimize the integrated healthcare delivery system.