Explaining integration and differentiation by identifying the rules and coordination mechanisms in a hospital's logistical system

A. van der Ham*, A. van Raak, D. Ruwaard, F. van Merode

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Purpose Integration, that is, the coordination and alignment of tasks, is widely promoted as a means to improve hospital performance. A previous study examined integration and differentiation, that is, the extent to which tasks are segmented into subsystems, in a hospital's social network. The current study carries this research further, aiming to explain integration and differentiation by studying the rules and coordination mechanisms that agents in a hospital network use. Design/methodology/approach The current case study deepens the analysis of the social network in a hospital. All planning tasks and tasks for surgery performance were studied, using a naturalistic inquiry approach and a mixed method. Findings Of the 314 rules found, 85% predominantly exist in people's minds, 31% are in documents and 7% are in the information system. In the early planning stages for a surgery procedure, mutual adjustment based on hospital-wide rules is dominant. Closer to the day of surgery, local rules are used and open loops are closed through mutual adjustment, thus achieving integration. On the day of surgery, there is mainly standardization of work and output, based on hospital-wide rules. The authors propose topics for future research, focusing on increasing the hospital's robustness and stability. Originality/value This exploratory case study provides an overview of the rules and coordination mechanisms that are used for organizing hospital-wide logistics for surgery patients. The findings are important for future research on how integration and differentiation are effectively achieved in hospitals.
Original languageEnglish
Pages (from-to)66-84
Number of pages19
JournalJournal of Health, Organisation and Management
Issue number9
Publication statusPublished - 23 Feb 2021


  • coordination mechanisms
  • hospital
  • integration
  • rules
  • social network
  • Integration
  • Coordination mechanisms
  • Social network
  • Hospital
  • Rules


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