Integration and differentiation in a hospital’s logistical system

Long before the Covid-19 pandemic, calls have been made for better streamlining and coordination of healthcare processes, so that hospitals perform better. Much research has been done into better functioning parts of hospitals, such as an Emergency Room or an Intensive Care Unit, but relatively little is known about how operational processes work hospital-wide. This thesis provides in-depth insight into how a hospital organizes care. The social network – i.e., all interactions between hospital staff – of the Slingeland Hospital in Doetinchem in The Netherlands has been analysed. Nurses and a handful of coordinators are central to the hospital's social network. They often coordinate care 'voluntarily' and in an informal way. People with a formal hierarchical position, team leaders or managers, contribute relatively little to the organization of care. The fact that the workplace seems to be largely self-organizing is on the one hand perhaps good – the required knowledge lies at the operational level -, but it makes hospitals also vulnerable.