Table 1 A synthesis of Mintzberg’s design parameters and Porter’s VBHC principles
Design parameter | Mode of coordination and division of tasks | Value-based design parameter |
|---|---|---|
1. Unit size | Usually, units with more members will rely more on various forms of standardization for coordination; smaller units allow for more frequent and immediate interactions, and can thus more easily rely on mutual adjustment and interpersonal relationships | Value-based sizing refers to the process by which the size of organizational units is taken into consideration regarding coordination around medical conditions over full cycles of care |
2. Unit grouping | By grouping positions (i.e. employees with certain roles and tasks) into units, an organization establishes its formal authority structure, which enables coordination through direct supervision. Additionally, grouping encourages frequent (informal) communication among unit members, thus facilitating coordination through mutual adjustment | Establishing value-based organizational units around medical conditions (instead of specialty-based departments) |
3. Liaison devices | These devices facilitate mutual adjustment, mainly through informal communication, between units. They constitute contacts (liaisons), such as meetings and positions, that are woven into the formal structure to spur coordination across unit boundaries | Formally establishing contacts between units that are aimed at the coordination of activities around a medical condition (over the full cycle of care) |
4. Planning and control systems | These systems generate the standardization of output (the results of work). Plans specify a desired standard; controls assess whether a standard is achieved | Utilizing outcome and cost measurements as value-based performance indicators |
5. Training and indoctrination | Enabling coordination through the standardization of skills, norms, and specialized knowledge | Propagating information and knowledge concerning VBHC within the organization |
6. Job specialization | Key parameter for the division of labor; enables the organization to match people to tasks, fostering specialization and efficiency | Task delegation specifically targeted at coordination around medical conditions |
7. Formalization of behavior | Standardizes work processes through predetermined regulations; activities are tightly coordinated, thus formalizing workflow | Establishing value-based clinical pathways for groups of patients with a particular medical condition |
8. Decentralization | Altering the way in which decision-making power is distributed within the organization. Decentralization refers to the dispersal of decision-making power | Value-based decentralization occurs when value-based units acquire more decision-making power |