Table 3 Overview of organizational theory and applications to the implementation of GOC
Perspective | Propositions | Application to the implementation of GOC | Illustrative quotes |
|---|---|---|---|
Institutional theory | Change is prompted by norms, values, and expectations deriving from the institutional environment | Belgian policy steers primary care actors towards person-centered, GOC by creating structures and actors that support its uptake and regulations that tie in with GOC | This was a conscious effort to introduce it in primary care. An entire transition trajectory has been started since 2017. Integrated care, GOC are essential parts of that vision note. All our policies that we are rolling out are grafted on this. — INT04 |
Resources dependency theory | Decisions and actions of organizations will be affected by the external resources they need to secure their activities | The current financial system (fee for service) does not support interprofessional collaboration nor GOC | We will remain stuck as long as finances are based on the consult model and on performances.. this doesn’t promote GOC. — INT21 |
Network theory | Actors that are connecting and working together to achieve a shared goal will attain outcomes more efficiently and integrated than actors working independently | Interprofessional collaboration and a shared language between different disciplines are a prerequisite for providing GOC. The newly established care councils are facilitators as they connect different PCPs and hereby put forward GOC as a common goal. However, the current available technology does not allow PCPs to collaborate according to a GOC with other disciplines | The importance of this overarching part… I as a GP want to engage in GOC; you as a physiotherapist; a social worker wants to do it; a family care department wants to do it. But how do we do it together? — INT23 |
Contingency theory | An organization adapts and responds to external context variables. The social and economic landscape can shape organizational decisions and actions | Social and demographic variables such as the aging population and the increasing pressure in terms of workload and complexity of patient profiles on healthcare can form the circumstances in which GOC can be a possible answer towards the emerging needs in the primary care context | This partly has to do with our ageing population. We run into a shortage of capacity to provide care for them. And this will be the main driver towards change. — INT04 |