Hospitals that organise care around a particular condition or patient group can focus care while drawing on expertise in existing departments. But interviews from six such condition-based units found a recurring organisational fault line: a unit may be responsible for improving the whole care process without having clear authority over changes that cross departmental boundaries.
The qualitative study covered 26 interviews in six condition-based units across two Dutch hospitals. Participants included unit leaders, medical specialists, nurses or nurse practitioners and support staff; 12 came from Hospital A and 14 from Hospital B.
Researchers used a multiple-case design to explore organisational dynamics. They analysed verbatim transcripts for functional concentration, specialisation and centralisation, then coded reported opportunities and challenges; three authors discussed the interpretation.
The value of shared support
The units were responsible for condition-specific care and improvement across the whole process, but delivery tasks remained divided among functional departments. Functional managers kept important operational, decision-making and resource responsibilities.
Participants said designated contacts in those departments acted as coordination interfaces, giving unit members access to knowledge and expertise for care-process improvement and patient needs.
The study’s discussion also describes knowledge moving between units through employees in non-medical departments who worked with more than one condition-based unit. Shared support could therefore carry insights, experiences and practices across care teams.
Who has the final say?
The difficulty emerged when a change affected the care process as a whole. Unit members reported no formal agreement on who held that authority. Functional managers controlled departmental decisions, while the units had little authority over changes spanning departments.
Participants described cross-departmental improvement decisions as time-consuming and potentially vulnerable to delay or non-implementation. In one initiative at Hospital B, seven functional managers had to be involved.
They also described potential conflict between a unit’s whole-process goals and the objectives and priorities of the departments supporting it.
The authors reported similar structural patterns, opportunities and challenges in both hospitals despite differences in hospital size, bed capacity and staffing. Because the hospitals and units were purposefully selected and the work was conducted in the Dutch healthcare context, the comparison offers limited grounds for generalisation.
What the study cannot answer
The interviews describe organisational experiences; they do not show that integrating condition-based units improves patient outcomes, patient-reported value, costs or quality by a measured amount. The study also did not establish that the structure causes better or worse collaboration, coordination, delays or implementation.
The authors recommend clearer mandates and contacts and, where feasible, bringing operational and decision-making responsibility closer together within the units. They present this as learning-oriented experimentation rather than a tested organisational formula.
The study’s focus on organisational structure did not fully examine other conditions such as culture, and the authors say the Dutch setting limits generalisability. Comparative research would be needed to test how different arrangements affect care, costs and collaboration.
Paper data and sources
Original title: The organizational impact of value-based health care: structure-related opportunities and challenges of condition-based units integrated within functional hospital structures
Authors: Meijer F, Van der Nat P, Vriens D et al.
Journal/Repository: Journal of health organization and management
Status: Peer-reviewed
First online: 2026-08-19
DOI: Not available
Original paper · Full text