The Importance of Time in Developing a Boundaryless Hospital: An Example from Northern Portugal

Abstract

The role of time in developing a Boundaryless Hospital is explored, as time is a critical component in the dynamical evolution of a hospital’s interaction with its neighborhood, especially when health systems are calling for more coordination. It is expected that the effective coordination of care would promote, with time, and by a step-by-step process, the removing of the boundaries that still exist in local health systems.

A Local Health Unit in Portugal, established in 1999, was revised using case study approach, combining both qualitative and quantitative data. Kingdon’s “three-streams” theory was used to analyze the gaps between the intentions expressed by policy-makers and the reality of integration as perceived by performance results.

This Local Health Unit, within an organizational and legal framework aiming at optimizing services’ response through an integrated management of various health care facilities, involved several governments and difficult conditions. However, it successfully is presenting today several boundaryless hospital characteristics—from full quality certification in 2012, to strengthened links with primary care to reduce hospital admissions and to an information system that was critical to support referral services and, further, in establishing new connections with patients and other local players. After 16 years of effort trying to build a more integrated organization, time was clearly a critical factor. Time enabled the establishment a culture of working together to solve problems, to learn and understand their different requirements. Time is necessary to nurture the “organizational thread” that bonds the different care levels. The challenge of establishing a boundaryless hospital is multi-dimensional, but yields significant long-term benefits.