Technological healthcare management arrangements: challenges for contemporary hospitals

The aim of the present study was to analyze technological arrangements for the management of care and beds at a public reference hospital in Portugal. Technological arrangements combine technologies and management practices for greater effectiveness in complex organizational contexts and are used to address challenges, such as excessive demand, rising costs, and complaints with regards to the quality of care. The application of technological arrangements in different contexts has produced varying results and studies are needed to address the impact on interprofessional relationships and the connection between hospitals and service networks. A qualitative, ethnographic case study was conducted, involving 15 interviews with 22 administrators and employees as well as participant observation of three technological arrangements: Inpatient Management Support Service; 11 a.m. Meeting; and High Users Resolution Group. Technological arrangements for managing admissions (input), care (throughput), and hospital discharges (output) were described. The in-depth observation highlighted the dynamics, potential, and challenges of technological arrangements for integrating bed and discharge management. When well implemented, technological arrangements help address hospital overcrowding, but do not solve systemic problems related to discharge and the continuity of care in the network. Strong employee adherence to technological arrangements was found, with a focus on the leadership of nursing staff and the silence of physicians, suggesting new challenges related to autonomy and power. Technological arrangements are effective at bed and care management, alter multidisciplinary practices and interprofessional relationships, and exert an impact on the network of external services. The production of contemporary hospitals requires evidence-based technological arrangements that increase efficiency, sustainability, as well as technical and organizational capabilities.

Keywords:
Comprehensive Health Care; Hospital Care; Patient-Centered Care; Hospital-Patient Relations; Diffusion of Innovation