Three faces of integrative coordination: a model of interorganizational relations in community-based health and human services

• Published in: Health services research 1994-08, Vol.29 (3), p.341-366
• Main Authors: Bolland, J M, Wilson, J V
• Format: Article
• Language: English
• Subjects: Affiliations; Aged; Alabama; Child abuse & neglect; Community health services; Community Health Services - organization & administration; Cooperation; Coordination; Delivery of Health Care - organization & administration; Drug abuse; Health care industry; Health care policy; Health facilities; Health facility affiliations; Health Planning - organization & administration; Health Services for the Aged - organization & administration; Human services; Humans; Integrated approach; Interinstitutional Relations; Managed competition; Medical cooperation; Mental disorders; Mental health; Mental health care; Models, Organizational; Public health; Researchers; Studies
• ISSN: 0017-9124; 1475-6773

This study develops a theoretically justified, network-based model of integrative coordination in community-based health and human services, and it uses this model to measure and compare coordination in six elder service systems. We collected data between 1989 and 1991 in six Alabama counties, including two major MSAs, two small MSAs, and two rural areas. STUDY DESIGN AND DATA COLLECTION/EXTRACTION METHODS: Our measurement of coordination is based on patterns of interorganizational relationships connecting the agencies constituting a community-based health and human services system. Within each site, we interviewed representatives from these agencies, asking them to indicate client referral, generalized support, and agenda-setting relationships they had developed with each of the other agencies in the system. Using network analysis procedures we then identified the network associated with each of these organizational functions (i.e., service delivery, administration, and planning) in each site, and we assessed levels of coordination in each network. Our measure of integrative coordination is consistent with other indicators of coordination we derive from our data, suggesting its validity. In addition, levels of integrative coordination across sites for each organizational function are generally comparable. Comparisons across sites show integrative coordination to be consistently highest for service delivery networks and lowest for planning networks. Previous attempts to assess interorganizational coordination without regard to organizational function are subject to misinterpretation. The differing interorganizational dynamics involved in service delivery, administration, and planning appear to generate different patterns of interorganizational relationships, and different levels of coordination.