Systems Theory and the Sociology of Health and Illness #Luhmann

Today I got my copy from Systems Theory and the Sociology of Health and Illness – Observing Healthcare, a book edited by Morten Knudsen and Werner Vogd. The book contains very interesting chapters on this topic, and though it is not so cheap for private purchasing, you may consider ordering this book through your library.

Here is a short abstract of my contribution, Sustainability in Integrated Care Partnerships: a systems and network theoretical approach to analyse co-operation networks. The chapter highlights the importance and role of networks in the stabilization of meaningful arrangements between different contextures that refer to the basic conflict between medical and economic systems. Control mechanisms, which are applied to arrange these polycontextural conditions, have been analysed. Qualitative interviews were conducted with actors involved integrated care partnerships. Results show that loosely linked networks can take on important control functions in the sustainable balancing of financial, nursing and medical demands. Too tightly forged links prevent dynamic balancing and relating of different contextures. In such cases, networks can lose beneficial self-regulation capacities to eliminate drawbacks.


Patient centredness in integrated care (from systems theoretical perspective) #Luhmann #Systemstheory

My paper Patient centredness in integrated care: results of a qualitative study based on a systems theoretical framework has just been published in the International Journal of Integrated Care. It’s an open acces journal, so there’s no paywall to read it.
Let me provide you the abstract:

Introduction: Health care providers seek to improve patient-centred care. Due to fragmentation of services, this can only be achieved by establishing integrated care partnerships. The challenge is both to control costs while enhancing the quality of care and to coordinate this process in a setting with many organisations involved. The problem is to establish control mechanisms, which ensure sufficiently consideration of patient centredness.

Theory and methods: Seventeen qualitative interviews have been conducted in hospitals of metropolitan areas in northern Germany. The documentary method, embedded into a systems theoretical framework, was used to describe and analyse the data and to provide an insight into the specific perception of organisational behaviour in integrated care.

Results: The findings suggest that integrated care partnerships rely on networks based on professional autonomy in the context of reliability. The relationships of network partners are heavily based on informality. This correlates with a systems theoretical conception of organisations, which are assumed autonomous in their decision-making.

Conclusion and discussion: Networks based on formal contracts may restrict professional autonomy and competition. Contractual bindings that suppress the competitive environment have negative consequences for patient-centred care. Drawbacks remain due to missing self-regulation of the network. To conclude, less regimentation of integrated care partnerships is recommended.

The full text is also available as PDF file.

Organizational Behaviour im Kooperationsnetzwerk

eine systemtheoretisch-qualitative Analyse von Kooperationsnetzwerken unter den Bedingungen polykontexturaler Verhältnisse

Das ist das Thema meines Beitrags zum frisch bewilligten DFG-Netzwerkantrag Organizational Behaviour in health care institutions in Germany – theoretical approaches, methods and empirical results im Rahmen der DGMS-AG-Versorgungsforschung.

Weiter zum Abstract…

Integrated Care Partnerships – Organizational Behaviour in Co-Operation Networks

Mein Abstract zum Vortrag über Integrated Care Partnerships – Organizational Behaviour in Co-Operation Networks auf der diesjährigen Jahrestagung der Deutschen Gesellschaft für Medizinische Soziologie wurde angenommen. Der Vortrag entstand im Rahmen eines geplanten Forschernetzwerks zum Thema Organizational Behaviour in health care institutions in Germany – theoretical approaches, methods and empirical results.

Mein Beitrag fokussiert auf Versorgungsnetzwerke und integrierte Versorgung bzw. vernetzte Versorgung. Im Rahmen einer system- und netzwerktheoretischen Analyse soll der Frage nachgegangen werden, wie Entscheidungsfindungen im Verhältnis von medizinischen und ökonomischen Kontexturen zustande kommen und welche Steuerungsmechanismen greifen, um zwischen diesen Ebenen zu vermitteln. Die Vermutung ist, dass weder hierarchische Programme in Organisationen noch Marktelemente (bspw. DRG) ideal sind, um medizinische Notwendigkeiten und ökonomische Anforderungen auszutarieren, sondern sich Netzwerke bilden, die den jeweils beteiligten Organisationen ausreichend „Handlungsfreiheiten“ (Entscheidungsfreiheiten) lassen.

Meine Vermutung ist, dass sich die Netzwerke der „nächsten Gesellschaft“ sehr gut mit Hilfe der Integration des Konzepts der Polykontexturalität nach Günther in die Luhmann’sche Systemtheorie analysieren lassen und man formtheoretische Überlegungen in diesem Zusammenhang (vorerst) außen vor lassen kann.