The influence of boundaries on supply chain performance (patient flow, speed)
| Type of boundary | Factor | Impact on integration | Impact on flow |
|---|---|---|---|
| Structural | Dual roles | Lack of availability and reachability | Consultation delays, lead times |
| Lack of information sharing | |||
| Spatial separation | Poor and indirect communication, lack of face-to-face contact, no development of long-term orientation | Patient stacking (residents), consultation delays | |
| Resource constraints | Lack of knowledge sharing, poor communication | Limited efficiency, patient flow suffers | |
| Interpersonal | Low familiarity | Prevents joint decision-making, increased rigidity, poor interpersonal relations, poor communication, low trust | Consultation delays, sequential consults, delays in discharge, admission |
| Lack of commitment | De-prioritization of ED tasks, poor collaboration, lack of responsibility | Bed blocking, sequential consults | |
| Lack of trust and understanding | Poor interpersonal relations, restricts formation of informal agreements | Patient boarding, increased lead times, duplication of tasks | |
| Cultural | Educational differences | Limits delegation of tasks and discretion of EPs | Variability across groups, increase of lead times |
| Working culture | Misaligned goals | Sequential consults, increased lead times | |
| Independent working | Formation of bottlenecks | ||
| Status differences | Power dynamics create thresholds for communication | May encourage patient “stacking” (residents). Limits EP autonomy and decision-making |
| Type of boundary | Factor | Impact on integration | Impact on flow |
|---|---|---|---|
| Structural | Dual roles | Lack of availability and reachability | Consultation delays, lead times |
| Lack of information sharing | |||
| Spatial separation | Poor and indirect communication, lack of face-to-face contact, no development of long-term orientation | Patient stacking (residents), consultation delays | |
| Resource constraints | Lack of knowledge sharing, poor communication | Limited efficiency, patient flow suffers | |
| Interpersonal | Low familiarity | Prevents joint decision-making, increased rigidity, poor interpersonal relations, poor communication, low trust | Consultation delays, sequential consults, delays in discharge, admission |
| Lack of commitment | De-prioritization of ED tasks, poor collaboration, lack of responsibility | Bed blocking, sequential consults | |
| Lack of trust and understanding | Poor interpersonal relations, restricts formation of informal agreements | Patient boarding, increased lead times, duplication of tasks | |
| Cultural | Educational differences | Limits delegation of tasks and discretion of EPs | Variability across groups, increase of lead times |
| Working culture | Misaligned goals | Sequential consults, increased lead times | |
| Independent working | Formation of bottlenecks | ||
| Status differences | Power dynamics create thresholds for communication | May encourage patient “stacking” (residents). Limits EP autonomy and decision-making |
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