Barriers and enablers of coordination across healthcare system levels

• Published date: 01 November 2023
• Author: Christian Gadolin,Erik Eriksson
• Date: 01 November 2023
• DOI: http://doi.org/10.1002/pa.2871

RESEARCH ARTICLE

Barriers and enablers of coordination across healthcare

system levels

Christian Gadolin

1,2

| Erik Eriksson

2,3

1

School of Business, Economics and IT,

University West, Trollhättan, Sweden

2

Centre for Healthcare Improvement,

Department of Technology Management and

Economics, Chalmers University of

Technology, Gothenburg, Sweden

3

Department of Work Life and Social Welfare,

University of Borås, Borås, Sweden

Correspondence

Christian Gadolin, School of Business,

Economics and IT, University West,

Trollhättan, Sweden.

Email: christian.gadolin@hv.se

Coordination across healthcare system levels is a global imperative to ensure efficient

resource utilization and provide high-quality care. The substantial body of research

on coordination in healthcare mainly concerns coordination across professional and

organizational domains. Consequently, there is a dearth of empirical research aimed

at delineating the determinants of coordination across healthcare system levels. This

paper describes and analyses the barriers and enablers of healthcare coordination

across national, regional, and local system levels in a populous Swedish region. Indi-

vidual interviews and focus group discussions, encompassing a total of 63 individuals,

were conducted with managers, administrators, and politicians. The findings of the

paper underscore that the barriers identified were most often of a structural or insti-

tutional character, whereas the enablers of the studied cross-level coordination were

mostly relational. Therefore, we propose that future research should aim to further

delineate the prerequisites for personal relationships to emerge, as well as how they

may act as enablers of coordination across healthcare system levels.

KEYWORDS

healthcare coordination, healthcare efficiency, healthcare systems, high-quality care

1|INTRODUCTION

A widespread consequence of reforms associated with New Public

Management (NPM) is the fragmentation of the public service sector

and its interrelated impeded ability to coordinate public service deliv-

ery (Agranoff, 2012; Gregory, 2003; Sullivan & Skelcher, 2017; van

Meerkerk & Edelenbos, 2018; Webb, 1991). Various approaches in

the contemporary public administration and management literature

have aimed to facilitate the coordination of public service delivery,

through decreasing and/or efficiently managing fragmentation

(Bryson et al., 2014; Christensen & Lægreid, 2007; Halligan, 2010;

Klijn & Koppenjan, 2015;Lægreid et al., 2015; Trein et al., 2019; Trein

et al., 2020). The need to improve service delivery coordination has

been identified as pivotal, not least within various national healthcare

systems globally (Cebul et al., 2008; Elhauge, 2010; Mossialos

et al., 2005; Nolte et al., 2012; Snow et al., 2020; Vargas et al., 2015).

Unsurprisingly, given the healthcare sector's major exposure to NPM-

associated reforms (Simonet, 2011), the inability to coordinate service

delivery has majorly impeded healthcare systems' efficient utilization

of available resources, hampering their ability to provide high-quality

care (Eriksson et al., 2020; Eriksson & Hellström, 2021; Schultz

et al., 2013). This constitutes a major concern, not least given the

magnitude of the cost associated with healthcare provision in most

developed countries (OECD, 2019).

Although actors across distinct levels within healthcare systems

have had difficulty coordinating their efforts, which has hampered

their ability to collaborate (cf. Gulati et al., 2012), studies addressing

coordination across these system levels are scarce (Vargas

et al., 2016). Therefore, although a substantial body of research has

addressed care coordination across professional and organizational

domains, often locally or related to a specific condition (e.g., Gadolin

et al., 2022; Gorin et al., 2017; Karam et al., 2018; Røsstad

Received: 30 January 2023 Revised: 5 April 2023 Accepted: 22 May 2023

DOI: 10.1002/pa.2871

This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium,

provided the original work is properly cited.

© 2023 The Authors. Journal of Public Affairs published by John Wiley & Sons Ltd.

J Public Affairs. 2023;23:e2871. wileyonlinelibrary.com/journal/pa 1of11

https://doi.org/10.1002/pa.2871