health care thesis

Research Topics & Ideas: Healthcare

F inding and choosing a strong research topic is the critical first step when it comes to crafting a high-quality dissertation, thesis or research project. If you’ve landed on this post, chances are you’re looking for a healthcare-related research topic , but aren’t sure where to start. Here, we’ll explore a variety of healthcare-related research ideas and topic thought-starters across a range of healthcare fields, including allopathic and alternative medicine, dentistry, physical therapy, optometry, pharmacology and public health.

NB – This is just the start…

The topic ideation and evaluation process has multiple steps . In this post, we’ll kickstart the process by sharing some research topic ideas within the healthcare domain. This is the starting point, but to develop a well-defined research topic, you’ll need to identify a clear and convincing research gap , along with a well-justified plan of action to fill that gap.

If you’re new to the oftentimes perplexing world of research, or if this is your first time undertaking a formal academic research project, be sure to check out our free dissertation mini-course. In it, we cover the process of writing a dissertation or thesis from start to end. Be sure to also sign up for our free webinar that explores how to find a high-quality research topic.

Overview: Healthcare Research Topics

• Allopathic medicine
• Alternative /complementary medicine
• Veterinary medicine
• Physical therapy/ rehab
• Optometry and ophthalmology
• Pharmacy and pharmacology
• Public health
• Examples of healthcare-related dissertations

Allopathic (Conventional) Medicine

• The effectiveness of telemedicine in remote elderly patient care
• The impact of stress on the immune system of cancer patients
• The effects of a plant-based diet on chronic diseases such as diabetes
• The use of AI in early cancer diagnosis and treatment
• The role of the gut microbiome in mental health conditions such as depression and anxiety
• The efficacy of mindfulness meditation in reducing chronic pain: A systematic review
• The benefits and drawbacks of electronic health records in a developing country
• The effects of environmental pollution on breast milk quality
• The use of personalized medicine in treating genetic disorders
• The impact of social determinants of health on chronic diseases in Asia
• The role of high-intensity interval training in improving cardiovascular health
• The efficacy of using probiotics for gut health in pregnant women
• The impact of poor sleep on the treatment of chronic illnesses
• The role of inflammation in the development of chronic diseases such as lupus
• The effectiveness of physiotherapy in pain control post-surgery

Topics & Ideas: Alternative Medicine

• The benefits of herbal medicine in treating young asthma patients
• The use of acupuncture in treating infertility in women over 40 years of age
• The effectiveness of homoeopathy in treating mental health disorders: A systematic review
• The role of aromatherapy in reducing stress and anxiety post-surgery
• The impact of mindfulness meditation on reducing high blood pressure
• The use of chiropractic therapy in treating back pain of pregnant women
• The efficacy of traditional Chinese medicine such as Shun-Qi-Tong-Xie (SQTX) in treating digestive disorders in China
• The impact of yoga on physical and mental health in adolescents
• The benefits of hydrotherapy in treating musculoskeletal disorders such as tendinitis
• The role of Reiki in promoting healing and relaxation post birth
• The effectiveness of naturopathy in treating skin conditions such as eczema
• The use of deep tissue massage therapy in reducing chronic pain in amputees
• The impact of tai chi on the treatment of anxiety and depression
• The benefits of reflexology in treating stress, anxiety and chronic fatigue
• The role of acupuncture in the prophylactic management of headaches and migraines

Topics & Ideas: Dentistry

• The impact of sugar consumption on the oral health of infants
• The use of digital dentistry in improving patient care: A systematic review
• The efficacy of orthodontic treatments in correcting bite problems in adults
• The role of dental hygiene in preventing gum disease in patients with dental bridges
• The impact of smoking on oral health and tobacco cessation support from UK dentists
• The benefits of dental implants in restoring missing teeth in adolescents
• The use of lasers in dental procedures such as root canals
• The efficacy of root canal treatment using high-frequency electric pulses in saving infected teeth
• The role of fluoride in promoting remineralization and slowing down demineralization
• The impact of stress-induced reflux on oral health
• The benefits of dental crowns in restoring damaged teeth in elderly patients
• The use of sedation dentistry in managing dental anxiety in children
• The efficacy of teeth whitening treatments in improving dental aesthetics in patients with braces
• The role of orthodontic appliances in improving well-being
• The impact of periodontal disease on overall health and chronic illnesses

Topics & Ideas: Veterinary Medicine

• The impact of nutrition on broiler chicken production
• The role of vaccines in disease prevention in horses
• The importance of parasite control in animal health in piggeries
• The impact of animal behaviour on welfare in the dairy industry
• The effects of environmental pollution on the health of cattle
• The role of veterinary technology such as MRI in animal care
• The importance of pain management in post-surgery health outcomes
• The impact of genetics on animal health and disease in layer chickens
• The effectiveness of alternative therapies in veterinary medicine: A systematic review
• The role of veterinary medicine in public health: A case study of the COVID-19 pandemic
• The impact of climate change on animal health and infectious diseases in animals
• The importance of animal welfare in veterinary medicine and sustainable agriculture
• The effects of the human-animal bond on canine health
• The role of veterinary medicine in conservation efforts: A case study of Rhinoceros poaching in Africa
• The impact of veterinary research of new vaccines on animal health

Topics & Ideas: Physical Therapy/Rehab

• The efficacy of aquatic therapy in improving joint mobility and strength in polio patients
• The impact of telerehabilitation on patient outcomes in Germany
• The effect of kinesiotaping on reducing knee pain and improving function in individuals with chronic pain
• A comparison of manual therapy and yoga exercise therapy in the management of low back pain
• The use of wearable technology in physical rehabilitation and the impact on patient adherence to a rehabilitation plan
• The impact of mindfulness-based interventions in physical therapy in adolescents
• The effects of resistance training on individuals with Parkinson’s disease
• The role of hydrotherapy in the management of fibromyalgia
• The impact of cognitive-behavioural therapy in physical rehabilitation for individuals with chronic pain
• The use of virtual reality in physical rehabilitation of sports injuries
• The effects of electrical stimulation on muscle function and strength in athletes
• The role of physical therapy in the management of stroke recovery: A systematic review
• The impact of pilates on mental health in individuals with depression
• The use of thermal modalities in physical therapy and its effectiveness in reducing pain and inflammation
• The effect of strength training on balance and gait in elderly patients

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Topics & Ideas: Optometry & Opthalmology

• The impact of screen time on the vision and ocular health of children under the age of 5
• The effects of blue light exposure from digital devices on ocular health
• The role of dietary interventions, such as the intake of whole grains, in the management of age-related macular degeneration
• The use of telemedicine in optometry and ophthalmology in the UK
• The impact of myopia control interventions on African American children’s vision
• The use of contact lenses in the management of dry eye syndrome: different treatment options
• The effects of visual rehabilitation in individuals with traumatic brain injury
• The role of low vision rehabilitation in individuals with age-related vision loss: challenges and solutions
• The impact of environmental air pollution on ocular health
• The effectiveness of orthokeratology in myopia control compared to contact lenses
• The role of dietary supplements, such as omega-3 fatty acids, in ocular health
• The effects of ultraviolet radiation exposure from tanning beds on ocular health
• The impact of computer vision syndrome on long-term visual function
• The use of novel diagnostic tools in optometry and ophthalmology in developing countries
• The effects of virtual reality on visual perception and ocular health: an examination of dry eye syndrome and neurologic symptoms

Topics & Ideas: Pharmacy & Pharmacology

• The impact of medication adherence on patient outcomes in cystic fibrosis
• The use of personalized medicine in the management of chronic diseases such as Alzheimer’s disease
• The effects of pharmacogenomics on drug response and toxicity in cancer patients
• The role of pharmacists in the management of chronic pain in primary care
• The impact of drug-drug interactions on patient mental health outcomes
• The use of telepharmacy in healthcare: Present status and future potential
• The effects of herbal and dietary supplements on drug efficacy and toxicity
• The role of pharmacists in the management of type 1 diabetes
• The impact of medication errors on patient outcomes and satisfaction
• The use of technology in medication management in the USA
• The effects of smoking on drug metabolism and pharmacokinetics: A case study of clozapine
• Leveraging the role of pharmacists in preventing and managing opioid use disorder
• The impact of the opioid epidemic on public health in a developing country
• The use of biosimilars in the management of the skin condition psoriasis
• The effects of the Affordable Care Act on medication utilization and patient outcomes in African Americans

Topics & Ideas: Public Health

• The impact of the built environment and urbanisation on physical activity and obesity
• The effects of food insecurity on health outcomes in Zimbabwe
• The role of community-based participatory research in addressing health disparities
• The impact of social determinants of health, such as racism, on population health
• The effects of heat waves on public health
• The role of telehealth in addressing healthcare access and equity in South America
• The impact of gun violence on public health in South Africa
• The effects of chlorofluorocarbons air pollution on respiratory health
• The role of public health interventions in reducing health disparities in the USA
• The impact of the United States Affordable Care Act on access to healthcare and health outcomes
• The effects of water insecurity on health outcomes in the Middle East
• The role of community health workers in addressing healthcare access and equity in low-income countries
• The impact of mass incarceration on public health and behavioural health of a community
• The effects of floods on public health and healthcare systems
• The role of social media in public health communication and behaviour change in adolescents

Examples: Healthcare Dissertation & Theses

While the ideas we’ve presented above are a decent starting point for finding a healthcare-related research topic, they are fairly generic and non-specific. So, it helps to look at actual dissertations and theses to see how this all comes together.

Below, we’ve included a selection of research projects from various healthcare-related degree programs to help refine your thinking. These are actual dissertations and theses, written as part of Master’s and PhD-level programs, so they can provide some useful insight as to what a research topic looks like in practice.

• Improving Follow-Up Care for Homeless Populations in North County San Diego (Sanchez, 2021)
• On the Incentives of Medicare’s Hospital Reimbursement and an Examination of Exchangeability (Elzinga, 2016)
• Managing the healthcare crisis: the career narratives of nurses (Krueger, 2021)
• Methods for preventing central line-associated bloodstream infection in pediatric haematology-oncology patients: A systematic literature review (Balkan, 2020)
• Farms in Healthcare: Enhancing Knowledge, Sharing, and Collaboration (Garramone, 2019)
• When machine learning meets healthcare: towards knowledge incorporation in multimodal healthcare analytics (Yuan, 2020)
• Integrated behavioural healthcare: The future of rural mental health (Fox, 2019)
• Healthcare service use patterns among autistic adults: A systematic review with narrative synthesis (Gilmore, 2021)
• Mindfulness-Based Interventions: Combatting Burnout and Compassionate Fatigue among Mental Health Caregivers (Lundquist, 2022)
• Transgender and gender-diverse people’s perceptions of gender-inclusive healthcare access and associated hope for the future (Wille, 2021)
• Efficient Neural Network Synthesis and Its Application in Smart Healthcare (Hassantabar, 2022)
• The Experience of Female Veterans and Health-Seeking Behaviors (Switzer, 2022)
• Machine learning applications towards risk prediction and cost forecasting in healthcare (Singh, 2022)
• Does Variation in the Nursing Home Inspection Process Explain Disparity in Regulatory Outcomes? (Fox, 2020)

Looking at these titles, you can probably pick up that the research topics here are quite specific and narrowly-focused , compared to the generic ones presented earlier. This is an important thing to keep in mind as you develop your own research topic. That is to say, to create a top-notch research topic, you must be precise and target a specific context with specific variables of interest . In other words, you need to identify a clear, well-justified research gap.

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18 Comments

I need topics that will match the Msc program am running in healthcare research please

Hello Mabel,

I can help you with a good topic, kindly provide your email let’s have a good discussion on this.

Can you provide some research topics and ideas on Immunology?

Thank you to create new knowledge on research problem verse research topic

Help on problem statement on teen pregnancy

This post might be useful: https://gradcoach.com/research-problem-statement/

can you give me research titles that i can conduct as a school nurse

can you provide me with a research topic on healthcare related topics to a qqi level 5 student

Please can someone help me with research topics in public health ?

Hello I have requirement of Health related latest research issue/topics for my social media speeches. If possible pls share health issues , diagnosis, treatment.

I would like a topic thought around first-line support for Gender-Based Violence for survivors or one related to prevention of Gender-Based Violence

Please can I be helped with a master’s research topic in either chemical pathology or hematology or immunology? thanks

Can u please provide me with a research topic on occupational health and safety at the health sector

Good day kindly help provide me with Ph.D. Public health topics on Reproductive and Maternal Health, interventional studies on Health Education

may you assist me with a good easy healthcare administration study topic

May you assist me in finding a research topic on nutrition,physical activity and obesity. On the impact on children

I have been racking my brain for a while on what topic will be suitable for my PhD in health informatics. I want a qualitative topic as this is my strong area.

Hi, may I please be assisted with research topics in the medical laboratory sciences

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Home > College of Public Health > Health Services Research & Administration > Theses & Dissertations

Theses & Dissertations: Health Services Research, Administration, and Policy

Theses/dissertations from 2024 2024.

Telehealth for Healthy Aging: A Multi-Level, Multi-Methods Approach , Vaibhavi Mone

Theses/Dissertations from 2023 2023

Factors Associated with the Difficulty of Computerized Tasks Among Office-Based Physicians in the United States , Khalid Alshehri

Reducing Oral Health Disparities: Effectiveness of Preventive Dental Care on Treatment Use, Expenditures and Determinants of Service Utilization , Rashmi Lamsal

'The Very Structure of Opportunities Has Collapsed': How Taxation Policies Enhance, Decay, and Otherwise Affect the Distribution of Health & Health Services in the United States , Valerie Pacino

An Exploration of Policies, Equity, and Emerging Threats to the Traffic Safety Environment in the U.S. , Sachi Verma

Theses/Dissertations from 2022 2022

The State of Oral Health in People with Disabilities and the Impact of Family-Centered Care on the Oral Health of Children with Special Health Care Needs , Bedant Chakraborty

Theses/Dissertations from 2021 2021

The Ecology of Mental Health and the Impact of Barriers on Mental Health Service Utilization , Alisha Aggarwal

Health Service Utilization and Expenditure in Cardio-Metabolic Conditions in the United States Adults , Kavita Mosalpuria

Impact of Prescription Drug Monitoring Program on Drug Misuse and Drug-related Fatal Vehicle Crashes , Moosa Tatar

Theses/Dissertations from 2020 2020

Essays on rehospitalization under the Hospital Readmission Reduction Program , Yangyuna Yang

Theses/Dissertations from 2019 2019

Impact of Healthcare Delivery and Policies on Children's Outcomes after the Affordable Care Act of 2010 , Shreya Roy

Examining the Effects of Approaches on Reducing Hospital Utilization: The Patient-Centered Medical Home, Continuity of Care, and the Inpatient Palliative Consultation at the End-of-Life , Xiaoting Sun

Theses/Dissertations from 2018 2018

Essays on the Patient-Centered Medical Home in the United States Military Health System , Glen N. Gilson

A Multi-Level Assessment of Healthcare Facilities Readiness, Willingness, and Ability to Adopt and Sustain Telehealth Services , Jamie Larson

Healthcare Utilization for Behavioral Health Disorders: Policy Implications on Nationwide Readmissions, and Outcomes in the States of Nebraska and New York , Rajvi J. Wani

Theses/Dissertations from 2017 2017

Structural violence and gender-based violence in the United States , Sarbinaz Z. Bekmuratova

Community Benefits Spending by Private Tax-Exempt Hospitals in the U.S. , Wael ElRayes

Patient-Centered Medical Home Adoption in School-Based Health Centers , Abbey Gregg

Meaningful Use of Electronic Health Records for Population Health Management in U.S. Acute Care Hospitals , Niodita Gupta

Hospital Based Emergency Department Visits With Dental Conditions: Outcomes and Policy Implications in the States of California, Nebraska and New York , Sankeerth Rampa

Theses/Dissertations from 2016 2016

Adoption of Medication Management Technologies by U.S. Acute Care Hospitals after the HITECH Act , Aastha Chandak

The Impact of Electronic Health Records on Healthcare Service Delivery, Patient Safety, and Quality , Kate Elizabeth Trout

Essays on Immigration-Related Disparities in Health Behavior and Health Care Utilization , Yang Wang

Theses/Dissertations from 2015 2015

The Impact of Gasoline Prices on Medical Care and Costs of Motor Vehicle Injuries , He Zhu

Theses/Dissertations from 2014 2014

Provision, cost, and quality of robot-assisted radical prostatectomies in the United States , Soumitra Sudip Bhuyan

Organizational factors associated with the implementation of evidence-based public health interventions in local health department settings , Janelle J. Jacobson

Hospital cost shifting in the United States , Tao Li

Patient-centered medical home readiness in the veterans health administration: an organizational perspective , Anh T. Nguyen

Organizational and environmental correlates of electronic health records implementation and performance in acute care hospitals in the United States , Diptee Ojha

Assessing geographic variation and migration behaviors of foreign-born medical graduates in the United States , Samuel Tawiah Yaw Opoku

Theses/Dissertations from 2013 2013

Organizational and environmental correlates of strategic behavior and financial performance in the US hospice industry , Bettye Appiah Apenteng

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Master of Public Health

A thesis is a substantive and original body of work that allows the student to synthesize and integrate knowledge from their public health course work and practicum experiences, apply it to a particular topic area, and communicate their ideas and findings through a scholarly written product. The thesis represents the culmination of the student’s educational experience in the Vanderbilt MPH Program.

The thesis may take on different formats, depending on the student’s track focus and interests. Regardless of the format chosen, the student must apply critical thought, systematic analysis, and clear presentation.

Each student is responsible for identifying a topic and appropriate format for their thesis with the assistance and guidance of faculty advisers and faculty thesis readers.

The practicum product must be distinct from the thesis. Although the practicum and thesis can be related, the student must be able to articulate how the two projects are independent from one another. The practicum is a practice experience that allows students to apply and develop skills in public health concepts. The thesis is the synthesis and integration of knowledge acquired in coursework and through the practicum and results in an original scholarly work.

View selection of published theses

Additionally, students have the option to pursue publishing their thesis products in scholarly journals.

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Thesis summary

Creating integrated health care, bengt ahgren.

Gothenburg, Sweden

Bengt Ahgren  Creating integrated health care. Gothenburg: The Nordic School of Public Health. 2007. p. 174 ISBN: 978 91 85721 09 2.

It was the ambition of this thesis to contribute to the growing interest in integrated care and to the ongoing research in this area by exploring the Swedish development of integrated health care. The general purpose was to study different strategies to improve integration in the Swedish health care system in order to identify some of the key issues and conditions in the creation of integrated care.

For the purpose of exploring the status of chains of care, the determinants of integrated health care development, and the evaluation of integrated health care, a combination of different quantitative and qualitative methods was used, and the research was guided by a philosophy of triangulation, that is, an application and combination of several research methodologies in the study of the same phenomenon.

The results showed that chain of care development has a high priority in Swedish health care. However, regardless of the high official priority and several years of experience, chain of care development is making slow progress. Seven out of ten county councils regard themselves as unsuccessful in developing and implementing chains of care. Even so, it seems that chains of care are here to stay. All the county councils declare that they will continue to develop chains of care. This faith in chains of care can to some extent be explained by the crucial role they have as links in the ongoing development of local health care. This is an upgraded family- and community-oriented primary care, supported by flexible hospital services. Many politicians and policy makers are convinced that such an integrated system will assure both high quality and a cost-effective health care.

The study indicated that top-down approaches are obstructing the chain of care development. Negative response emanates mostly from professional values of the body of physicians. Conversely, if a chain of care project is initiated locally by dedicated professionals, there is a good chance of a successful outcome. The legitimacy of the development work among colleagues and stakeholders is of vital importance to the success of the work. It also applies to confidence among participating organisations and authorities. This attitude includes giving space for prime movers and also trust between the participants.

A chain of quality data of input/structure, process and outcome, where the latter is dependent on the previous links in the chain, made it possible to evaluate integration from three perspectives: the patient, the professional and the management. Furthermore, a model measuring clinical functional integration, the foundation for developing integration synergy and effectiveness, was successfully validated in a local health care organisation.

Thus, chains of care are increasingly regarded as building stones of local health care. In this sense, chains of care may have a renaissance, after being high on the policy agendas for several years but with modest development results. As development of local health care has predominantly had a top-down approach, it seems that new ways have to be found to create change bottom-up by engaging health care professionals and facilitating professional dedication, legitimacy and confidence in the development work. Furthermore, clinical integration is the foundation of integrated health care and should therefore get prime attention. The validated measurement model can provide managers with crucial evaluation data. Especially for extensive evaluations, with the objective to increase understanding of the integration logic, the quality chain matrix has proven to be a helpful framework as it regards the creation of integrated care as a chain of acts. Such activities include managerial tasks, which makes it possible to evaluate the sometimes neglected role of management.

The results presented in this review are based on the author's thesis presented at the Nordic School of Public Health on 5 June 2007.

Further information on this research has been published by this author in the International Journal of Integrated Care:

Ahgren B. Chain of care development in Sweden: results of a national study. International Journal of Integrated Care [serial online] 2003 Oct 7;3. Available from: http://www.ijic.org/ .

Ahgren B, Axelsson R. Evaluating integrated health care: a model for measurement. International Journal of Integrated Care [serial online] 2005 Aug 31;5. Available from: http://www.ijic.org/ .

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PhD Program: Dissertations

• The Effect of Private Managed Care on Medicaid Spending and Fiscal Predictability
• Physician Learning: The Role of Physician Practice Organization and Competition
• Firm Response to Low-Reimbursement Patients in the Market for Unscheduled Outpatient Care
• The Demand for Preventive Activities and its Association with Medicare Expenditures
• Perspectives on Firm Decision Making During Risky Technology Acquisitions
• Information in Medicare HMO Markets: The Interplay of Advertising and Report Cards
• Generic Pharmaceutical Entry via Paragraph IV Certification
• Precautionary Savings to Manage Common Health Risks Among the Poor
• The Impact of Medical Spending Growth on Guaranteed Renewable Health Insurance
• The Effect of Publicized Hospital Charges on Hospital Choice
• The Effects of Language and Geography-Defined Groups on Health Insurance Choice
• The Effect of Specialty Tier Placement on Enrollment and Utilization in Medicare Part D.
• Competition, Ownership Type, and Provider Behavior in the Hospice Industry
• Market Heterogeneity and Drug Innovation
• Changing Activity and Behavior of Primary Care Physicians Following Practice by Academic Medical Centers
• Medicare Prescription Drug Legislation: An Analysis of Economic Effect
• Economic Determinants and Consequences of Physical Activity
• The Impact of Competition in Hospital Markets on Disparities in Procedure Use: The Care of CABG Surgery for AMI Patients
• Organizational Form and Niche Overlap: The Dynamics of Surgery Center Entry and Exit
• Is More Necessarily Better? The Impact of Prescription Drug Coverage on Clinical Outcomes in the Medicare Population
• The Impact of Physical Activity on Short-Run Healthcare Utilization and Costs in US Adults
• Perception, Selection and Performance: Hospitals’ Adaption Strategies
• Creative Value in Pharmaceutical and Biotechnology Research: The Role of Resource Allocation and Capabilities Development
• Patent Policy and Entry: Evidence form Pharmaceutical Patent Challenges
• The Formation of Surgeon Peer Reputation and its Effect on Technology Adoption
• Understanding the Role of Genetic Factors and Risky Health Behavior on Adolescent Student Outcomes
• Public Insurance Programs: The Impact of Uncompensated Care, Reimbursement Funds and Medicaid
• Analysis of Acquisitions by Medical Device Manufacturers
• Responses to Cardiac Surgery Mortality Report Cards
• Medicare and Prescription Drug Coverage: Impacts on Non-Drug Medical Spending and Disability
• The Impact and Response of Physicians to Malpractice Liability Claims
• Physician Agency Issues and Response to FDA Labeling: The Case of Anti-Cancer Drugs
• The Adoption and Diffusion of Hospital Information Systems
• Firm Ownership Form and Quality: An Examination of the Impact of the Balanced Budget Act of 1997 on Hospitals
• Responses to Mortality Report Cards for Cardiac Surgery
• Educational Programs As Incentives to Students for Selecting Dental Schools of Their Choice
• The Value of Choice in Health Insurance Purchasing
• Price Regulation, Capital Market Imperfections, and Strategic R&D Investment Behavior in the Pharmaceutical Industry: Consequences for Innovation
• The Impact of CABG Report Cards on Racial Disparities

1999 – 2002

• Community Rating and Regulatory Reform in Health Insurance Markets
• Access to Free Care for the Uninsured and its Effect on Private Health Insurance
• Employee Demand for Health Insurance and Employer Health Benefit Choices
• Physician’s Practice Styles and How They Change as a Higher Percentage of Managed Care Patients are Treated as a Percentage of their Patient Panel
• Demand for and Provision of HMO Quality Information
• How People Trade-Off Pregnancy and HIV Risk When Choosing Forms of Contraception

1996 – 1998

• Do Relative Fees Affect Utilization of Surgical Procedures Under Medicare? A Study of Geographic Variations
• Technology Diffusion of Marketed and Unmarketed Products: Addressing the Social Welfare of Promotional Restriction and Positive Reimbursement Policy for Off-Label Anti-Cancer Drugs
• The Impact of Internal Structural Changes on Hospital Costs
• Environmental Turbulence, Organizational Capabilities and Strategic Response: Hospital Strategy in an Era of Managed Care
• Role of Functional Status in Predicting Inpatient Mortality with AIDS
• How Parent’s Schooling Affects Child Health: The Importance of Quality Time

1992 – 1995

• A Theory of Congestion in General Hospitals
• An Analysis of the Effect of Changes in Coinsurance Rates on Health Care Use and Cost
• The Effects of Alternative Third Party Reimbursement Systems on the Adoption and Diffusion of New Medical Technologies
• Hospital Pricing and Organizational Control: The Effect of Government Payment Changes on Hospital Prices
• A Theory of Incentives for Providers: Payment Systems, Quality of Services, and Consumer Information in Health Care Markets
• Productive Efficiency and Cost-Effectiveness of Public-Funded Drug Treatment Programs in New Jersey

1987 – 1991

• A Theoretical and Empirical Study of Physician Compensation Arrangements
• The Effects of Liability on the Practice Patterns of Obstetricians and Gynecologists
• Measuring Hospital Quality of Care: A Study of the Failure Rate, Adverse-Occurrence Rate and Death Rate
• Consumer Discount Rates for Health and Money in Health Care Cost Effectiveness Analysis
• The Extent and the Determinants of Variations in Nursing Home Staffing and Practice

Should Healthcare Be Free? Essay on Medical System in America

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Introduction

Problem statement, why healthcare should be free, why healthcare should be paid, works cited.

The US government has historically taken a keen interest in the health of its citizens. As far back as the beginning of the 1900s, President Theodore Roosevelt declared that “nothing can be more important to a state than its public health: the state’s paramount concern should be the health of its people” (Gallup and Newport 135). Despite these, the United States is classified as the nation with the most expensive, and yet inefficient, health care system among developed nations.

An expensive health care system translates to an increasing proportion of the population being unable to access the much needed medical care. The New York Times reports that according to census survey carried out in the year 2007, an estimated 45.6 million people in the USA were uninsured and hence unlikely to receive comprehensive medical care from hospitals (1). Due to the perceived inefficiencies, there has been agreement that the current health care system is faulty and therefore in need of radical changes to make it better.

Majority of American’s are greatly dissatisfied with the current health care system which is extremely expensive and highly inefficient. While an effective system can be deemed to be one which is efficient, acceptable and at the same time equitable, the current system is lacking in this attributes.

The aim of this paper will be to analyze the effects that free health care system in America would have. This paper will argue that a health care system which guarantees free health care for all Americans is the most effective system and the government should therefore adopt such a system.

Free health care would result in a healthier nation since people would visit the doctors when necessary and follow prescriptions. Research by Wisk et al. indicated that both middle and lower class families were suffering from the high cost of health care (1). Some families opted to avoid going to the doctor when a member of the family is sick due to the high cost of visiting the doctor and the insurance premiums associated with health care.

In the event that they go to the doctor, they do not follow prescriptions strictly so as to reduce cost. Brown reveals that “60 percent of uninsured people skipped taking dosages of their medication or went without it because it cost too much” (6). Such practices are detrimental to a person’s health and they cost more in the long run.

The last few years have been characterized by financial crises and recessions which have negatively affected the financial well being of many Americans. In these economic realities, the cost of health care has continued to rise to levels that are unaffordable to many Americans. This loss of access to health care has led to people being troubled and generally frustrated. A report by Brown indicates that the price for prescription drugs in the US has escalated therefore becoming a financial burden for the citizens (6).

The productivity of this people is thereby greatly decreased as they live in uncertainty as to the assurance of their health and thereby spend more time worrying instead of being engaged in meaningful activities that can lead the country into even greater heights of prosperity. Free health care would lead to a peace of mind and therefore enable people to be more productive.

Since medical care is not free, many people have to make do with curative care since they cannot afford to visit medical facilities for checkups or any other form of preventive medical care. This assertion is corroborated by Colliver who reveals that many people are opting to go without preventative care or screening tests that might prevent more serious health problems due to the expenses (1).

Research shows that approximately 18,000 adults die annually due to lack of timely medical intervention (The New York Times 1). This is mostly as a result of lack of a comprehensive insurance cover which means that the people cannot receive medical attention until the disease has progressed into advanced stages. This is what has made medical care so expensive since “sick patients need more care than relatively healthy ones” (Sutherland, Fisher, and Skinner 1227).

This is an opinion shared by Sebelius who reveals that 85% of medical costs incurred in the country arise from people ailing from chronic conditions (1). She further notes that if screened early, these diseases such as diabetes and obesity can be prevented thus saving the medical cost to be incurred in their treatment. It therefore makes sense to have a health care system that makes it possible for everyone to access preventive care thus curbing these conditions before they are fully blown.

While most people assume that free health care will result in better services as more people will be able to access health care, this is not the case. The increase in people who are eligible for health care will lead to an increase in the patients’ level meaning that one may have to wait for long before receiving care due to shortage of medical personnel or the rationing of care.

A European doctor, Crespo Alphonse, reveals that when health care is free, people start overusing it with negative implications for the entire system (AP). In addition to this, free health care would invariably lead to cost cutting strategies by hospitals.

This would lead to scenario where finding specialized care is hard and the rate of medical mistakes would increase significantly. As a matter of fact, a survey on Switzerland hospitals found that medical errors had jumped by 40% owing to the introduction of mandatory health insurance (AP). While it is true that free health care will increase the number of people visiting the doctor, this may be a positive thing since it will encourage preventive care as opposed to the current emphasis on curative care.

Free health care is a move towards a socialistic system. As it is, the US is a nation that is built on strong capitalistic grounds. This is against the strong capitalistic grounds on which the United States society is build on. While detractors of the private insurance firms are always quick to point out that the firms make billions of dollars from the public, they fail to consider the tax that these firms give back to the federal government (Singer 1).

Free health care would render players in the health industry such as private insurance companies unprofitable. Free health care will bring about a shift from a profit oriented system to a more people oriented system. Without money as a motivation, research efforts will plummet thereby leading to a decrease in the medical advancement as investment in research will not be as extensive (Singer 1).

The Associate Press reveals that doctors may also lack to be as motivated if they are no incentives and thereby the quality of their work may weaken (1). As such, a free health care system would have far reaching consequences for the economy of the nation since the health care industry is a profitable industry for many.

The Healthcare system is one of the most important components of the U.S. social system since full productivity cannot be achieved without good health. This paper has argued that a free health care system would be the most effective system for America. To reinforce this assertion, the paper has articulated the benefits that the country would accrue from free health care.

With free health care, all Americans would be able to access health services when they need it leading to increased quality of life. In addition, many people would make use of preventive healthcare services, therefore reducing the financial burden that the expensive curative services result in.

The paper has taken care to point out that free health care has some demerits, most notably of which is overloading the health services with a high number of patients. Even so, the observably advantages to be reaped from the system far outweigh the perceived risks. As it is, decades of reform on the US health care system have failed to provide any lasting solution to the problem.

Making health care free for all may be the strategy that will provide a solution for the ideal health care system that has thus far remained elusive. From the arguments presented in this paper, it can irrefutably be stated that free health care will result in a better health care system for the country.

Associate Press. (AP). Europe’s free health care has a hefty price tag . 2009. Web.

Brown, Paul. Paying the Price: The High Cost of Prescription Drugs for Uninsured Americans. U.S. PIRG Education Fund, 2006.

Colliver, Victoria. “Jump in middle-income Americans who go without health insurance,” San Francisco Chronicle (SFGate), 2006.

Gallup, Andrew, and Newport Francis. The Gallup Poll: Public Opinion . Gallup Press, 2005. Print.

Sebelius, Kathleen. Health Insurance Reform Will Benefit All Americans . 2009. Web.

Singer, Peter. Why We Must Ration Health Care . 2009. Web.

Sutherland, Jason., Fisher Elliott, and Skinner Jonathan. “Getting Past Denial – The High Cost of Health Care in the United States” . New England Journal of Medicine 361;13, 2009).

The New York Times. The Uninsured . 2009. Web.

Wisk, Lauren. High Cost a Key Factor in Deciding to Forgo Health Care . 2011. Web.

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IvyPanda. (2018, October 12). Should Healthcare Be Free? Essay on Medical System in America. https://ivypanda.com/essays/free-health-care-in-america/

"Should Healthcare Be Free? Essay on Medical System in America." IvyPanda , 12 Oct. 2018, ivypanda.com/essays/free-health-care-in-america/.

IvyPanda . (2018) 'Should Healthcare Be Free? Essay on Medical System in America'. 12 October.

IvyPanda . 2018. "Should Healthcare Be Free? Essay on Medical System in America." October 12, 2018. https://ivypanda.com/essays/free-health-care-in-america/.

1. IvyPanda . "Should Healthcare Be Free? Essay on Medical System in America." October 12, 2018. https://ivypanda.com/essays/free-health-care-in-america/.

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IvyPanda . "Should Healthcare Be Free? Essay on Medical System in America." October 12, 2018. https://ivypanda.com/essays/free-health-care-in-america/.

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• Open access
• Published: 22 September 2022

Redesigning value-based hospital structures: a qualitative study on value-based health care in the Netherlands

• Gijs Steinmann   ORCID: orcid.org/0000-0002-9478-3725 1 ,
• K. Daniels   ORCID: orcid.org/0000-0002-0534-1432 2 , 3 ,
• Fabio Mieris 2 ,
• Diana Delnoij 1 , 4 ,
• Hester van de Bovenkamp 1 &
• Paul van der Nat 2 , 3  

BMC Health Services Research volume  22 , Article number:  1193 ( 2022 ) Cite this article

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A crucial component of value-based health care concerns the redesign of organizational structures. In theory, hospital structures should follow value creation: addressing medical conditions for specific groups of patients over full cycles of care. In practice, however, it remains unclear how hospitals can reorganize themselves into value-based structures. The purpose of this study is to explore the ways in which Dutch hospitals are currently implementing and pursuing value-based redesign.

This qualitative exploratory study used semi-structured interviews and a focus group for data collection. Transcripts were analyzed through deductive coding, for which we used Mintzberg’s theory on organizational structures, particularly his work on design parameters.

In their efforts to create more value-based structures, Dutch hospitals often employ a variety of liaison devices, such as project teams and committees. By contrast, the actual formation of units around medical conditions is much rarer. Outcome data are widely used within planning and control systems, and some hospitals partake in external benchmarking. Not all hospitals use cost indicators for monitoring performance.

Conclusions

Value-based redesign is not necessarily a matter of radical changes or binary choices. Instead, as Dutch hospitals show, it can be an incremental process, with a variety of potential knobs to turn to various degrees. Health care executives, managers, and professionals thus have a wide range of options when they aim for more value-based structures. Our conceptualization of “value-based design parameters” can help guide the selection and implementation of strategies and mechanisms for further coordination around medical conditions over full cycles of care.

Peer Review reports

The organizational structures of hospitals have repeatedly been criticized for impeding coordination, hampering efficiency, and delivering suboptimal patient care [ 1 , 2 , 3 ]. Moreover, much of this critique is supported empirically [ 2 , 4 , 5 , 6 ]. In this regard, the recent and widespread uptake of value-based health care (VBHC) is of particular interest since a key component of VBHC concerns the redesign of organizational structures [ 3 , 7 , 8 ].

Although parallels exist between VBHC principles and approaches such as process-based design [ 2 ], VBHC distinguishes itself by the way it defines and emphasizes value. In health care delivery, the argument goes, value consists of what matters most to patients: the health status they achieve (outcomes) and the resources needed to reach that status (costs) [ 7 ]. By relating outcomes to costs, value encompasses efficiency and establishes an overarching aim for health care systems: to optimize value by continuously striving to achieve the best outcomes as efficiently as possible [ 7 ]. A foundational premise within VBHC—especially regarding organizational design—is that value is created at the level of medical conditions over full cycles of care ([ 7 ] p99-105). The idea is that value is not created at levels as broad as organizations such as hospitals or at levels as narrow as separate medical specialties or procedures, but over a full cycle of interdependent activities that together generate value for patients with a particular medical condition ([ 7 ] p44-51&203), [ 8 ].

For hardline VBHC proponents, a deep appreciation of this premise comes with three interrelated implications. The first is that providers should start to systematically measure both the outcomes and costs of their care cycles for each of the medical conditions they treat [ 3 , 7 , 8 ]. Second, provider organizations should realign their organizational structures with the goal of value and the level at which it is created. Thus, rather than organizing around medical specialties, hospitals ought to create integrated practice units (IPUs) that coordinate the full cycle of services necessary to treat patients with a particular medical condition ([ 7 ] p167-77). In our subsections below, we elaborate on this implication and the notion of value-based redesign. Third, the payment structures (i.e. procurement contracts) should also be in line with value creation: with bundled payments for full cycles or episodes of care for patients with a particular medical condition ([ 7 ] p265–67).

While the pioneering work on VBHC has informed a range of health policies across the globe [ 9 , 10 , 11 , 12 ], the actual reorganization into value-based hospital structures remains unclear and understudied [ 10 , 13 , 14 ]. This study aims to provide a deeper understanding of how hospitals realign their organizational structure with the creation of value for patients. Our research zooms in on the Netherlands, a country in which VBHC is high on the national health policy agenda and where multiple hospitals have started implementing VBHC principles [ 15 , 16 ]. Therefore, we examine how Dutch hospitals are currently working toward value-based redesign : structural coordination around medical conditions over full cycles of care. Accordingly, we offer insight into the various ways in which value-based redesign is established in practice.

The structuring of hospitals

In general, all organized activities require both a division of labor into specific tasks and the coordination of those tasks. An organizational structure, basically speaking, refers to the way in which task allocation and coordination are designed ([ 17 ] p2). Most of today’s hospitals are structured around medical specialties, with organizational units that are based on specific knowledge and skills (i.e. the functions) that are needed to perform certain complex tasks [ 1 , 18 ]. Thus, hospitals typically have what is called a functional design : an organizational structure based on specialized skills [ 1 , 17 ].

A main benefit of a functional design is that it facilitates contact and communication among similar (medical) specialists, thus supporting the continual transmission of complex skills [ 1 , 17 ]. A downside, however, is that these structures are prone to pose workflow problems, resulting from a lack of coordination between organizational units [ 17 ]. This can become particularly problematic when the specialized activities within the various units are highly dependent on one another—such as in hospitals [ 1 , 3 ]. Consequently, much of the criticism of hospitals’ functional design revolves around issues of interdependency and a lack of coordination between units [ 1 , 2 , 3 , 18 ].

• Value-based redesign

Value-based redesign—task allocation and coordination around medical conditions over full cycles of care—would disrupt hospitals’ traditional structures [ 3 , 7 , 8 ]. According to the pioneering scholars on VBHC, such disruption is critical: improving value for patients requires a “fundamental restructuring” of the way health care delivery is organized [ 8 ].

A value-based approach will require challenging conventional wisdom and making changes in structures and practice patterns that have been in place for decades [ 8 ].

In practice, however, profound structural changes such as these are highly challenging, particularly in organizations such as hospitals, where a highly professionalized workforce operates within firmly established traditional structures [ 1 , 19 ]. Additionally, most of the changes professed by hardline VBHC proponents are primarily described conceptually, and several scholars have expressed the need for a deeper connection with real-life organizational complexities, including more explicit guidance that can aid providers in their internal reorganization process [ 10 , 20 ].

In this article, we build on Henry Mintzberg’s [ 17 ] research synthesis on the structuring of organizations, in which he elaborately addresses, among other topics, the mechanisms by which organizations arrange and coordinate their work and the reasoning behind them. Mintzberg is a renowned scholar in the field of management and organization studies, and his widely cited “ The Structuring of Organizations” (1979) remains highly relevant today—something our current study re-emphasizes. Here, to examine how Dutch hospitals work toward value-based redesign, we particularly build on his conceptualization of “design parameters” ([ 17 ] p65-213). For Mintzberg ([ 17 ] p65), organizational design essentially comes down to “turning the knobs” that affect the division of labor and modify the mechanisms that coordinate work within an organization. In slightly more technical terms, these knobs are labeled the “design parameters” of organizational structures ([ 17 ] p65).

In Table 1 , we list Mintzberg’s eight design parameters (first column); we describe the main ways in which each parameter can be used to organize the division and coordination of work (second column); and we outline our own conceptualization of “value-based design parameters” (third column), referring particularly to value-based redesign: task allocation and coordination around medical conditions over full cycles of care. The first and second columns are strictly based on Mintzberg’s compelling synthesis of research on organizational structures [ 17 ]; the third column is derived from our own synthesis of Mintzberg’s design parameters and Porter’s seminal texts on VBHC [ 7 , 8 ]. Thus, our conceptualization of “value-based design parameters” refers to potential “knobs” that can be turned to modify the mechanisms that coordinate the interdependencies between the various people and activities involved in treating patients with a particular medical condition. See Additional File 1 for an elaboration on the theory from which Table 1 is derived.

For the purpose of our study, “unit grouping” is a particularly relevant design parameter since the notion of an IPU can be regarded as the ideal type of organizational unit within VBHC theory. However, within this study, we distinguish these ideal type IPUs from what we conceive of as “value-based units.” In the context of hospitals, an IPU would acquire and manage its own budget and ideally be an independent “profit-and-loss center” [ 3 ]. Thus, next to shifting lines of authority, reorganizing into IPUs would break up the traditional flow of funds through specialty departments [ 3 ]. What we conceive of as value-based units, however, does not necessarily imply a shift in financial structures. Nevertheless, these value-based units are formally grouped together into distinctive parts of the organization (e.g. in a breast cancer department); they are assigned official authority within the hierarchy of a hospital. Accordingly, they differ from interunit multidisciplinary teams , which are informal parts of the organization (i.e. liaison devices that overlay the formal structure).

To explore the ways in which Dutch hospitals are working toward more value-based structures, this qualitative study made use of semi-structured interviews and a focus group for data collection. Throughout the research, we have built on our synthesis of organizational design parameters [ 17 ] and VBHC [ 7 ].

For this study, the need for ethical approval was waived by the Medical Ethics Committee Erasmus MC (MEC-2019–0189).

Our research focuses on the organizational structures of hospitals (outpatient specialty clinics do not fall within the scope of this study). In hospitals—relatively large health care organizations that provide a wide range of services out of a traditionally well-established functional structure—the organizational changes professed by hardline VBHC proponents seem particularly challenging.

The Netherlands forms an interesting setting, as the concept of VBHC is currently being adopted by a variety of organizations, including national policy institutions, health care insurers, hospitals and other provider organizations [ 15 , 16 ]. The Dutch health care system is characterized by regulated or managed competition. Roughly speaking, insurers are encouraged to compete for members by offering attractive premiums, which should incentivize them to critically purchase health care provision, thereby stimulating providers to demonstrate quality and efficiency. A crucial piece of regulation concerns the mandatory health insurance package that each citizen is required to take on and each insurer must cover for any (potential) member (at an equal price irrespective of individual characteristics). This basic insurance package aims to ensure the accessibility and affordability of high-quality health care provision, covering family care, specialist care, and inpatient hospital care, among others [ 21 ].

In total, the Netherlands currently has 69 hospitals (including eight academic hospitals). Within the system of regulated competition, all of these hospitals are private not-for-profit organizations [ 22 ]. Academic hospitals are required to contractually employ their medical specialists (i.e. have them on payroll, similar to all nursing and most other staff). However, the majority of medical specialists working in general hospitals are not salaried employees but rather self-employed consultants within a closed hospital system. The contractual relation between consultants and the hospital is not arranged on an individual level but through a so-called “corporation” of medical specialists ( Medisch Specialistisch Bedrijf ). In essence, these corporations form within-hospital firms; they collectively negotiate contracts with a hospital, and fees are divided internally among members, usually differing between medical specialties [ 22 ].

Keeping our main objective in mind, we made use of purposive sampling [ 23 ], targeting hospitals that explicitly claim to be working toward value-based organizational structures. Therefore, we built on our professional network combined with gray and academic literature on VBHC in the Netherlands, which led us to list sixteen hospitals. Next, we contacted each hospital via e-mail. We briefly explained our research before asking 1) whether the respective hospital is indeed working on value-based organizational structures around medical conditions; and 2) if so, whether we could interview a suitable representative from within the organization. In most cases, our professional network allowed us to either directly contact a potentially suitable hospital representative or to contact a particular hospital employee in search of a referral; in other cases, we contacted the hospital’s main secretariat. Ultimately, we left it up to the potential interviewee to determine—based on the background information we provided about our research topic and objectives—whether he or she would be a suitable representative.

Data collection

Between April and November 2020, we conducted a series of semi-structured interviews with representatives of Dutch hospitals. For this study, we composed an interview guide founded upon our theoretical framework (see Additional File  2 ). Hence, our questions focused on the ways in which hospitals are coordinating (or attempting to coordinate) health care delivery around medical conditions over full cycles of care.

We complemented our interviews with a focus group, for which we again made use of purposive sampling. Accordingly, we focused on the Linnean Initiative: an open multidisciplinary knowledge network that aims to accelerate the implementation of VBHC in the Netherlands [ 24 ]. One of their nine workgroups focuses specifically on the transition toward integrated practice units (IPUs). Within this IPU workgroup, “the frontrunners in the field of value-based care in the Netherlands are considering this issue and are developing a step-by-step plan to build towards an archetypal IPU” [ 25 ]. We organized an online focus group in which the members of this IPU workgroup would discuss our theoretical framework and our initial findings from the interviews, which we briefly presented beforehand (see Additional File 2 for our topic list). Through their hands-on expertise and their active involvement in an independent national knowledge network, the data from this focus group were used to strengthen our findings.

The interviews were conducted by either the first author (GS) or the third author (FM). At the time of the interviews, the first author was a male PhD candidate with an educational background in cultural anthropology, whose research focuses on VBHC in the Netherlands. The third author was a male student within the Health Sciences, Healthcare Policy and Management bachelor program ( Gezondheidswetenschappen , Beleid & Management Gezondheidszorg ) and was doing an internship at a VBHC department in a Dutch general hospital at the time of the study. Next to the first and third authors, the focus group was also attended by the second author (KD): a female PhD candidate with an educational background in health care policy and management, doing her research out of the same hospital department (VBHC) where the third author was doing his internship. Together, the first, second, and third authors conducted the data analysis.

Both the interviews and focus group were recorded and transcribed verbatim. All transcripts were analyzed through deductive coding [ 26 ]. We converted our theoretical framework into a coding scheme, in which the design parameters (see Table 1 ) formed the initial codes. Although we employed a predominantly theory-driven deductive coding process, we did remain sensitive to relevant findings that would not fit easily into the initial coding scheme [ 26 ]. See Additional File 3 for our final coding scheme.

The entire coding process, from the development of the initial coding scheme to the coding of all transcripts, was conducted by two primary coders (first and second authors). A third of the transcripts were coded in tandem, and the other two-thirds were coded individually by both coders, who discussed all conflicts and potential adaptations or additions to the coding scheme. Accordingly, we aimed to reduce variability within our analysis [ 27 ]. From October 2020 onward, all authors met regularly in group sessions to discuss the preliminary results and earlier drafts of this paper.

Representatives of eleven hospitals agreed to partake in an interview ( n  = 11); three hospitals refused to partake due to COVID-19; one declared itself a poor match for our study; and another did not respond to our request. Of the eleven interview participants, nine represented a general hospital, and two represented an academic hospital. At the time of the interviews, four participants worked as a “Program Manager VBHC” and one as a “Project Lead VBHC”. An additional four worked on a hospital’s organizational strategy and innovation team: two as an “Advisor”, one as a “Project Manager”, and another as a “Program Director.” We also interviewed a “Chair Oncological Center” and a “Medical Director.” The interviews lasted 57 min on average.

Regarding the focus group, seven of the ten members of the Linnean Initiative’s IPU workgroup participated in a 90-min digital session. The focus group consisted of two hospital employees whom we interviewed before; two employees of hospitals from which we interviewed someone else; three health care consultants; and one delegate of a government institution.

Our synthesis of Mintzberg’s design parameters and Porter’s principles of VBHC—see Table 1 for an overview—formed the basis of our analysis and laid the groundwork for this section. Thus, each of the following subsections addresses a separate design parameter and how these are utilized by Dutch hospitals to coordinate work in line with the principles of VBHC. In our description, we adhere to Mintzberg’s [ 17 ] terminology (e.g. “unit grouping”, “standing committee”, “liaison devices”, “indoctrination”). When quoting respondents, we refer to them with a particularly assigned number in parentheses; expressions from the focus group are referred to by the number twelve (12).

In each of the interviews, the topic of unit size was brought up by the researcher. However, none of our respondents indicated that value-based sizing—the process by which the size of organizational units is taken into consideration in relation to enhanced coordination—was a particularly relevant item.

We have chosen to not express that in a number of millions or a number of employees, but rather just to check with common sense: what would be good homogenous groups [of patients] for which you can put together a [value-based] unit (7).

Thus far, the issue of size was relevant only in relation to the number of team leaders or the core set of team members who met and regularly discussed interunit affairs.

Unit grouping

The concept of “value-based grouping” refers to the establishment of hospital units around medical conditions. Within Dutch hospitals, the considerations concerning the formation of units were relatively comparable. For instance, most interviewees expressed the belief that value-based units could indeed enable closer collaboration among everyone involved in treating patients with a particular medical condition. However, hospitals had acted upon this recognition in different ways.

I think you have two possible change strategies. One is that you have an idea, top-down, and you force it upon the organization, based on some kind of blueprint. [O]r, you let it arise organically from practice, bottom up, because the demand for a new organizational structure comes up. And that is the choice [our hospital] made (2).

Most hospitals opted for a more bottom-up approach in regard to value-based grouping. Accordingly, several hospitals had started “pilots” (1, 11,) in which they established multidisciplinary teams around a relatively small number of medical conditions. Respondents stated that the idea was to eventually create more of these teams and to incrementally carve these teams into the formal organizational structure.

Multidisciplinary, around a medical condition, we have now four [teams]. [E]ach of those [multidisciplinary teams] has a daily leadership board. [A]s the daily management of the team, the leadership board is responsible for the quality of care within such a team. [N]ow, we are mainly concerned with really working from within those multidisciplinary teams, that people know each other, know the process that a patient goes through, and know what the most important objectives are and shape that into a whole. [W]hat we are working toward is that these teams will be incorporated into the organizational structure (3).

But in small parts, of course. You could first start with those three integrated units with which we have started. So, a gradual transition (1).

Not all hospitals applied such an incremental approach. One, in particular, consciously made a different choice regarding the grouping into units around medical conditions:

We discussed that this was going to be the new reality, and that means that people have just switched from A to B. [T]hen, that also means that everyone around [those medical conditions], that those people are just added to another flow. So, we have discussed it and said: listen, we are going to organize it differently. [W]e made various patient flows, what we call [value-based units]. So, for example, the breast cancer flow contains the doctors, nurses, the breast cancer department. They are all added to this patient flow, and together they are responsible for finances and quality (7).

In sum, the respondents widely recognized that grouping into units around medical conditions could enable hospitals to better address the interdependencies of various activities that are needed to care for patients. Yet, most hospitals were hesitant to radically transform their traditionally functional unit structure into multidisciplinary value-based units around medical conditions.

Liaison devices

Rather than switching to units around conditions, most hospitals were trying to increase coordination between their functional units through various types of liaison devices.

Liaison positions

To start, hospitals were making use of liaison positions. In fact, most hospitals had appointed a VBHC manager precisely to foster interunit coordination around medical conditions.

I work as a program manager VBHC. [S]o yes, in essence, I am responsible for setting up and continuing the VBHC program within our organization. So, the roll-out of care around medical conditions. And adding value, for the patient (1).

More specifically, these managers were assigned the task to coordinate the work conducted in several distinct units; they should have a “primarily supporting role” and “help teams organize themselves around a clinical pathway as best as possible” (11). Some respondents stated that in their hospitals, these managers are usually approached by a group of medical specialists, who then ask for support related to VBHC. In other organizations, it was usually the other way around, and managers had to actively search for potential cooperation.

I go to the highest manager below the executive board and ask “hey, on which medical conditions do you want to work in light of VBHC?” Because I need to know what is interesting for the hospital. Then, I go to that physician […] and we discuss the matter one-on-one. Afterward, we see who else we need to include, but it usually starts with me and a specialist. From there, I’ll work things out and discuss with the physician how to get things off the ground (8).

At the time of the interviews, some hospitals had a single VBHC manager who was operating relatively autonomously, but it was not uncommon for hospitals to have several managers with complementary roles in a VBHC management team. The exact composition of these VBHC management teams varied considerably among hospitals. In some organizations, the program manager was accompanied by a single medical specialist (a medical manager). Others had appointed a few more members, each focusing on a specific aspect of VBHC (e.g. one focusing on building a data infrastructure, one on work-process optimization, one on cost measurement) (10). Overall, the primary role of these VBHC managers was to foster communication between separate units that are involved in the full cycle of care for a medical condition. In practice, they were often doing this by utilizing another type of liaison device.

Standing committees

To facilitate mutual adjustment, hospitals had commonly established what Mintzberg ([ 17 ], p163) labels “standing committees,” referring to institutionalized meetings that take place regularly and enable interunit communication. In general, these committees are not temporal project teams but permanently woven into the official structure ([ 17 ], p163). So, in hospitals, “value-based” committees somewhat resemble value-based units in that they bring together a multidisciplinary group of employees around a medical condition. However, these committees are not official units; they are liaisons , overlaying the formal (functional) structure.

Within the project, we did not just look at the organizational structure but also at the meetings and consultation structure that goes with it, and we have set that up so that you can exchange and switch faster […] so, more of different levels, putting different disciplines together (6).

At the time of our data collection, developing these liaison “committees” had been much more common and widespread than the actual formation of units around a medical condition. In a common pattern, these committees started with a kickoff meeting, in which a large multidisciplinary group partook in determining the overarching mission and goal of the multidisciplinary interunit teamwork. After the kickoff, hospitals moved on to regular meetings—monthly was a common timeframe—to discuss their performance with a select group of delegates from the various specialties involved.

It is a periodic meeting in which basically the team gets together, [those] who are involved in the care of the medical condition. [A]nd in such a meeting, based on KPIs, they look at which outcomes can be improved. A nurse will also join, so basically everyone who should be involved, so someone from business intelligence also joins. And, yes, then you will basically determine “which KPI now requires the most attention, and which actions are we going to [undertake] to improve it?” (1).

Now, although these value-based committees are not actual units, in some hospitals, these committees did form the basis for the “pilots” in which the value-based units around a medical condition were being experimented with (see the section on Unit grouping above).

Matrix structure

As we have seen, at the time of our interviews, several Dutch hospitals were forming multidisciplinary units around a medical condition. However, this does not imply they were intending to sacrifice their functional units. Instead, they were conceiving of a transition toward a matrix structure—an organizational design that combines functional and value-based units.

We are trying to insert a kind of matrix structure. When you look at an organizational structure, then you’ll see the specialties on the vertical lines, and the care paths horizontally run through them. At this moment, the [hospital name] has chosen not to make the switch, and maybe we will never do that, because in the end it will be a matrix anyway. You want coordination within the specialties, but you also want coordination across specialties (9).

Not everyone appeared to be convinced, though, of the desirability of such a matrix structure. A recurring theme—regarding the matrix structure but also regarding value-based redesign in general—was that the end goal, the ideal structure, should be determined along the way.

A disadvantage of a matrix organization is that it will generate a lot of coordination at the intersections between vertical and horizontal management. If that is going to cause a lot of hassle, this can be a reason to eventually switch completely, in one direction or the other (3).

In sum, what applies to the (possible) transitions toward a matrix structure, in many cases applies to the use of all liaison devices: hospitals were utilizing them with caution, incrementally tweaking and experimenting with various types of connections between units.

Planning and control systems

Value-based planning and control systems refer to the utilization of outcome and cost measurements as performance indicators. Whether concerning project teams or official units, all hospitals were engaged in some type of value-based performance measurement.

Outcome measurements

All hospitals we spoke to were actively involved in outcome measurements, thus trying to optimally standardize the outputs of their services—in this case, referring to the effects of these services on patients’ health. The way in which these measurements were used, however, differed from one hospital to the next. Most notably, there were differences regarding the issue of benchmarking and comparison with other providers. Some hospitals had formed collaborations in which they benchmarked their outcome data:

The approach of [hospital name] is that you benchmark the scorecard, and when you see differences, these will be discussed. And when you think one of the hospitals is doing something which leads to better results, then the others will adopt that—free of obligation, for the time being (3).

Several hospitals had been able to establish such benchmark partnerships, and those that had not seemed to recognize the potential benefits of these collaborations; some explicitly expressed the desire to form such partnerships in the future (7). Although not all hospitals were, at the time of the interviews, involved in external benchmarking, all of them were either developing or already making use of dashboards for internal reflection.

We are building quality dashboards, some of which are already implemented. [A]nd we use those to continuously improve the care paths, for the [multidisciplinary] teams, but we also use them for reporting to the board of directors (2).

Next to standardizing work output, value-based performance measurements seemed to have generated a boosting effect on the collaboration among team members by creating a sense of shared responsibility for particular goals:

They really start to cooperate better, being aware of each other’s problems and also solving those better with each other. [B]etween different specialties, nurses but doctors too, they will really look much better at that dashboard together: this is what we find important, this is what patients find important in terms of treatment and outcomes, and we actually think this is important too. They make dashboards that much more belong to them, which also makes them put much more effort into improvement. (7).

Cost measurements

With regard to value-based performance measurement, costs seemed to have received relatively little attention compared to outcomes. While all Dutch hospitals were involved in outcome measurement, several hospitals had not (yet) utilized cost measurements in their efforts to create more value-based coordination. This was exemplified by one respondent when s/he was asked whether their multidisciplinary teams were accounting for costs:

No, not yet actually. On the cost side we are struggling quite a bit to make that insightful. That is also not our focus. Our focus is: we want to improve the outcomes of care, from the philosophy that the costs will then lower automatically (9).

Among those that were measuring costs, approaches differed. Some were making use of “cost drivers”—with proxy indicators such as length of stay, without immediately connecting these indicators to hard currency (5). Several hospitals, however, had been using cost price calculations, and some had hired an external agency to make this work (11). Moreover, these cost measurements were increasingly becoming part of the dashboards that enable multidisciplinary teams to evaluate their performance.

In sum, at the time of our data collection, multiple hospitals had been struggling to gain insight into the costs of their services, yet others seemed to have made steps by incorporating cost price indicators into their performance dashboards. These differences among hospitals though, may have been related—at least partly—to the degree of official commitment from the highest levels of the organizations and the recourse allocation that comes with it.

Training and indoctrination

For organizational redesign to be successful, whether sweepingly or incrementally, it was widely recognized that a solid support base among all levels of the organization is crucial.

Tell the story. Explain why you do this and repeat it. Repeat it. Repeat it. Repeat it. And explain, each time, this is the reason why we do this, we think changing this will work better. So, don’t begin by telling them what you are going to change, but first just start by creating the setting in which it makes sense to change (5).

To generate a deep and widespread support base within the organization, Dutch hospitals utilized particular tactics. Some applied a focused but unofficial approach, in which the executives first “look for the right informal leaders and convince them,” and then, through these informal leaders, they tried to get everyone else on board (7). But while several hospitals were handling their “indoctrination” ([ 17 ] p97-99) informally, others had officially developed internal training programs, specifically focusing on VBHC.

We are actively involved in training within those [multidisciplinary teams]. Both specifically for the daily leadership and also more broadly. [N]ext tot that, we have set up a general training program in which within the [multidisciplinary teams] they can use this training. On the one hand, that is really about clear knowledge, so “what is value-based health care, what are those [multidisciplinary teams], why do we do this, how does this match the developments in the Dutch health sector?” On the other hand, knowledge and education for a specific [multidisciplinary team] (3).

So, with regard to the provision of training and value-based “indoctrination,” some hospitals had relatively formalized frameworks in place. Others, however, found themselves making “baby steps” in developing a more coherent program (11). Additionally, there were cases in which the leadership was not actively propagating VBHC theory—even when VBHC was part of the official hospital strategy.

Really including the leadership of the hospital in that vision, that’s still missing for us. I think that this is also essential for success in the long term. [T]hat somewhere there will be a turning point from bottom-up to also top-down management. [T]hat element is still missing for us to make that switch, because that does seem like a very nice one, when you can combine that with the bottom-up enthusiasm (12).

To conclude, regarding value-based indoctrination, an important distinction we noted among the approaches of various hospitals relates to the degree of official commitment to value-based redesign, particularly from the higher levels of the organization.

Job specialization

Value-based job specialization concerns the division of labor that is explicitly related to VBHC. Ideally, job specialization enables organizations to effectively match individual workers to their specific tasks ([ 17 ] p70-79). Within Dutch hospitals, the issue of value-based job specialization was primarily relevant regarding the leadership of multidisciplinary teams rather than the task division within those teams. This is because the actual tasks that most personnel needed to perform were usually not affected by VBHC initiatives; what did change was with whom people collaborated on a day-to-day basis (7).

When it comes to appointing the leadership roles within the multidisciplinary teams—the daily management referred to in the section on Unit grouping —hospitals varied in their approach. Within some hospitals, the composition of this leadership was determined organically, usually depending on the enthusiasm of particular individuals, and had thus been different from one team to the next (10). Others had clearly defined a particular set of roles for each of their multidisciplinary teams, with a clinical leader, an administrative manager, and a leading nurse, for example (1). The importance of the composition of this leadership was widely recognized, and several interviewees referred to this daily management when they were asked about a vital lesson they had learned:

For me, a big lesson is the importance of a good leader above those [multidisciplinary] teams. And this is also a challenge we’re facing. Currently, the leaders are the ones that took initiative, but they are not always the best leaders. That is something we definitely have to deal with (9).

One of the lessons is that appointing a daily leadership [group]—formally, through an application procedure—has been very beneficial (3).

In sum, some Dutch hospitals had come to develop official application procedures for the daily management of multidisciplinary teams, while others were—thus far—favoring a more organic approach.

Formalization of behavior

In general, as a design parameter, “formalization of behavior” refers to the predetermined standardization of work processes ([ 17 ] p81-83). In health care delivery—particularly in the context of VBHC—clinical pathways for medical conditions have been a widely used form of standardization that enables a sequence of interdependent activities to be tightly coordinated beforehand.

In 2016, we started with internal VBHC clinical paths, kind of a combination of Lean and VBHC. So, really trying to streamline the processes, measuring the right outcome indicators, assessing those, and steering on that basis (8).

All of the hospitals we spoke to were involved in the development and implementation of clinical pathways around medical conditions. In many cases, however, this continued to be a work-in-progress.

Decentralization

For the purpose of this study, value-based decentralization refers to the process by which value-based units acquire greater organizational autonomy. As with other design parameters, most Dutch hospitals had been hesitant to turn this knob. For some, it remained questionable why and to what extent such autonomy is even desirable:

In my opinion, you should first have results, in a small setting, and then see “what have we learned from this? What works and what doesn’t?” In terms of ICT [information and communications technology], dashboards, indoctrination, all those variables you take into consideration. And those, you scale up, before you start looking at structures, systems, architectures (12).

Some hospitals were starting to experiment, on small scales, with more autonomy for their value-based pilot units. In particular, this concerned financial autonomy: value-based units with their own budget control.

[T]he current integrated [value-based] units, they will start next year with sort of their own budget. You could call it a “shadow budget.” [A]nd for new integrated units we’ve set aside a kind of mandate to give them some financial leeway so that they control their own development. So, there is already something like a budget. But we are also seriously considering, thinking about, “can we really autonomize them entirely?” That’s a question we’ll be taking about (1).

A recurring theme regarding decentralization but also more generally regarding value-based redesign, was the notion of a gradual transition toward more value-based structures. Interestingly, in many cases, the final stage of this transition was not clearly envisioned but rather seen as something that would be determined later on, based on the experiences and lessons learned during that incremental process.

This research combines theory on value-based health care with theory on organizational structures, and explores how Dutch hospitals currently work toward value-based redesign: structural coordination around medical conditions over full cycles of care. Our study demonstrates that Mintzberg’s [ 17 ] organizational design parameters offer a useful framework to analyze the implementation of value-based health care delivery.

Interestingly, while the core literature on VBHC depicts value-based redesign as a fundamental change, with radical and sweeping implications [ 3 , 7 , 8 ], our study portrays a different picture: one of incremental redesign, with hospitals applying a variety of design parameters to various degrees.

The design parameter that best illustrates this contrast is unit grouping. Although one hospital did establish value-based units (through a top-down approach), most hospitals we spoke to are hesitant, at least for the time being, to (re)group into units around medical conditions. Rather, these organizations aim to spur coordination through various liaison devices, such as intermediary managers and regular multidisciplinary team meetings, leaving the original functional units intact. This contrasts with the authentic notion of integrated practice units (IPUs)—which concerns, above all, a basis for grouping in health care organizations [ 3 ].

Whereas our current study describes the use of liaison devices (rather than unit grouping) to enhance coordination between functional units in terms of applying VBHC principles, this can also be seen as the manifestation of a broader trend in which hospitals worldwide are trying to overlay their functional designs with multidisciplinary teams [ 28 ]. This trend within hospitals, in turn, parallels a more general tendency seen in many sectors whereby organizations increasingly become “process-oriented,” emphasizing workflow interdependencies instead of functional structures [ 29 ].

When it comes to organizational structures, VBHC coincides with the idea of process orientation, although there are some defining characteristics. Similar among both, though, is the belief that the traditional functional structures of hospitals are flawed organizational designs that can and should be overcome [ 2 , 3 , 8 ]. To do so, a process-based design would be built on the premise that to optimize quality and efficiency, an organization should be structured around its core business processes [ 2 ]. Accordingly, process orientation contrasts with the old and nowadays controversial dictum in organization theory that “structure follows strategy” [ 30 ]. Instead, these scholars propose that “structure follows process” [ 2 , 29 ]. VBHC theory also appears to profess process orientation, but only as a consequence of seeing the specific processes (i.e. care cycles) of addressing medical conditions as the chain of activities that generates value for patients. Within this framework, it is first and foremost the creation of value that should determine organizational structures [ 8 ]. Hence, if there were a VBHC variant of the old dictum, it might be something like “structure follows process follows value creation,” or maybe just “structure follows value.”

Whatever the phrase, the point would be that health care organizations should structurally coordinate their work activities such that value for patients is optimized. And hard-line adherents of VBHC are convinced that this requires a radical transformation toward IPUs for medical conditions, rather than just overlaying a (dys)functional structure [ 3 , 8 ].

However, an important finding of our study, one that mirrors accounts on process orientation [ 31 ], is that the prevailing existence of a functional structure does not imply a complete absence of value-based redesign. Indeed, our study demonstrates that although the more radical switch to value-based units remains rare in the Netherlands, this does not preclude other forms of value-based redesign from taking hold. For example, aside from the aforementioned liaison devices, hospitals utilize planning and control systems (i.e. outcomes and costs measurement) to upgrade coordination around medical conditions. Scorecards and dashboards containing outcome measurements are universally used for internal evaluation, but not all hospitals participate in benchmarking with other organizations. And although the use of cost measurements is less prevalent, several hospitals conduct cost accounting and relate this to outcome data. None of the hospitals we spoke to, however, actually measures or estimates patient costs over full cycles of care.

Overall, Dutch hospitals aim for incremental redesign . These organizations employ a variety of design parameters to various degrees. They generally envision a transition toward more value-based structures, but this is usually described as a “slow process,” starting with “experiments” and “pilots,” characterized by “baby steps.” Moreover, the envisioned end point of this transition—the quintessential design—remains unclear; the idea is that this will be determined along the way. So, even when the core principles of VBHC are widely embraced, many of our interviewees do not acknowledge IPUs as the pinnacle of structure in health care.

For several reasons, an incremental approach to value-based redesign may well be more viable than the radical transformations professed by Porter [ 3 , 8 ]. To start, organizations generally tend to hang on to their structures for relatively long periods of time [ 17 , 30 ], and this appears to apply to hospitals as well. Additionally, profoundly changing well-established behavioral patterns is often resisted [ 17 ], and studies have well documented such resistance within health care organizations [ 28 ]. This may at least partially explain why, in reality, most organizational restructuring does not occur radically but rather incrementally, through continuous modifications of existing structures ([ 17 ] p105). Moreover, the long history of the functional design of hospitals has left deep imprints on work practices, professional identities, and social norms within these organizations [ 28 ]. This type of historical impact is not easily swept away, and creating multidisciplinary units in hospitals by itself is not enough to overcome the extensive reliance on disciplinary boundaries in everyday health care delivery practices [ 28 ]. Breaking down these “invisible walls” will require additional time and effort [ 28 ]. Therefore, an incremental approach to value-based redesign (rather than a radical one) seems better suited to do justice to the history of medicine (rather than sweeping it away), while also allowing interdisciplinary collaboration to evolve over time (rather than enforcing it immediately), and thus appears (as far as we can tell) a more viable avenue for the adoption of VBHC principles than the (fundamentalistic) one professed by their originators [ 3 , 7 , 8 ].

This study has at least four important limitations. First, it should be noted that while Mintzberg’s design parameters have proven to be highly useful for analyzing value-based redesign, our use of this framework has undoubtedly shaped our findings. Second, our study focuses on Dutch hospitals; the existing policies, regulations and financial arrangements in the Dutch health sector have likely molded how these organizations may or may not pursue a more value-based design. Third, we interviewed only one representative per hospital, most of whom did not have a clinical role. Interviewing only one (nonclinical) representative per hospital may have generated biased pictures of what is happening within the individual hospitals, which could potentially have spilled over to our aggregate findings. Fourth, while our conceptualization of “value-based design parameters” may be useful for analyzing and implementing VBHC, it was beyond the scope of this study to examine the effects of utilizing these design parameters on performance. We strongly encourage future research regarding the results of value-based redesign.

Practical implications

Hospital executives, managers and leading physicians who want to upgrade coordination around medical conditions have a variety of organizational knobs to turn to various degrees. Our study indicates that many providers will likely favor incremental redesign over radical transformation. Considering hospital units, rather than radically regrouping the entire organization into units around medical conditions, a more incremental approach could be one in which a hospital first experiments with one or a few condition-based pilot units (around breast cancer or maternity care, for example). Depending on how the pilot proceeds, modifications can be made, such as granting more financial autonomy to the respective unit.

If, at least for the time being, (most) traditional specialty units are left intact, coordination around medical conditions can still be enhanced in various ways. For instance, hospitals could appoint one or more (value-based health care) managers, whose roles are first and foremost to foster interunit communication and coordination. A common way to do this is by forming multidisciplinary teams around a medical condition, with members from various specialty units meeting on a regular basis. One point of discussion during these meetings can be how to improve value for patients with a similar medical condition—based on value-based performance measurements (e.g. outcomes and costs).

It is widely recognized that structural changes, whether sweepingly or incrementally, benefit from a solid support base across all levels of the organization. Concerning value-based redesign in Dutch hospitals, systematically propagating information (through training programs, for instance) has been regarded as a useful way to generate awareness and support throughout the organization.

Multiple Dutch hospitals initially struggled with the composition of the leadership of their multidisciplinary teams. Their experiences indicate that the characteristics of these leaders matter: it is probably good to have multiple leaders, each representing a particular organizational component (e.g. administrative, nursing, business intelligence), and several hospitals have come to favor official application procedures over automatically granting leadership to the most enthusiastic physicians.

Ideally, hospitals would not have to repeatedly develop all of these approaches by themselves. Instead, the path toward more value-based structures could be built on the efforts and lessons of others. Therefore, we encourage providers to gather information, evaluate proceedings and report on their experiences; this can give rise to a knowledge base on which value-based redesign may be founded.

Value-based redesign is not necessarily a matter of radical changes or binary choices between traditional structures on one side and value-based designs on the other. Instead, inspired by the idea to achieve the best outcomes as efficiently as possible, hospitals are incrementally exploring various ways to improve coordination around medical conditions over full care cycles. Our study demonstrates that Mintzberg’s [ 17 ] organizational design parameters offer a useful framework to analyze the implementation of value-based health care delivery. Hopefully, our conceptualization of “value-based design parameters” offers guidance to providers who find themselves in search of more value-based structures. Moreover, we hope the framework we sketched here can assist research on and the evaluation of what works—e.g. which knobs might be turned, to what degree, in which contexts—in terms of value for patients.

Availability of data and materials

The dataset analyzed during the current study is available from the corresponding author on reasonable request.

Abbreviations

• Value-based health care

Integrated practice unit

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Zorginstituut Nederland (National Health Care Institute) funded this research. There was no involvement of this funding body in the design of the study; the collection, analysis, and interpretation of data; or writing the manuscript.

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Scientific Center for Quality of Healthcare (IQ Healthcare), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands

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GS: study design; data collection, analysis and interpretation; drafting and completing the manuscript. KD: data analysis and interpretation; assisted in drafting and completing the manuscript. HB: assisted in data interpretation; assisted in completing the manuscript. DD: assisted in the interpretation of data; assisted in completing the manuscript. FM: study design; data collection, data analysis and interpretation; assisted in drafting and completing the manuscript. PN: study design; assisted in data analysis and interpretation; assisted in drafting and completing the manuscript. All authors read and approved the final manuscript.

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Supplementary Information

Additional file 1..

Theory on design parameters.

Additional file 2.

Interview guide and topic list.

Additional file 3.

Coding scheme.

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20 Thesis topics related to Healthcare Architecture

Healthcare Architecture is one of the most important, complex, and demanding fields as it requires precision, needs, and respect for privacy. As architects, we design these structures so that the public is able to walk through the health care system in a proper way. There are many students who work with the topic during their thesis project as it is not only challenging but also opens new doors into tackling pandemics such as Covid-19.

Here are 20 thesis topics related to healthcare architecture:

1. Children friendly healthcare design

Children’s hospitals have been one of the most challenging designs. As the hospital is the last place a child might want to go. So making hospitals less scary and motivating the children to accept the care is one of the biggest psychological challenges that the designer has to encounter. But when dealing with children it can help unleash the child inside the designer. So if you can design for those little ones; this one’s for you.

2. Multispecialty hospital design

A hospital design that deals with different types of multispeciality facilities available under one single roof. This design is in high demand in the urban context and is one of the biggest rising designs. As they’re able to adhere and cater to a large number of people with different ailments.

3. Drug rehabilitation center

Addiction has been and is going to be one of the biggest ailments that our generations have encountered. As there is a subsequent increase in the death rates that have been caused by an overdose of drugs. And somewhere there is a share of rehabilitation spaces too. As they need to feel less of a prison and more of a recovery center which can guarantee the addicted people that this is the road to recovery. Hence the role of architecture is highly important in this context. So if you would like to bring a change to this biggest problem of generation this one’s for you.

4. Redesigning intensive care units

One of the most unique and detailed topics of healthcare architecture which peek into the technicalities of the medical world. With a dominating services part. As including the technical part, there is a lot to design on this topic as it is one of the key elements of the hospitals.

5. Mental health hospital design

Still today mental health problems are always seen with a judgemental eye. And mental hospitals are still aren’t reached by the suffering people just out of the pressure and disgrace created around mental problems. This is why there is an immense need to break the imageability of the mental hospitals and redefine them in a new thought. A new image that can make it a lot less scary and way more approachable. So if you want to risk and break the mold; this is the best one.

6. Autistic healthcare redesign

Autistic care is one of the most creative and challenging ones. As they need for us to dwell into the life of autistic children and understand how their world works. And how can we make it better? Even though the percentage of their population might be small their needs are often ignored as most of the time they’re pushed into our normal worlds that don’t cater to their needs or care at all. So if you would like to step into their shoes and empathize. This one is a good option for you to choose from.

7. Advanced trauma recovery and care center

Trauma is a lot of complex phenomena that don’t just affect momentarily but can change a person’s life forever. Which makes these trauma recovery centers all the more important. They’re supposed to provide the care and refuge for them that can make them feel better and start their journey to recovery. It is a challenging phenomenon to give a solution to through architecture. But the built environment can do wonders that are beyond the comprehension of the human mind.

8. Cancer hospital and research center

Cancer hospitals are one of the most important elements of society and are always needed. With a large amount of infrastructure, technology, and care involved in making them. It undoubtedly makes it one of the most promising thesis topics.

9. Counseling Clinic: Rethinking mental healthcare

Counseling clinics are on a subsequent rise as they are easily approached and overall more preferred by the people who feel they need help. So this design doesn’t just need to step out from the big scary hospital vibe to a friendly place where one might feel like going to have some help. This thesis explores a lot of urban human psychology and the needs of today’s generations of healthcare. Indeed a topic for the promising future.

10. Juvenile trauma recovery center

With the considerable increase in juvenile crimes . Juvenile health and development have been the top priority of many countries worldwide. So out of the many efforts being done for their betterment, this one is one of the most crucial ones. This design needs to cater to the raging young minds while healing them of their trauma and help them walk the road of recovery without falling into the traps of crime. Children’s psychology will play a very important role in their recovery. Thus this project in a real sense is going to shape the future of tomorrow.

11. Pediatric hospital and care center

This one demands a good understanding of infant to toddler development and physiology. Their reactions in certain environments and how to make a peaceful place that can cater to these tender beings with care. It is a very creative and positive topic that prolifically deals with the news.

12. Lodging and care center for cancer patients

Peeking deeper into the journey of a cancer warrior. It gives us the chance to create a better environment for them when they’re battling and are feeling at their lowest. This calls for healing that is done through spaces that make them feel less pained and can provide hope. Something design is very much capable of.

13. Prison recovery and rehabilitation center

The time post-prison is as important as the time inside is. As the prisoners are often left in open with a shock of a new reality right ahead of them. Which at times is a lot to handle, especially in a positive mindset. Thus this rehab center won’t just make them prepared, but also will help them step into this new world as a better human.

14. Adaptive reuse of hospital buildings

The reuse of hospital spaces is challenging. But provides ample opportunities on the way depending on the context and background the design is going to set up in.

15. Cancer prevention, diagnosis, treatment, and survival unit

Covering the whole process of development and recovery this center is supposed to be the most important center in the life of the patients who are to be motivated and kept hopeful throughout. Which requires a conscious approach as a designer to make a space that can help them feel better and give them a will to survive.

16. Eldercare: Redefining healthcare for the elderly

Care for the elderly can be one of the needed topics in today’s world. As the care they need is much beyond a hospital. As they need a hospital that feels like hope. A place where they will be willing to stay rather than run away from. And the design can be the one that can create such an effect successfully.

17. Rural hospice center redesign

Hospice centers in rural areas serve as many other things rather than just healthcare architecture. They act as a refuge space for the general public and even an educational area. Considering its multidimensional use it can be used for many things. Thus providing it as an opportunity to work on a singular space that can serve as a multipurpose space .

18. Dementia: Care center redesign

The dementia care center is a healthcare architecture design that deals with the lives of dementia suffering patients. Which requires them to step into the shoes of the patients. As it can help us create a good environment for them.

19. Behavioral Healthcare facility

The behavioral health facility is the new healthcare facility that has been created. Which has been created to tackle the behavioral and other problems that are dealt with every day in the urban and rural contexts? Thus making it more approachable for the people suffering it. And thus it can become one of the futuristic architecture designs

20. Post-trauma recovery center

From the admission phase to the complete recovery. Different phases are involved and are needed to be catered carefully. Thus it makes the healthcare architecture of the space equally important in the healing of the trauma and the road towards recovery.

Renuka is an artist, architect, and writer. With a keen interest in psychology; she is passionate about 'User-centric and need-based designs'. As an empath herself she finds writing as a way to empower and voice people. While aiming to make this world a better place as a designer.

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Impact of IoT in Healthcare: Improvements and Challenges

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• H. Swapna Rekha 4 ,
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Since last one decade, IoT has been a challenging field of application for the simulation in real-time environment. Rapid changes in information and communication technologies have assisted to the wider usage of Internet of Things (IoT) in areas such as intelligent transport systems, intelligent cities, intelligent healthcare, intelligent homes, intelligent grid, industry automation, smart farming and many others. Among them healthcare has always been a hot interest among various research communities and is a rapidly growing area with the advancement of technology. Managing health issues is becoming a serious factor in healthcare system, as insufficient healthcare services are available to meet the increasing demands of ageing population with chronic diseases. So, the world healthcare system needs the transformation from clinic-centric environment to personalized information allied environment. In modern healthcare system, physicians and patients can be brought together with the usage of IoT technologies for automated and efficient monitoring of daily activities of all age group people and to provide ‘one-stop’ service to people at remote locations by network architecture that provides continuous monitoring of body signals based on sensors. As rapid development occurred in controlling healthcare, this research aims in describing the history, development of futuristic studies and standard assessment of emerging technologies of IoT in healthcare system. Further, various factors affecting the health concerns are disseminated through the latest findings of IoT which will serve as basis of information for scientist, technocrats, researchers and common people in and beyond to this area. This research work also provides an approach to future trends, advancement in the technology made so far and to cope with the challenges such as management of data, compatibility, security, adaptable and privacy.

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A Comprehensive Review of IoT Technologies and Applications for Healthcare

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Department of CSE, Aditya Institute of Technology and Management, Tekkali, Srikakulam, India

H. Swapna Rekha & Janmenjoy Nayak

Department of EEE, Sri Sivani College of Engineering, Srikakulam, India

G. T. Chandra Sekhar

Faculty of Communication Sciences, University of Teramo, Coste Sant’Agostino Campus, Teramo, Italy

Danilo Pelusi

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Correspondence to Janmenjoy Nayak .

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Gujarat Institute of Development Research (GIDR), Ahmedabad, Gujarat, India

School of Computer Engineering, KIIT University, Bhubaneswar, Odisha, India

Bhabani Shankar Prasad Mishra

School of Computer Engineering, KIIT University, Bhubaneswar, India

Madhabananda Das

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Rekha, H.S., Nayak, J., Sekhar, G.T.C., Pelusi, D. (2020). Impact of IoT in Healthcare: Improvements and Challenges. In: Das, K., Mishra, B.S.P., Das, M. (eds) The Digitalization Conundrum in India. India Studies in Business and Economics. Springer, Singapore. https://doi.org/10.1007/978-981-15-6907-4_5

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Published : 02 March 2021

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