Commentary: on "a taxonomy of healthcare networks and systems: bringing order out of chaos".

Abstract

Bazzoli, Shortell, and Dubbs et al. make a timely contribution in this issue to our understanding of emerging organizational forms in the healthcare industry, particularly within the hospital sector. They have constructed a much needed taxonomy that differentiates hospital combinations along two major dimensions: (1) their interorganizational structures, by whether or not they are systems or networks; and (2) their service configurations, that is, the ways by which services are shared or configured across the hospitals participating within the systems and networks. The latter are measured using three structural indicators derived from organization theory: differentiation, integration, and centralization. The first dimension, interorganizational structure, examines the critically important multihospital systems that are the product of merger and acquisition activity since the late 1960s. It also includes the newer organizational forms-the loosely structured networks-most of which are the result of local market collaboration within the current decade. This clearly is the place to begin in constructing a taxonomy of the forming hospital organizations. These two types of organizations differ a great deal structurally as well as in terms of approaches to achieving operational and strategic objectives for their participating hospitals. The second dimension, service configurations, focuses on the hierarchical properties of multiorganizational service delivery. This points directly to the fundamental rationale for consolidation in this industry: that hierarchy through organizational combinations will help to eliminate redundancies in service capacity, generate synergies in the provision of care, and improve the