Moving Patients across Organizations: Exploring the Antecedents of Effective and Efficient Referral Processes

The purpose of this study was to explore what makes the interorganizational referral process effective and efficient from the perspectives of acute care referral senders and post acute care referral receivers. The referral process was conceptualized as the classic communication model involving a sender, receiver, information, a communication channel and contextual factors such as formalization and relationships. The hypotheses proposed that the relationships between each of the variables information usefulness, communication channel richness, and degree of formalization affected each of perceived referral process effectiveness and efficiency through the variable ‘relational coordination’. Key informants who either sent referrals from acute care settings or who received them in post acute care inpatient settings were asked to discuss each variable. These results were combined with those of a literature review to develop questionnaires containing a scale with acceptable Chronbach alpha for each. Surveys were disseminated through networks and associations involved in acute and post acute stroke and hip fracture care and in discharge planning and Long Term Care. Useable responses included 114 surveys from referral senders and 171 from referral recipients. Baron and Kenny’s four step test for mediation was used to test the hypotheses. For senders, each of channel richness (adjR2 = 10% p= 0.001), information usefulness (adjR2 = 16% p= 0.000), and formalization (adjR2 = 10% p= 0.000) were significantly related to perceived effectiveness. For channel richness, the relationship with perceived effectiveness was partially mediated by relational coordination (adjR2 = 19% p= 0.001). This was also the case for the relationship between information usefulness and perceived effectiveness (adjR2 = 0.20; p=000). For receivers, channel richness is related to perceived effectiveness through relational coordination (adjR2 = 12% p= 0.003). This was also the case for information usefulness (adjR2 = 13% p= 0.000). In neither group were any of the variables significantly related to efficiency. We may conclude that in the referral process, channel richness and information usefulness are related to perceived effectiveness for both senders and receivers. These may provide an important return on investment if chosen as an areas for referral process improvement, if accompanied by concurrent investments in relational coordination.

Department dc:contributor.department

Health Policy, Management and Evaluation

Year dc:date.issued

2011

Author dc:creator

• Saryeddine, Tina

Advisor dc:contributor.advisor

• Lemieux-Charles, Louise

• Communication
• Referral process
• Interorganizational
• Coordination
• Information
• Relational coordination
• Transitions
• Continuum of care
• Long term care
• Acute care
• Post acute care
• Referral
• Decision making
• Organizations
• Effectiveness
• Performance

Statement dc:rights

• Attribution-NonCommercial-NoDerivs 3.0 Unported

Licence dc:rights.uri

• http://creativecommons.org/licenses/by-nc-nd/3.0/

Language dc:language.iso

en_ca

Handle dc:identifier.uri

http://hdl.handle.net/1807/29858

OAI identifier oai:identifier

oai:utoronto.scholaris.ca:1807/29858