Análisis de la primera colaboración público-privada en asistencia maternal en atención primaria y especializada en España: una aplicación del análisis de redes sociales
DOI:
https://doi.org/10.3989/ris.2021.79.1.19.057Palabras clave:
Coordinación sanitaria, niveles de atención sanitaria, modelos de gestión, matronasResumen
El Hospital Universitario de La Ribera (Alzira, Valencia) fue la primera experiencia de colaboración público-privada en el Sistema Nacional de Salud español. Además de la necesidad de coordinar dos niveles de atención sanitaria (primaria/especializada) hubo que coordinar dos modelos de gestión de recursos humanos (público/privado). Para ejemplificar esta complejidad, se toma el colectivo de matronas del área de salud, analizando sus pautas relacionales mediante la aproximación metodológica del Análisis de Redes Sociales. En cuanto a resultados, de una población de 31 matronas, las del modelo público ocupan posiciones periféricas y cooperan poco, tanto interna como externamente. Las del modelo privado constituyen un subgrupo cohesivo, que supone tanto una fortaleza como una debilidad. Las matronas de Atención Primaria y modelo privado constituyen puentes entre subgrupos. Por tanto, la presencia de dos modelos de gestión condiciona la eficiencia de la atención maternal más que la división de la atención en dos niveles.
Descargas
Citas
Balkundi, P. and M. Kilduff. 2006. "The ties that lead: A social network approach to leadership." The Leadership Quarterly 17(4): 419-439. https://doi.org/10.1016/j.leaqua.2006.01.001
Barlow, J., J. Roehrich and S. Wright. 2012. The search for lowcost integrated healthcare. The Alzira model - from the region of Valencia. Brussels: NHS European Office.
Barlow, J., J. Roehrich and S. Wright. 2013. "Europe sees mixed results from Public-Private Partnerships for building and managing health care facilities and services." Health Affairs 32(1): 146-154. https://doi.org/10.1377/hlthaff.2011.1223 PMid:23297282
Borgatti, S. P. 2002. Netdraw for Windows: Software for Social Network Analysis. Harvard: Analytic Technologies.
Borgatti, S. P., M. G. Everett and L. C. Freeman. 2002. UCINET for Windows: Software for Social Network Analysis. Harvard: Analytic Technologies.
Borgatti, S. P., K. M. Carley and D. Krackhardt. 2006. "On the robustness of centrality measures under conditions of imperfect data." Social Networks 28(2): 124-136. https://doi.org/10.1016/j.socnet.2005.05.001
Borgatti, S. P., A. Mehra, D. J. Brass and G. Labianca. 2009. "Network analysis in the social sciences." Science 323: 892-895. https://doi.org/10.1126/science.1165821 PMid:19213908
Borgatti, S. P., M. G. Everett and J. C. Johnson. 2013. Analyzing Social Networks. London: Sage Publications Ltd.
Boyer, L., R. Belzeaux, O. Maurel, K. Baumstarck‐Barrau and J. C. Samuelian. 2010. "A social network analysis of healthcare professional relationships in a French hospital." International Journal of Health Care Quality Assurance 23(5): 460-469. https://doi.org/10.1108/09526861011050501 PMid:20845677
Brandt, P. T. and J. T. Williams. 2007. Basic Vector Autoregression Models. London: Sage Research Methods.
Caballer-Tarazona, M. and D. Vivas-Consuelo. 2016. "A cost and performance comparison of PPP and public hospitals in Spain." Health Economics Review 6: 17. https://doi.org/10.1186/s13561-016-0095-5 PMid:27180236 PMCid:PMC4870542
Camacho-Morell, F., J. Espert-Galera, S. Sanchis-Valero and S. Sebastián-Abril. 2019. "Coordinación entre matronas del área de salud de La Ribera desde un enfoque fenomenológico." Matronas Profesión 20(1): 5-12.
Cappellaro, G. and F. Longo. 2011. "Institutional public private partnerships for core health services: evidence from Italy." BMC Health Services Research 11: 82. https://doi.org/10.1186/1472-6963-11-82 PMid:21504580 PMCid:PMC3103412
Chambers, D., P. Wilson, C. Thompson and M. Harden. 2012. "Social network analysis in healthcare settings: a systematic scoping review." PLoS One 7: e41911. https://doi.org/10.1371/journal.pone.0041911 PMid:22870261 PMCid:PMC3411695
Cunningham, F. C., G. Ranmuthugala, J. Plumb, A. Georgiou, J. I. Westbrook and J. Braithwaite. 2012. "Health professional networks as a vector for improving healthcare quality and safety: a systematic review." BMJ Quality & Safety 21: 239-249. https://doi.org/10.1136/bmjqs-2011-000187 PMid:22129933 PMCid:PMC3285140
De Brún, A. and E. McAuliffe. 2018. "Social Network Analysis as a Methodological Approach to Explore Health Systems: A Case Study Exploring Support among Senior Managers/Executives in a Hospital Network." International Journal of Environmental Research and Public Health 15(3): 511. https://doi.org/10.3390/ijerph15030511 PMid:29534038 PMCid:PMC5877056
Den Breejen, E. M., M. A. Hilbink, W. L. Nelen, T. J. Wiersma, J. S. Burgers, J. A. Kremer and R. P. Hermens. 2014. "A patientcentered network approach to multidisciplinary-guideline development: a process evaluation." Implementation Science 9: 68. https://doi.org/10.1186/1748-5908-9-68 PMid:24898160 PMCid:PMC4087268
Esparcia, J. and J. Serrano. 2016. "Analysing social networks in rural development: a gender approach." International Review of Social Research 6: 206-220. https://doi.org/10.1515/irsr-2016-0023
Esparcia, J. 2017. "Capital social y desarrollo territorial: redes sociales y liderazgos en las nuevas dinámicas rurales en España." Ph.D. dissertation, Department of Sociology, Autonomous University of Barcelona. https://tdx.cat/handle/10803/457367#page=1
Gould, R. V. and R. M. Fernandez. 1989. "Structures of Mediation: A Formal Approach to Brokerage in Transaction Networks." Sociological Methodology 19: 89-126. https://doi.org/10.2307/270949
Government of Spain. 1986. "Law 14/1986: General Health Law." Boletín Oficial del Estado 102:15207-15224, December 12th 2018.
Government of Spain. 1997. "Law 15/1997: Enabling new ways of managing the National Health System." Boletín Oficial del Estado 100:13449-13450, December 12th 2018.
Groenen, C., N. van Duijnhoven, M. Faber, J. Koetsenruijter, J. Kremer and F. Vandenbussche. 2017. "Use of social network analysis in maternity care to identify the profession most suited for case manager role." Midwifery 45: 50-55. https://doi.org/10.1016/j.midw.2016.12.007 PMid:28024229
Haggerty, J., R. Reid, G. K. Freeman, B. H. Starfield, C. E. Adair and R. Mc-Kendry. 2003. "Continuity of care: a multidisciplinary review." British Medical Journal 327: 1219-1221. https://doi.org/10.1136/bmj.327.7425.1219 PMid:14630762 PMCid:PMC274066
Hanneman, R. A. and M. Riddle. 2005. Introduction to social network methods. Riverside: University of California.
Henao, D., M. L. Vázquez and I. Vargas. 2009. "Factores que influyen en la coordinación entre niveles asistenciales según la opinión de directivos y profesionales sanitarios." Gaceta Sanitaria 23(4): 280-286. https://doi.org/10.1016/j.gaceta.2008.05.001 PMid:19250716
Herr, A., H. Schmitz and B. Augurzky. 2011. "Profit efficiency and ownership of German hospitals." Health Economics 20: 660-674. https://doi.org/10.1002/hec.1622 PMid:21456049
Hoeve, Y, S. Kunnen, J. Brouwer and P. F. Roodbol. 2018. "The voice of nurses: Novice nurses' first experiences in a clinical setting. A longitudinal diary study." Journal of clinical nursing 27: e1612-e1626. https://doi.org/10.1111/jocn.14307 PMid:29446496
Klijn, E. H. and G. R. Teisman. 2003. "Institutional and Strategic Barriers to Public-Private Partnership: An Analysis of Dutch Cases." Public Money and Management 23(3): 137-146. https://doi.org/10.1111/1467-9302.00361
Knoke, D. and S. Yang. 2008. Social network analysis. Thousand Oacks, CA: Sage Publications. https://doi.org/10.4135/9781412985864
Kroll-Desrosiers, A. R., S. L. Crawford, T. A. Moore Simas, A. K. Rosen and K. M. Mattocks. 2016. "Improving pregnancy outcomes through maternity care coordination: a systematic review." Womens Health Issues 26(1): 87-99. https://doi.org/10.1016/j.whi.2015.10.003 PMid:26586143
Lillrank, P. 2012. "Integration and coordination in healthcare: an operations management view." Journal of Integrated Care 20(1): 6-12. https://doi.org/10.1108/14769011211202247
López-Casanovas, G. and J. E. Llano-Señarís. 2017. Colaboración público-privada en Sanidad: el modelo Alzira. Madrid: Fundación Gaspar Casal.
Luke, D. A. 2005. "Getting the big picture in community science: Methods that capture context." American Journal of Community Psychology 35: 185-200. https://doi.org/10.1007/s10464-005-3397-z PMid:15909794
Luke, D. A. and J. K. Harris. 2007. "Network analysis in public health: History, methods and applications." Annual Review of Public Health 28: 69-93. https://doi.org/10.1146/annurev.publhealth.28.021406.144132 PMid:17222078
Marek K., L. Popejoy, G. Petroski and M. Rantz. 2006. "Nurse care coordination in community-based long-term care." Journal of Nursing Scholarship 38(1): 80-86. https://doi.org/10.1111/j.1547-5069.2006.00081.x PMid:16579328
Martínez, J. and M. I. Baena. 2004. "Sistema nacional de salud español: estructura y competencias." Pp. 239-256 in Los Sistemas de Salud de Iberoamérica de Cara al Siglo XXI. México: Universidad de Guadalajara.
Ojeda, J. J., J. M. Freire and J. Gérvas. 2006. "La coordinación entre Atención Primaria y Especializada: ¿reforma del sistema sanitario o reforma del ejercicio profesional?" Revista de Administración Sanitaria 4(2): 357-382.
Oliver, K., M. Everett, A. Verma and F. de Vocht. 2012. "The human factor: Re-organisations in public health policy." Health Policy 106(1): 97-103. https://doi.org/10.1016/j.healthpol.2012.03.009 PMid:22494525
Ortún, V. and G. López. 2000. Financiación capitativa, articulación entre niveles asistenciales y descentralización de las organizaciones sanitarias. Barcelona: Universitat Pompeu Fabra.
Perdok, H., L. Mokkink, J. van Dillen, M. Westerneng, S. Jans, B. W. Mol and A. de Jonge. 2014. "Opinions of maternity care professionals about integration of care during labor for "moderate risk" indications: a Delphi study in the Netherlands." Birth 41: 195-205. https://doi.org/10.1111/birt.12102 PMid:24702519
Perdok, H., S. Jans, C. Verhoeven, L. Henneman, T. Wiegers, B. W. Mol, F. Schellevis and A. de Jonge. 2016. "Opinions of maternity care professionals and other stakeholders about integration of maternity care: a qualitative study in the Netherlands." BMC Pregnancy and Childbirth 16:188. https://doi.org/10.1186/s12884-016-0975-z PMid:27459967 PMCid:PMC4962345
Perkins, J. M., S. V. Subramanian and N. A. Christakis. 2015. "Social networks and health: A systematic review of sociocentric network studies in low- and middleincome countries." Social Science & Medicine 125: 60-78. https://doi.org/10.1016/j.socscimed.2014.08.019 PMid:25442969 PMCid:PMC5690563
Provan, K. G., J. Harvey and J. Guernsey de Zapien. 2005. "Network structure and attitudes toward collaboration in a community partnership for diabetes control on the US-Mexican border." Journal of Health Organization and Management 19(6): 504-518. https://doi.org/10.1108/14777260510629706 PMid:16375071
Ramos-Vidal, I. 2019. "Social network analysis in public health research: a systematic review." Revista de salud pública (Bogota, Colombia) 21(1): 109-114. https://doi.org/10.15446/rsap.v21n1.68530 PMid:33206917
Rechel, B., J. Erskine, B. Dowdeswell, S. Wright and M. McKee. 2009. Capital investment for health: case studies from Europe. Copenhagen: European Observatory on Health Systems and Policies, WHO Regional Office for Europe.
Robinson, K. M. 2010. "Care coordination: a priority for health reform." Policy, Politics, and Nursing Practice 11(4): 266-274. https://doi.org/10.1177/1527154410396572 PMid:21531963
Rodríguez, C. and C. des Rivières-Pigeon. 2007. "A literature review on integrated perinatal care." International Journal of Integrated Care 7: e28. https://doi.org/10.5334/ijic.202 PMid:17786177 PMCid:PMC1963469
Roehrich, J. K., M. A. Lewis and G. George. 2014. "Are PPP a healthy option? A systematic literature review." Social Science and Medicine 113: 110-119. https://doi.org/10.1016/j.socscimed.2014.03.037 PMid:24861412
Sánchez-Martínez, F. I., J. M. Abellán-Perpiñán and J. Oliva- Moreno. 2014. "Privatization in healthcare management: an adverse effect of the economic crisis and a symptom of bad governance. SESPAS report 2014." Gaceta Sanitaria 28(S1): 75-80. https://doi.org/10.1016/j.gaceta.2014.02.019 PMid:24863997
Schmied, V., A. Mills, S. Kruske, L. Kemp, C. Fowler and C. Homer. 2010. "The nature and impact of collaboration and integrated service delivery for pregnant women, children and families." Journal of Clinical Nursing 19: 3516-3526. https://doi.org/10.1111/j.1365-2702.2010.03321.x PMid:20946442 PMCid:PMC4010236
Schölmerich, V., A. G. Posthumus, H. Ghorashi, A. Waelput, P. Groenewegen and S. Denktaş. 2014. "Improving interprofessional coordination in Dutch midwifery and obstetrics: a qualitative study." BMC Pregnancy and Childbirth 14: 145. https://doi.org/10.1186/1471-2393-14-145 PMid:24731478 PMCid:PMC4021099
Schroeder, E., S. Petrou, N. Patel, J. Hollowell, D. Puddicombe, M. Redshaw and P. Brocklehurst. 2012. "Cost effectiveness of alternative planned places of birth in woman at low risk of complications: evidence from the birthplace in England national prospective cohort study." British Medical Journal 344: e2292. https://doi.org/10.1136/bmj.e2292 PMid:22517916 PMCid:PMC3330132
Sekhri, N., R. Feachem and A. Ni. 2011. "Public-Private Integrated Partnerships Demonstrate The Potential To Improve Health Care Access, Quality, And Efficiency." Health affairs 30(8): 1498-1507. https://doi.org/10.1377/hlthaff.2010.0461 PMid:21821566
Shelton, R. C., M. Lee, L. E. Brotzman, D. M. Crookes, L. Jandorf, D. Erwin and E. A. Gage-Bouchard. 2019. "Use of social network analysis in the development, dissemination, implementation, and sustainability of health behavior interventions for adults: A systematic review." Social Science and Medicine 220: 81-101. https://doi.org/10.1016/j.socscimed.2018.10.013 PMid:30412922 PMCid:PMC7857673
Smith, K. P. and N. A. Christakis. 2008. "Social Networks and Health." Annual Review of Sociology 34: 405-429. https://doi.org/10.1146/annurev.soc.34.040507.134601
Stewart, G., P. Bradd, T. Bruce, T. Chapman, B. McDougall, D. Shaw and L. Soars. 2017. "Integrated care in practice - the South Eastern Sydney experience." Journal of Integrated Care 25(1): 49-60. https://doi.org/10.1108/JICA-07-2016-0025
Tahan, H. A. and V. Campagna. 2010. "Case management roles and functions across various settings and professional disciplines." Professional Case Management 15(5): 245-277. https://doi.org/10.1097/NCM.0b013e3181e94452 PMid:20616764
Tarazona, E., A. de Rosa and M. Marín. 2005. "La experiencia del "Modelo Alzira" del Hospital de La Ribera a la Ribera-área 10 de salud: la consolidación del modelo." Revista de Administración Sanitaria 3: 83-98.
Tasselli, S. 2014. "Social Networks of Professionals in Health Care Organizations: A Review." Medical Care Research and Review 71: 619-660. https://doi.org/10.1177/1077558714557079 PMid:25380607
Terraza, R., I. Vargas and M. L. Vázquez. 2006. "La coordinación entre niveles asistenciales: una sistematización de sus instrumentos y medidas." Gaceta Sanitaria 20: 485-495. https://doi.org/10.1157/13096516 PMid:17198628
Torres, L. and V. Pina. 2001. "Public-private partnership and private finance initiatives in the EU and Spanish local governments." European Accounting Review 10(3): 601-619. https://doi.org/10.1080/09638180120081607
Valente, T. W. and P. Pumpuang. 2007. "Identifying Opinion Leaders to Promote Behavior Change." Health Education & Behaviour 34(6): 881-896. https://doi.org/10.1177/1090198106297855 PMid:17602096
Valentino, C. L. 2004. "The role of middle managers in the transmission and integration of organizational culture." Journal of Healthcare Management 49(6): 393-404. https://doi.org/10.1097/00115514-200411000-00009 PMid:15603115
Vassliev, I., P. Marques-Sánchez and N. Serrano-Fuentes (Eds). 2019. "Social Networks and Health." International Journal of Environmental Research and Public Health. Special Issue available in https://www.mdpi.com/journal/ijerph/special_issues/SNA
Vázquez, M. L., I. Vargas, J. Farré and R. Terraza. 2005. "Integrated health care organizations: Guideline foranalysis." Revista Española de Salud Pública 79: 633-643.
Waibel, S., I. Vargas, M. B. Aller, J. Coderch, J. Farré and M. L. Vázquez. 2016. "Continuity of clinical management and information across care levels: perceptions of users of different healthcare areas in the Catalan national health system." BMC Health Services Research 16: 466. https://doi.org/10.1186/s12913-016-1696-8 PMid:27590595 PMCid:PMC5010665
Wasserman, S. and K. Faust. 1994. Social network analysis: Methods and applications. New York: Cambridge University Press. https://doi.org/10.1017/CBO9780511815478
West, E., D. N. Barron, J. Dowsett and J. N. Newton. 1999. "Hierarchies and cliques in the social networks of health care professionals: Implications for the design of dissemination strategies." Social Science and Medicine 48: 633-646. https://doi.org/10.1016/S0277-9536(98)00361-X
Publicado
Cómo citar
Número
Sección
Licencia
Derechos de autor 2021 Consejo Superior de Investigaciones Científicas (CSIC)

Esta obra está bajo una licencia internacional Creative Commons Atribución 4.0.
© CSIC. Los originales publicados en las ediciones impresa y electrónica de esta Revista son propiedad del Consejo Superior de Investigaciones Científicas, siendo necesario citar la procedencia en cualquier reproducción parcial o total.Salvo indicación contraria, todos los contenidos de la edición electrónica se distribuyen bajo una licencia de uso y distribución “Creative Commons Reconocimiento 4.0 Internacional ” (CC BY 4.0). Puede consultar desde aquí la versión informativa y el texto legal de la licencia. Esta circunstancia ha de hacerse constar expresamente de esta forma cuando sea necesario.
No se autoriza el depósito en repositorios, páginas web personales o similares de cualquier otra versión distinta a la publicada por el editor.
Datos de los fondos
Ministerio de Ciencia, Innovación y Universidades
Números de la subvención CSO2015-68215-R