Aafke Gerarda Coopmans

BACKGROUND Inter-organizational collaboration has become crucial in healthcare as complex challenges require coordinated efforts across organizational boundaries. Individuals, acting as brokers, play a pivotal role in bridging organizational boundaries by coordinating, transferring and translating knowledge across organizations. However, these brokers are often unaware of the different broker roles they enact, limiting their ability to collaborate effectively. OBJECTIVE This study aimed to describe the design of a serious game on brokerage behavior and report initial insights from its use in practice. METHODS Learning objectives and a game were formulated based on multiple 'open triads' as network structure to encourage players to engage in different brokerage roles, described by Gould and Fernandez. The serious game's development was followed by a series of try-outs including reflection sessions in which players reflected on the experienced collaboration efforts and brokering behavior. RESULTS Gameplay lasted 15-25 minutes, during which players engaged in different forms of brokerage behavior. As the game progresses, players employed different brokering strategies to overcome barriers and work collaboratively towards common goals. As designed, several tensions emerged when players experienced conflicting goals or forms of (competitive) network dynamics. Subsequent reflection sessions deepened the understanding of how individual and collective goals shape brokering behavior and vice versa, and how this can influence inter-organizational collaboration. CONCLUSIONS The application of the serious game demonstrated its potential to foster game-based learning on brokerage behavior and its influence on inter-organizational collaboration. During gameplay, players enacted different brokerage roles and were also engaged in broader network dynamics, such as boundary spanning. Through gameplay and reflection, players recognized boundary roles and overcame typical counterproductive network behavior, such as ‘siloing’.

Background: The success of eHealth relies on interorganizational collaboration (IOC) throughout the development, evaluation, and implementation phases of eHealth deployment. This IOC is complex, as it involves a diversity of organizations from different sectors, such as technological, academic, health care, and governmental organizations, collaborating to deploy eHealth. Between these organizations, organizational boundaries, defined as the demarcation of an organization from its environment, arise. When these boundaries are perceived as aligned and enable complementarity, IOC is facilitated. By contrast, misalignment of organizational boundaries can hinder IOC. A dialogical learning mechanism, defined as a learning process that occurs when boundaries hinder IOC, can support learning how to navigate such boundaries. However, it is difficult to determine whether and when organizational boundaries facilitate or hinder IOC, and which dialogical learning mechanisms can be used to address these challenges during eHealth deployment. Previous literature presents the barriers and facilitators of IOC during eHealth deployment only for subsets of organizations or specific phases, leaving their generic versus phase specific applicability uncharted. Objective: This scoping review aims to identify whether, and under what circumstances, organizational boundaries facilitate or hinder IOC during the development, evaluation, and implementation of eHealth. Methods: A scoping review was conducted using searches in the PubMed, PsycINFO, CINAHL, and Web of Science databases. Articles were eligible for inclusion if they were empirical studies written in English or Dutch and contained findings on factors influencing IOC during the development, evaluation, or implementation phases of eHealth deployment. The search yielded 11,867 articles, of which 16 met the inclusion criteria. Open and axial coding of the extracted findings was performed to identify organizational boundaries and dialogical learning mechanisms that hindered or facilitated IOC during eHealth deployment. Results: In each phase, different organizational boundaries either hindered or facilitated IOC. The dialogical learning mechanism identification was crucial for enhancing IOC and was supported by training or by establishing IOC from previous relationships. Additionally, the learning mechanism coordination improved IOC and depended on the involvement of boundary spanners (ie, individuals who span organizational boundaries) and the use of boundary objects (ie, objects which help bridge different social worlds). Furthermore, the mechanism reflection, fostered through open and frequent communication, facilitated IOC. The dialogical learning mechanism transformation did not influence IOC during any phase of eHealth deployment. Conclusions: IOC in eHealth deployment is a dynamic process that depends on the dialogical learning mechanisms identification, coordination, and reflection to navigate organizational boundaries. This review is the first to present organizational boundaries and dialogical learning mechanisms that influence IOC across the different phases of eHealth deployment. However, further research that explicitly considers these phases is needed to deepen the understanding of IOC in eHealth deployment.

Background: A good patient-clinician relationship is an important aspect of quality of care according to patients living with a rare congenital craniofacial condition and their parents. Despite efforts, the challenging question remains how to improve this relationship. Objective: The authors describe the value and impact of using arts-based methods as a catalyst for bringing the 2 ‘worlds’ of patients and their parents and that of clinicians together. Methods: FACE ME, developed by 2 visual artists, consisted of reorganizing the house of a surgeon with a group of patients (n=3), surgeons (n=3), and a parent (n=1) resulting in 2 artworks. The following data were analyzed using reflexive thematic analysis: the film recording the process, photos of the artworks (i.e., end-results of 2 reorganizations), conversations and reflections of the project group involved, and survey results of respondents who watched the film and photos. Results: Four intertwined themes describe the impact and value of FACE ME: (1) importance of exchanging trust, (2) seeing each other as a person, (3) imagine standing in each other’s shoes, and 4) working as a team. These themes represent both perspectives and their similarities in expectations of a good relationship, and findings were supported by the views of the project group and the audience watching the film. Conclusion: FACE ME crossed the boundaries of clinicians, patients, and their parents, and created a better mutual understanding. This arts-based project started a different conversation, and reflection, changed mindsets, and provoked actions towards a better relationship.

BACKGROUND The success of eHealth relies on interorganizational collaboration (IOC) throughout the development, evaluation, and implementation phases of eHealth deployment. This IOC is complex, as it involves a diversity of organizations from different sectors, such as technological, academic, health care, and governmental organizations, collaborating to deploy eHealth. Between these organizations, organizational boundaries, defined as the demarcation of an organization from its environment, arise. When these boundaries are perceived as aligned and enable complementarity, IOC is facilitated. By contrast, misalignment of organizational boundaries can hinder IOC. A dialogical learning mechanism, defined as a learning process that occurs when boundaries hinder IOC, can support learning how to navigate such boundaries. However, it is difficult to determine whether and when organizational boundaries facilitate or hinder IOC, and which dialogical learning mechanisms can be used to address these challenges during eHealth deployment. Previous literature presents the barriers and facilitators of IOC during eHealth deployment only for subsets of organizations or specific phases, leaving their generic versus phase specific applicability uncharted. OBJECTIVE This scoping review aims to identify whether, and under what circumstances, organizational boundaries facilitate or hinder IOC during the development, evaluation, and implementation of eHealth. METHODS A scoping review was conducted using searches in the PubMed, PsycINFO, CINAHL, and Web of Science databases. Articles were eligible for inclusion if they were empirical studies written in English or Dutch and contained findings on factors influencing IOC during the development, evaluation, or implementation phases of eHealth deployment. The search yielded 11,867 articles, of which 16 met the inclusion criteria. Open and axial coding of the extracted findings was performed to identify organizational boundaries and dialogical learning mechanisms that hindered or facilitated IOC during eHealth deployment. RESULTS In each phase, different organizational boundaries either hindered or facilitated IOC. The dialogical learning mechanism identification was crucial for enhancing IOC and was supported by training or by establishing IOC from previous relationships. Additionally, the learning mechanism coordination improved IOC and depended on the involvement of boundary spanners (ie, individuals who span organizational boundaries) and the use of boundary objects (ie, objects which help bridge different social worlds). Furthermore, the mechanism reflection, fostered through open and frequent communication, facilitated IOC. The dialogical learning mechanism transformation did not influence IOC during any phase of eHealth deployment. CONCLUSIONS IOC in eHealth deployment is a dynamic process that depends on the dialogical learning mechanisms identification, coordination, and reflection to navigate organizational boundaries. This review is the first to present organizational boundaries and dialogical learning mechanisms that influence IOC across the different phases of eHealth deployment. However, further research that explicitly considers these phases is needed to deepen the understanding of IOC in eHealth deployment.