Resource dependency and strategy in healthcare organizations during a time of scarce resources: evidence from the metropolitan area of cologne.

"Collaborating authors in the CoRe-Net study group: Christian Albus, Frank Jessen, Ute Karbach, Christian Rietz, Nadine Scholten, Ingrid Schubert, Frank Schulz-Nieswandt, Julia Strupp, Raymond Voltz. Funding : This study was supported by the German Federal Ministry of Education and Research (BMBF) (grant no. 01GY1606). The funding body was not involved in the design of the study, the collection, analysis, and interpretation of data or writing the manuscript. Competing interests: Russell Mannion is associate editor of the Journal of Health Organization and Management . Holger Pfaff is member of the editorial advisory board of the Journal of Health Organization and Management ."

"Collaborating authors in the CoRe-Net study group: Christian Albus, Frank Jessen, Ute Karbach, Christian Rietz, Nadine Scholten, Ingrid Schubert, Frank Schulz-Nieswandt, Julia Strupp, Raymond Voltz. Funding : This study was supported by the German Federal Ministry of Education and Research (BMBF) (grant no. 01GY1606). The funding body was not involved in the design of the study, the collection, analysis, and interpretation of data or writing the manuscript. Competing interests: Russell Mannion is associate editor of the Journal of Health Organization and Management . Holger Pfaff is member of the editorial advisory board of the Journal of Health Organization and Management ."

"Data was collected as part of the research project OrgValue (Characteristics of value-based health and social care from organizations‘ perspectives; German Registry for Clinical Trials - DRKS00011925), which is part of the CoRe-Net (Cologne Research and Development Network) – a network of researchers and healthcare providers collaborating to redesign healthcare in an urban region ( ). The city of Cologne, situated in the mid-west of Germany, has a population of more than one million inhabitants and is the fourth largest city in Germany. Cologne is an urban core of a large and densely populated metropolitan area in the Midwest of Germany. As the urban core it has strong ties with surrounding rural areas and cities and thus has a large catchment area in terms of specialist healthcare. Thereby, it represents the urban core of a typical European metropolitan area in densely populated regions. OrgValue is a cross-sectional study examining healthcare organizations in the city of Cologne with respect to the implementation of patient-centered and resource-oriented healthcare ( ). Whereas OrgValue encompasses both qualitative and quantitative data collection, the focus of this article is on the quantitative arm of the study. Data were collected by a standardized postal survey of key decision makers in healthcare organizations in Cologne. Decision-makers were selected from clinicians or managers in leading positions with decision-making authority and leadership responsibility ( ). A key informant survey was chosen because it enables a substantially larger number of organizations to be surveyed at lower cost ( ). The person or steering board in the highest position within each organization was contacted by post with study information accompanied by an informed consent form, the questionnaire and prepaid return envelopes. Poor German language skills was an exclusion criterion. The included healthcare organizations comprised (1) inpatient nursing homes and hospices, (2) hospitals, (3) inpatient and outpatient rehabilitation organizations, (4) physician practices (GPs and cardiology specialists), (5) outpatient nursing and hospice care organizations, and (6) psychotherapy practices. Recruitment took place based on the contact information gathered from the Association of Statutory Health Insurance Physicians North Rhine and web-based search. The survey was conducted according to Dillman's Total Design Method with two personalized reminders sent out to non-responders ( ). In addition, several strategies shown to increase survey response rates were used (e.g. personalized letters, highlighting the academic origin, prepaid envelopes, promoting the study through outreach activities). As a financial incentive, a donation of 1€ per completed questionnaire was sent to a charity organization for disadvantaged children in the city of Cologne, survey feedback via anonymous benchmarking reports ( ), and outreach events for organizational learning were promoted. This study received ethical approval from the Ethics Committee of the Medical Faculty of the University of Cologne (reference nr. 17–210). Written informed consent was obtained from all study participants."