COMMUNITY-BASED TRAUMA SYSTEMS IN THE UNITED-STATES - AN EXAMINATION OF STRUCTURAL DEVELOPMENT

Objective: To examine the organizational, political, and community cha racteristics that facilitate or impede community progress in developin g a coordinative network of health services for trauma delivery. Study Setting/Design: A comparative case study design was used to examine t rauma network development in 6 U.S. cities with a population of 1 000 000 or more. Five key coordinative activities were selected for study. Each study site varied in the set of activities that had been impleme nted. Data Sources: Information on the structure and composition of lo cal trauma coordinating councils; interviews with a common set of info rmants in each site using a semi-structured interview protocol. Study Methods: The literature on interorganizational community structures an d local policy development was drawn upon to create a conceptual frame work for assessing the development of a coordinative service network. Analytical techniques included network analysis to understand the link ages across organizations in overseeing trauma network operations, ass essment of leadership structures to identify central actors and organi zations, and pattern matching techniques of case study analysis to ide ntify factors that affected trauma network development. Principal Find ings: Leaders capitalized on local events and were instrumental in kee ping network development on the top of the political agenda. Successfu l leaders spent substantial time and energy documenting problems, asse ssing the needs and understanding of stakeholders, educating stakehold ers and politicians, and creating trust and shared understanding of va lues. Conclusions: Prior research has documented the importance of cen tral actors and organizations in developing coordinative networks. The unique contribution of our research is its insights on how central ac tors and organizations are more likely to motivate collaboration in si tuations where they lack control over the allocation of payments acros s involved organizations. Our research suggests that under these circu mstances central players should focus their time and energy educating stakeholders and developing a shared understanding rather than using t heir centrality to impose a particular coordinative structure. To date , U.S. trauma networks have served as models for other industrialized countries, and thus, lessons learned in the U.S. about implementing in terorganizational networks of trauma care can assist other countries a chieve more effective coordination and avoid mistakes that impede prog ress. (C) 1998 Elsevier Science Ltd. All rights reserved.