The organization of virtual care centers: A qualitative study in Dutch hospitals

Virtual care centers (VCCs) facilitate remote patient monitoring (RPM), which has been shown to reduce secondary care utilization among patients, improve efficiency for healthcare providers, and decrease overall healthcare costs. Although VCCs are increasingly being employed, the way they are organized varies. Existing literature often conceptualizes VCCs as independent hospital wards, yet alternative organizational designs are emerging. However, there is a lack of empirical research examining how these designs differ and function. This study aims to examine and characterize the organizational designs of VCCs to provide a clearer understanding of their structure and implications. This qualitative, exploratory study, examined three VCCs in the Netherlands, selected through purposive sampling based on the volume of patients receiving virtual care and the range of care pathways offered. In April and May 2024, semi-structured interviews were conducted with twelve healthcare professionals. Thematic analysis was used to analyze the interview data. Two distinct organizational designs for VCCs have emerged from the data: decentralized designs, embedded within individual hospitals, and centralized designs, which coordinate care across multiple hospitals. To explore the different characteristics of the two organizational designs, these themes were derived: 1) operational implications, 2) collaboration between healthcare providers, 3) patient-healthcare provider relationships. Decentralized VCCs promote strong regional collaboration, fostering closer professional relationships and communication between healthcare providers and patients. However, their scalability is limited due to resource constraints and localized operational frameworks. In contrast, centralized VCCs optimize resource allocation, enabling broader patient coverage, and extended accessibility yet face challenges in maintaining care integration, trust among healthcare providers, and relational continuity with patients. Both designs exhibit difficulties in achieving multidisciplinary care integration, which is crucial for effectively supporting patients with complex and chronic conditions. The findings are relevant for policy makers working with VCCs, as setting up a VCC is more complex than it may appear. This study examines decentralized and centralized designs, each with different features and outcomes, that policy makers should consider. Future research should evaluate how VCCs accommodate varying care pathways to further inform evidence-based organizational design improvements.