The involvement of medical doctors in hospital governance and implications for quality management : a quick scan in 19 and an in depth study in 7 OECD countries
Rotar, A. M. (University of Amsterdam)
Botje, Daan (Berenschot BV)
Klazinga, Niek (University of Amsterdam)
Lombarts, Kiki (University of Amsterdam)
Groene, Oliver (Optimedis AG)
Suñol Sala, Rosa (Universitat Autònoma de Barcelona. Institut Universitari Avedis Donabedian)
Plochg, Thomas (University of Amsterdam)

Date:	2016
Abstract:	Hospital governance is broadening its orientation from cost and production controls towards 'improving performance on clinical outcomes'. Given this new focus one might assume that doctors are drawn into hospital management across OECD countries. Hospital performance in terms of patient health, quality of care and efficiency outcomes is supposed to benefit from their involvement. However, international comparative evidence supporting this idea is limited. Just a few studies indicate that there may be a positive relationship between medical doctors being part of hospital boards, and overall hospital performance. More importantly, the assumed relationship between these so-called doctor managers and hospital performance has remained a 'black-box' thus far. However, there is an increasing literature on the implementation of quality management systems in hospitals and their relation with improved performance. It seems therefore fair to assume that the relation between the involvement of doctors in hospital management and improved hospital performance is partly mediated via quality management systems. The threefold aim of this paper is to 1) perform a quick scan of the current situation with regard to doctor managers in hospital management in 19 OECD countries, 2) explore the phenomenon of doctor managers in depth in 7 OECD countries, and 3) investigate whether doctor involvement in hospital management is associated with more advanced implementation of quality management systems. This study draws both on a quick scan amongst country coordinators in OECD's Health Care Quality Indicator program, and on the DUQuE project which focused on the implementation of quality management systems in European hospitals. This paper reports two main findings. First, medical doctors fulfil a broad scope of managerial roles at departmental and hospital level but only partly accompanied by formal decision making responsibilities. Second, doctor managers having more formal decision making responsibilities in strategic hospital management areas is positively associated with the level of implementation of quality management systems. Our findings suggest that doctors are increasingly involved in hospital management in OECD countries, and that this may lead to better implemented quality management systems, when doctors take up managerial roles and are involved in strategic management decision making.
Grants:	European Commission FP7/2007-2013
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Subject:	Doctors in management ; Quality management ; Hospital governance ; European comparison ; Professionalism
Published in:	BMC health services research, Vol. 16 (may 2016) , ISSN 1472-6963

DOI: 10.1186/s12913-016-1396-4
PMID: 27228970

11 p, 382.7 KB

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Research literature > UAB research groups literature > Research Centres and Groups (research output) > Health sciences and biosciences > Avedis Donabedian Research Institute-UAB
Articles > Research articles
Articles > Published articles