Medical staff organization in three European multi-hospital systems: an exploratory study

Multi-hospital systems have increased rapidly in number in recent years. This development is based primarily on hoped-for economies of scale, better access to the capital market, and more expert management. The place and the role of doctors in this process has, to judge from the literature, been passed by almost unnoticed. Is this also a case of the "benign neglect" that prevailed with respect to the medical organization when management structures were established in the separate hospitals? The present article reports on an exploratory study of the situation of doctors and the medical staff organization in three European multi-hospital systems. Two important structural elements, the strengthening of management and the medical staff organization, appear to be of fundamental importance for the determination of the place and the role of doctors in multi-hospital systems and of the way the doctors themselves experience the system. There are a number of factors that one may assume affect the situation of doctors in such systems: the process of system formation, the size of the system, the influence of the general environment, cost-consciousness of the doctors, and the force of strong personalities.