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Structuring ambiguity in hospital governance.

Gerard Scholten1, Linda Muijsers-Creemers2, Jan Moen3

  • 1Erasmus School of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands.

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Summary

Four Dutch hospitals enhanced governability through dual governance structures, balancing doctor and manager roles. This approach relies on trust and mutual understanding for effective hospital governance.

Keywords:
Dutch hospitalsdecision-making arrangementsdual governancehospital governancestructuring

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Area of Science:

  • Healthcare Management
  • Organizational Governance
  • Hospital Administration

Background:

  • Developing effective governance structures is crucial for hospital performance.
  • Traditional governance models may not fully address the complexities of modern healthcare.
  • The need for collaborative decision-making between medical and managerial staff is increasing.

Purpose of the Study:

  • To investigate strategies employed by Dutch hospitals to enhance their governability.
  • To analyze the implementation and efficacy of dual governance structures in a healthcare setting.
  • To understand the role of consensual decision-making and shared responsibility in hospital governance.

Main Methods:

  • Empirical, multicase research design.
  • In-depth study of governance arrangements in four Dutch hospitals.
  • Analysis of strategies for structuring governance at both hospital and unit levels.

Main Results:

  • Hospitals adopted a dual governance approach, integrating doctors and managers.
  • Consensual decision-making and common responsibility were key elements.
  • Ambiguous positions with low formalization were intentionally created.
  • The success of dual governance is contingent on personal strength, trust, and mutual understanding.

Conclusions:

  • Dual governance offers potential for improved hospital governability.
  • The model's efficacy is sensitive to the interpersonal dynamics of key personnel.
  • Low formalization in governance roles presents both opportunities and vulnerabilities.