An exploration of governance in teaching hospitals in the Netherlands focused on educational objectives

Many countries are improving medical education in teaching hospitals through more focus on internal quality assurance, for example by creating new stakeholders like hospital-wide education committees. Adequate oversight is thought essential to ensure the quality of medical education. How teaching hospitals distribute roles and responsibilities for quality control across educational stakeholders to organize this oversight is rarely investigated. This study aims to answer the following exploratory question: Who are the primary stakeholders involved in educational governance, and what are their roles in safeguarding educational quality in teaching hospitals?

We conducted an exploratory qualitative study of educational governance structures in all teaching hospitals in the Netherlands with at least three training programs. We carried out document analysis of recent governance codes, documents drafted by Dutch teaching hospitals to describe their methods of internal governance for the national accreditor, and analyzed the data using a thematic analysis approach through the lens of organizational theories of Mintzberg and Freidson.

The study identified key stakeholders in quality management of medical education in all teaching hospitals of the Netherlands. An overview of their roles and responsibilities is given and a stakeholder map is drafted. Teaching hospitals gave the hospital-wide education committee three different roles: an advisory role, a quality controller role and a conflict mediation role.

Hospitals have set up the assignment of decision-making power in different ways, creating different variants of hospital-wide education committees and potentially causing them to be less effective at quality management. Whether these different roles affect the quality management of medical education in practice requires practice-oriented research. The study reveals remarkable ambiguity regarding the assignment and exercise of decision-making power between actors. This study contributes to the literature by identifying key actors and their roles in the quality management of postgraduate medical education, providing a foundation for follow-up research.