[Role of the hospital director: an interorganizational comparison]

This study analyzes the role of the medical director of general hospitals in Israel. 26 directors of general hospitals were interviewed, of whom 7 managed independent or nonprofit hospitals, and 19 government or Kupat Holim Clalit hospitals. In Israel, hospital directors deal mainly with issues referred to in the literature as the "production" of hospital outputs and spend less time adapting the hospital to its changing environment. Accordingly, hospital directors spend only one-fifth of their time outside the hospital negotiating with outside agencies, and half of their time in their offices. More than 2/3 of the directors expressed dissatisfaction with the way they allocated their time, and said they would prefer to spend more time on long-term planning, quality control, and professional development, and less on ongoing operation. The management style of directors of independent hospitals was less centralized and they perceived themselves as having more authority than did directors of hospitals which are part of large, public, multihospital organizations. The independence of hospitals and the creation of a more competitive hospital market may make adapting the hospital to its changing environment a central part of the hospital director's agenda. Moreover, as hospitals gain more independence, directors will be granted broader authority and will have to assume more responsibility. These changes will require directors to adopt a different managerial orientation than that indicated by the findings of this study.