1
|
Mohmad S, Lee KY, Bakit P. Do health-care institutions perform better under leaders with medical or non-medical backgrounds? A scoping review. Leadersh Health Serv (Bradf Engl) 2024; 37:142-156. [PMID: 38809264 DOI: 10.1108/lhs-11-2023-0084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2024]
Abstract
PURPOSE This study aims to summarize studies that compared the performance of health-care institutions led by leaders with medical background versus those with no medical background. DESIGN/METHODOLOGY/APPROACH A systematic search was conducted on three databases: PubMed, Ovid Medline and Google Scholar to identify relevant peer-reviewed studies using the keywords "performance," "impact," "physician," "medical," "doctor," "leader," "healthcare institutions" and "hospital." Only quantitative studies that compared the performance of health-care institutions led by leaders with medical background versus non-medical background were included. Articles were screened and assessed for eligibility before the relevant data were extracted to summarize, appraise and make a narrative account of the findings. FINDINGS A total of eight studies were included, four were based in the USA, two in the UK and one from Germany and one from the Arab World. Half of the studies (n = 4) reported overall better health-care institutional performance in terms of hospital quality ranking such as clinical effectiveness and patient safety under leaders with medical background, whereas one study showed poorer performance. The remaining studies reported mixed results among the different performance indicators, especially financial performance. PRACTICAL IMPLICATIONS While medical background leaders may have an edge in clinical competence to manage health-care institutions, it will be beneficial to equip them with essential management skills to optimize leadership competence and enhance organizational performance. ORIGINALITY/VALUE The exclusive inclusion of quantitative empirical studies that compared health-care institutional performance medical and non-medical leaders provides a clearer link between the relationship between health-care institutional performance and the leaders' background.
Collapse
Affiliation(s)
- Shazwani Mohmad
- Centre for Leadership and Professional Development, Institute for Health Management, National Institutes of Health (NIH), Shah Alam, Malaysia and Seremban District Health Office, Ministry of Health Malaysia, Putrajaya, Malaysia
| | - Kun Yun Lee
- Centre for Leadership and Professional Development, Institute for Health Management, National Institutes of Health (NIH), Shah Alam, Malaysia
| | - Pangie Bakit
- Centre for Leadership and Professional Development, Institute for Health Management, National Institutes of Health (NIH), Shah Alam, Malaysia
| |
Collapse
|
2
|
Belasen A, Belasen A, Feng Z. The physician CEO advantage and hospital performance during the COVID-19 pandemic: capacity utilization and patient satisfaction. J Health Organ Manag 2023; ahead-of-print. [PMID: 36859352 DOI: 10.1108/jhom-04-2022-0126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
PURPOSE Prior studies have shown that physician-led hospitals have several advantages over non-physician-led hospitals. This study seeks to test whether these advantages also extend to periods of extreme disruptions such as the COVID-19 pandemic, which affect bed availability and hospital utilization. DESIGN/METHODOLOGY/APPROACH The authors utilize a bounded Tobit estimation to identify differences in patient satisfaction rates and in-hospital utilization rates of top-rated hospitals in the United States. FINDINGS Among top-rated US hospitals, those that are physician-led achieve higher patient satisfaction ratings and are more likely to have higher utilization rates. RESEARCH LIMITATIONS/IMPLICATIONS While the COVID-19 pandemic generated greater demand for inpatient beds, physician-led hospitals improved their hospitals' capacity utilization as compared with those led by non-physician leaders. A longitudinal study to show the change over the years and whether physician Chief Executive Officers (CEOs) are more likely to improve their hospitals' ratings than non-physician CEOs is highly recommended. PRACTICAL IMPLICATIONS Recruiting and retaining physicians to lead hospitals, especially during disruptions, improve hospital's operating efficiency and enhance patient satisfaction. ORIGINALITY/VALUE The paper reviews prior research on physician leadership and adds further insights into the crisis leadership literature. The authors provide evidence based on quantitative data analysis that during the COVID-19 pandemic, physician-led top-rated US hospitals experienced an improvement in operating efficiency.
Collapse
Affiliation(s)
- Alan Belasen
- MBA Program, SUNY Empire State College, Saratoga Springs, New York, USA
| | - Ariel Belasen
- Department of Economics and Finance, Southern Illinois University Edwardsville, Edwardsville, Illinois, USA
| | - Zhilan Feng
- David D. Reh School of Business, Clarkson University, Potsdam, New York, USA
| |
Collapse
|
3
|
de Guzman RB, Chua MLK, Goldstein D, Aung S, Eaton V, Park K. ASCO's Leadership Development Program: Focusing on the Next Generation of Leaders in Asia Pacific. JCO Glob Oncol 2023; 9:e2200313. [PMID: 36812447 PMCID: PMC10166472 DOI: 10.1200/go.22.00313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Abstract
PURPOSE The demand for high-quality and more comprehensive oncology care will continue to rise globally. Effective leadership is particularly important. METHODS The evolving endeavor of ASCO to reach out globally has covered the development of the next-generation leaders from Asia Pacific. Through the Leadership Development Program, the untapped talent of the region and the future leaders in oncology will gain the knowledge and skill sets, which prepares them to navigate the complex dynamics of oncology health care. RESULTS The region is the largest and the most populous with more than 60% of the world's population. It has 50% of cancer cases and is estimated to account for 58% of cancer deaths worldwide. The demand for high-quality and more comprehensive oncology care will continue to rise in the years to come. This growth will intensify the need for capable leaders. Leadership styles and behaviors are different. These are shaped within the context of cultural and philosophical views and beliefs. The pan-Asian interdisciplinary group of young leaders are expected to gain knowledge and skillsets through the Leadership Development Program. They will learn to work on strategic projects within a team and gain knowledge about advocacy. Communication and presentation skills and conflict management are also important components of the program. Through learning culturally relevant skills, participants can effectively collaborate with others, build relationships, and lead within their own institutions and societies and within ASCO. CONCLUSION Institutions and organizations need to have a deeper and more sustained focus on leadership development. Successfully addressing the challenges on leadership development in Asia Pacific is important.
Collapse
Affiliation(s)
- Roselle B de Guzman
- Manila Central University-FDT Medical Foundation Hospital, Caloocan City, Philippines
| | - Melvin L K Chua
- Department of Head and Neck and Thoracic Cancers, Division of Radiation Oncology, National Cancer Centre Singapore, Singapore
| | - David Goldstein
- Nelune Cancer Centre, Prince of Wales Hospital, Randwick, Australia
| | - Soe Aung
- Myanmar Oncology Society, University of Medicine 1, Yangon, Myanmar
| | - Vanessa Eaton
- American Society of Clinical Oncology, Alexandria, VA
| | | |
Collapse
|
4
|
Affiliation(s)
- Bhagwan Satiani
- From the Department of Surgery (Satiani, Ellison), Wexner Medical Center, The Ohio State University, Columbus, OH
| | - David P Way
- the Department of Emergency Medicine, (Way, Wexner Medical Center, The Ohio State University, Columbus, OH
| | - E Christopher Ellison
- From the Department of Surgery (Satiani, Ellison), Wexner Medical Center, The Ohio State University, Columbus, OH
| |
Collapse
|
5
|
What Does a Systems Approach to Quality Improvement Look Like in Practice? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19020747. [PMID: 35055568 PMCID: PMC8775800 DOI: 10.3390/ijerph19020747] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 01/02/2022] [Indexed: 12/10/2022]
Abstract
Universally improving healthcare systems is difficult to achieve in practice with organisations implementing a range of quality improvement (QI) approaches, in varying and changing contexts, and efforts ranging from project-based improvements to whole system change. This study aimed to identify how organisations overcome the challenges to improving the quality of the services they deliver. Drawing on the eight challenges from the ‘Quality and Safety in Europe by Research (QUASER) hospital guide, we assessed eight cases reported by the UK-based regulator Care Quality Commission as improving their performance. A thematic analysis of these secondary data established that all eight challenges had been addressed or considered in varying degrees. Education and physical and technological challenges seemed less prominent than developments made to address other challenges such as developing leadership, structure, and culture to support improving quality. This paper relies on the analysis of secondary case data and one framework to assess improvement efforts. Further research is required to consider other models and frameworks and to collate longitudinal data to capture the dynamics and increasing the maturity of improving healthcare systems in practice.
Collapse
|
6
|
Gabay G, Ben-Asher S. From a View of the Hospital as a System to a View of the Suffering Patient. Front Public Health 2022; 9:800603. [PMID: 35071174 PMCID: PMC8782256 DOI: 10.3389/fpubh.2021.800603] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 12/02/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose: Hospitals aspire to provide patient-centered care but are far from achieving it. This qualitative mixed methods study explored the capacity of hospital directors to shift from a hospital systemic-view to a suffering patient-view applying the Salutogenic theory. Methods: Following IRB, we conducted in-depth narrative interviews with six directors of the six Israeli academic tertiary public hospitals, focusing on their managerial role. In a second meeting we conducted vignette interviews in which we presented each director with a narrative of a suffering young patient who died at 33 due to medical misconduct, allowing self-introspection. Provisional coding was performed for data analysis to identify categories and themes by the three dimensions of the sense-of-coherence, an anchor of Salutogenics: comprehensibility, manageability, and meaningfulness. Results: While at the system level, directors reported high comprehensibility and manageability in coping with complexity, at the patient level, when confronted with the vignette, directors acknowledged their poor comprehensibility of patients' needs and patient's experience during hospitalizations. They acknowledged their poor capacity to provide patient-centered care. Meaningfulness in the narrative interview focused on the system while meaningfulness in the vignette interview focused on providing patient care. Conclusions: The evident gaps between the system level and the patient level create lack of coherence, hindering the ability to cope with complexity, and are barriers to providing patient-centered care. To improve the delivery of patient-centered care, we suggest ways to consolidate the views, enabling the shift from a systemic-view to a patient-view.
Collapse
|
7
|
Chen KC, Hsieh FC, Hsiao YJ. Hospital Board of Directors' Composition and Financial Performance: Empirical Evidence from Taiwan. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2021; 58:469580211024897. [PMID: 34120497 PMCID: PMC8202319 DOI: 10.1177/00469580211024897] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 05/12/2021] [Accepted: 05/24/2021] [Indexed: 11/17/2022]
Abstract
The board of directors of a nonprofit proprietary hospital is responsible for supervising and managing major operational matters and reviewing operational results. This study investigates how hospital financial performance is influenced by director and supervisor characteristics among the board members of nonprofit proprietary hospitals in Taiwan. Data were obtained from the Division of Medical Services of the Ministry of Health and Welfare. A generalized linear model was used to evaluate 32 non-profit proprietary hospitals for the years 2006 to 2017, totaling 363 observations. The empirical results revealed a significant positive correlation between the proportion of directors with management qualifications and hospital financial performance. Moreover, the results represented that a higher proportion of board members with a medical background did not correspond to higher hospital financial performance. Although doctors accounted for the highest proportion of board members, indicating their key role in hospital management, the need for board members with management expertise cannot be ignored. Therefore, a balance between directors with management experience and medical knowledge on the board of directors is beneficial for hospital financial performance.
Collapse
Affiliation(s)
- Kuan-Chen Chen
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei city, Taiwan
| | - Fang-Chu Hsieh
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei city, Taiwan
| | - Yu-Jen Hsiao
- Executive master program of business administration in Biotechnology, College of management, Taipei Medical University, Taipei city, Taiwan
| |
Collapse
|
8
|
De Regge M, Eeckloo K. Balancing hospital governance: A systematic review of 15 years of empirical research. Soc Sci Med 2020; 262:113252. [PMID: 32771874 DOI: 10.1016/j.socscimed.2020.113252] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 05/24/2020] [Accepted: 07/22/2020] [Indexed: 01/23/2023]
Abstract
It is crucial that we gain a deeper understanding of the features of organizational governance and how they contribute to hospital performance. Health care governance research has traditionally had a strong focus on the size and composition (i.e., the attributes) of the governing bodies, but less attention has been given to the dynamics, processes, and roles. Furthermore, evidence regarding the interconnection between the board and the executive management is lacking. This systematic literature review is thus intended to give a detailed summary of the attributes, the dynamics, and the processes, as well as the roles of governing bodies, by synthesizing the findings of published empirical studies. The framework of Kane et al. (2009) was used to position the results, taking into account external constraints and outputs/performance. Sixty-three studies were included in the systematic review. The majority of these studies deal with attributes (n = 34) and roles (n = 27); the smallest number of studies (n = 11) focus on dynamics and processes. There is a lack of consistency in the research findings on attributes and there is too little research into the dynamics and processes of hospital governance. However, it has been shown that clinical participation on the hospital board and the focus on quality in hospital board roles can have a beneficial effect. The studies do not provide sufficient direction on what best practice for governing hospitals should be. For this reason, we here provide a useful framework for understanding the aspects of governance and their impact on performance in hospitals and compare these with general corporate governance literature. Therefrom we propose avenues for further research.
Collapse
Affiliation(s)
- Melissa De Regge
- Strategic Policy Cell, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium; Department of Marketing, Innovation and Organisation, Faculty of Economics and Business Administration, Ghent University, Tweekerkenstraat 2, 9000, Ghent, Belgium.
| | - Kristof Eeckloo
- Strategic Policy Cell, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium; Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Corneel heymanslaan 10, 9000, Ghent, Belgium.
| |
Collapse
|
9
|
Rothman DJ, Blumenthal D, Thibault GE. Medical Professionalism In An Organizational Age: Challenges And Opportunities. Health Aff (Millwood) 2020; 39:108-114. [DOI: 10.1377/hlthaff.2019.00186] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- David J. Rothman
- David J. Rothman is the Bernard Schoenberg Professor of Social Medicine in the Department of Medical Humanities and Ethics, Columbia University, in New York City
| | - David Blumenthal
- David Blumenthal is president and CEO of the Commonwealth Fund, in New York City
| | - George E. Thibault
- George E. Thibault is the Daniel D. Federman Professor of Medicine and Medical Education Emeritus in the Department of Medicine, Harvard Medical School, in Boston, Massachusetts
| |
Collapse
|
10
|
Anderson JE, Robert G, Nunes F, Bal R, Burnett S, Karltun A, Sanne J, Aase K, Wiig S, Fulop NJ. Translating research on quality improvement in five European countries into a reflective guide for hospital leaders: the 'QUASER Hospital Guide'. Int J Qual Health Care 2019; 31:G87-G96. [PMID: 31187862 DOI: 10.1093/intqhc/mzz055] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 02/26/2019] [Accepted: 05/06/2019] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE The aim was to translate the findings of the QUASER study into a reflective, dialogic guide to help senior hospital leaders develop an organization wide QI strategy. DESIGN The QUASER study involved in depth ethnographic research into QI work and practices in two hospitals in each of five European countries. Three translational stakeholder workshops were held to review research findings and advise on the design of the Guide. An extended iterative process involving researchers from each participant country was then used to populate the Guide. SETTING The research was carried out in two hospitals in each of five European countries. PARTICIPANTS In total, 389 interviews with healthcare practitioners and 803 hours of observations. INTERVENTION None. MAIN OUTCOME MEASURE None. RESULTS The QUASER Hospital Guide was designed for leadership teams to diagnose their organization's strengths and weaknesses in the eight QI challenges. The Guide supports organizational dialogue about QI challenges, enables leaders to share perspectives, and helps teams to develop solutions to their situated problems. The Guide includes extensive examples of QI strategies drawn from the data and is published online and on paper. CONCLUSIONS The QUASER Hospital Guide is empirically based, draws on a dialogical approach to Organizational Development and complexity science and can facilitate hospital leadership teams to identify the best solutions for their organization.
Collapse
Affiliation(s)
- Janet E Anderson
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London, UK
| | - Glenn Robert
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London, UK
| | - Francisco Nunes
- Department of Human Resources and Organizational Behavior, ISCTE-IUL, Lisbon, Portugal
| | - Roland Bal
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Netherlands
| | - Susan Burnett
- Honorary Research Fellow, Faculty of Medicine, Department of Surgery & Cancer, Imperial College, UK
| | - Anette Karltun
- Department of Industrial Engineering and Management, Jönköping University Sweden and The Jönköping Academy for Improvement of Healthcare and Welfare, Sweden
| | - Johan Sanne
- IVL Swedish Environmental Research Institute, Sweden
| | - Karina Aase
- SHARE-Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Norway
| | - Siri Wiig
- SHARE-Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Norway
| | - Naomi J Fulop
- Department of Applied Health Research, University College London, UK
| | | |
Collapse
|
11
|
Abstract
PurposeThere is growing interest in the potential need for clinical involvement in leadership and management of hospitals. Most studies of clinical leadership use US and European data. This paper contributes the first evidence for the country of Iran. It examines three different forms of hospital system: public, private and social security organisation, and these include teaching and non-teaching hospitals. This study adds to a small but growing literature that examines the possible value of ‘expert’ clinical leaders.MethodThis study uses data from 72 general hospitals in the city of Tehran. The data were collected for years 2015 and 2016. Data Envelopment Analysis is used to assess hospital performance. Hospitals’ chief operating officers are divided into two groups: clinicians, the majority of whom are physicians (doctors), and non-medically trained managers.FindingsThe average performance scores for hospitals with clinical managers and non-clinically trained managers are equal to 96.68±5.50 and 89.78±7.20, respectively (p<0.001). Performance is thus higher under clinical managers. Outcome differences are observed in each of the three types of ownership and in teaching and non-teaching hospitals. The advantage in performance-score varies, when comparing the clinically led institutions and managerially led institutions, by between 5 and 10 points on a 0–100 scale. These differences remain after regression-equation adjustment for other influences.Practical implicationsSuccession planning and targeted leadership development is made more efficient with greater awareness about the kinds of leaders and managers that enhance organisational performance.
Collapse
|
12
|
Management Control Systems and Clinical Experience of Managers in Public Hospitals. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15040776. [PMID: 29673192 PMCID: PMC5923818 DOI: 10.3390/ijerph15040776] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 03/19/2018] [Accepted: 04/11/2018] [Indexed: 11/23/2022]
Abstract
Healthcare authorities are encouraging managers in hospitals to acquire clinical experience and knowledge in order to better carry out and coordinate healthcare service delivery. The main objective of this paper is to analyse how the clinical experience of hospital managers is related to public health institutions’ performance. It is proposed that the effect of the clinical experience on operative and financial organizational performance is indirect through the mediating variables of perceived utility of management information and horizontal management control system. This paper analyses how these variables impact hospital performance through the data from a survey sent to 364 hospital managers in Brazil. The results show that managers’ clinical experience is related to higher perceived utility of historical, financial, short-term, and internal information, but not with horizontal control adoption in hospitals. Furthermore, our results show that, in hospitals, perceived utility of forecasted, non-financial, long-term, and external managerial information positively affects hospitals’ financial performance, while adoption of horizontal control management positively affects operational performance. Through showing evidence that clinical background could explain the differences not only in hospital service management but also in information capabilities and management control processes, this study offer meaningful implications for healthcare authorities and hospital managers involved in the development and implementation of strategies in the health sector.
Collapse
|
13
|
Clay-Williams R, Ludlow K, Testa L, Li Z, Braithwaite J. Medical leadership, a systematic narrative review: do hospitals and healthcare organisations perform better when led by doctors? BMJ Open 2017; 7:e014474. [PMID: 28947438 PMCID: PMC5623455 DOI: 10.1136/bmjopen-2016-014474] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 08/23/2017] [Accepted: 09/07/2017] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Despite common assumptions that doctors are well placed to lead hospitals and healthcare organisations, the peer-reviewed literature contains little evidence on the performance of doctors in leadership roles in comparison with that of non-medical managers. OBJECTIVES To determine whether there is an association between the leader's medical background and management performance in terms of organisational performance or patient outcomes. METHODS We searched for peer-reviewed, English language studies using Medline, Embase and Emerald Management between 2005 and 2017. We included quantitative, qualitative and mixed method empirical studies on the performance of senior healthcare managers where participants were described as doctors or leaders and where comparative performance data were provided on non-medical leaders. Studies without full text available, or no organisational, leadership behaviour or patient measures, were excluded. RESULTS The search, conducted in Medline (n=3395), Embase (n=1913) and Emerald Management (n=454) databases, yielded 3926 entries. After the application of inclusion and exclusion criteria, 16 studies remained. Twelve studies found that there were positive differences between medical and non-medical leaders, and eight studies correlated those findings with hospital performance or patient outcomes. Six studies examined the composition of boards of directors; otherwise, there were few common areas of investigation. Five inter-related themes emerged from a narrative analysis: the impact of medical leadership on outcomes; doctors on boards; contribution of qualifications and experience; the medical leader as an individual or part of a team and doctors transitioning into the medical leadership role. DISCUSSION AND CONCLUSION A modest body of evidence supports the importance of including doctors on organisational governing boards. Despite many published articles on the topic of whether hospitals and healthcare organisations perform better when led by doctors, there were few empirical studies that directly compared the performance of medical and non-medical managers. This is an under-researched area that requires further funding and focus.
Collapse
Affiliation(s)
- Robyn Clay-Williams
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Kristiana Ludlow
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Luke Testa
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Zhicheng Li
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| |
Collapse
|
14
|
Malfait S, Van Hecke A, Hellings J, De Bodt G, Eeckloo K. The impact of stakeholder involvement in hospital policy decision-making: a study of the hospital's business processes. Acta Clin Belg 2017; 72:63-71. [PMID: 27762170 DOI: 10.1080/17843286.2016.1246681] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION In many health care systems, strategies are currently deployed to engage patients and other stakeholders in decisions affecting hospital services. In this paper, a model for stakeholder involvement is presented and evaluated in three Flemish hospitals. In the model, a stakeholder committee advises the hospital's board of directors on themes of strategic importance. OBJECTIVES To study the internal hospital's decision processes in order to identify the impact of a stakeholder involvement committee on strategic themes in the hospital decision processes. METHODS A retrospective analysis of the decision processes was conducted in three hospitals that implemented a stakeholder committee. The analysis consisted of process and outcome evaluation. RESULTS Fifteen themes were discussed in the stakeholder committees, whereof 11 resulted in a considerable change. None of these were on a strategic level. The theoretical model was not applied as initially developed, but was altered by each hospital. Consequentially, the decision processes differed between the hospitals. Despite alternation of the model, the stakeholder committee showed a meaningful impact in all hospitals on the operational level. As a result of the differences in decision processes, three factors could be identified as facilitators for success: (1) a close interaction with the board of executives, (2) the inclusion of themes with a more practical and patient-oriented nature, and (3) the elaboration of decisions on lower echelons of the organization. CONCLUSION To effectively influence the organization's public accountability, hospitals should involve stakeholders in the decision-making process of the organization. The model of a stakeholder committee was not applied as initially developed and did not affect the strategic decision-making processes in the involved hospitals. Results show only impact at the operational level in the participating hospitals. More research is needed connecting stakeholder involvement with hospital governance.
Collapse
Affiliation(s)
- Simon Malfait
- Ghent University Hospital, Ghent, Belgium
- Faculty of Medicine and Health Sciences, Department of Public Health, University Center for Nursing and Midwifery, Ghent University, Ghent, Belgium
| | - Ann Van Hecke
- Ghent University Hospital, Ghent, Belgium
- Faculty of Medicine and Health Sciences, Department of Public Health, University Center for Nursing and Midwifery, Ghent University, Ghent, Belgium
| | - Johan Hellings
- Faculty of Medicine and Life Sciences, Hasselt University, Roeselare, Belgium
| | | | - Kristof Eeckloo
- Ghent University Hospital, Ghent, Belgium
- Faculty of Medicine and Life Sciences, Department of Public Health, Ghent University, Ghent, Belgium
| |
Collapse
|
15
|
Sarto F, Veronesi G. Clinical leadership and hospital performance: assessing the evidence base. BMC Health Serv Res 2016; 16 Suppl 2:169. [PMID: 27230873 PMCID: PMC4896259 DOI: 10.1186/s12913-016-1395-5] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A widespread assumption across health systems suggests that greater clinicians' involvement in governance and management roles would have wider benefits for the efficiency and effectiveness of healthcare organisations. However, despite growing interest around the topic, it is still poorly understood how managers with a clinical background might specifically affect healthcare performance outcomes. The purpose of this review is, therefore, to map out and critically appraise quantitatively-oriented studies investigating this phenomenon within the acute hospital sector. METHODS The review has focused on scientific papers published in English in international journals and conference proceedings. The articles have been extracted through a Boolean search strategy from ISI Web of Science citation and search source. No time constraints were imposed. A manual search by keywords and citation tracking was also conducted concentrating on highly ranked public sector governance and management journals. Nineteen papers were identified as a match for the research criteria and, subsequently, were classified on the basis of six items. Finally, a thematic mapping has been carried out leading to identify three main research sub-streams on the basis of the types of performance outcomes investigated. RESULTS AND CONTRIBUTION The analysis of the extant literature has revealed that research focusing on clinicians' involvement in leadership positions has explored its implications for the management of financial resources, the quality of care offered and the social performance of service providers. In general terms, the findings show a positive impact of clinical leadership on different types of outcome measures, with only a handful of studies highlighting a negative impact on financial and social performance. Therefore, this review lends support to the prevalent move across health systems towards increasing the presence of clinicians in leadership positions in healthcare organisations. Furthermore, we present an explanatory model summarising the reasons offered in the reviewed studies to justify the findings and provide suggestions for future research.
Collapse
Affiliation(s)
- F Sarto
- Department of Economics, Management, Institutions, "Federico II" University of Naples, Naples, Italy.
| | - G Veronesi
- Accounting and Finance Division, Leeds University Business School, Leeds, UK
| |
Collapse
|
16
|
Sidorov J. Just What the Doctor Ordered? Physician Participation in Health Care Organization Corporate Boards. Am J Med Qual 2016; 31:281-3. [DOI: 10.1177/1062860615604021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|