Clinical governance in Dutch hospitals

Abstract

Purpose – For accountability purposes, performance information sharing and clear divisions of responsibilities between medical specialists and executive boards are critical. The purpose of this paper is to explore whether these aspects of clinical governance have been taken up by executive boards and medical specialists in the Netherlands. Design/methodology/approach – This cross-sectional study aimed to explore the information-sharing between medical specialists and executive boards in Dutch hospitals as one key aspect of clinical governance. Between November 2010 and February 2011, 67 medical staff board chairs and 40 chief executive officers completed an online questionnaire concerning information-sharing and the clinical governance practices within their respective hospitals. Findings – Almost all respondents acknowledged the importance of information-sharing. However, the actual sharing differed per type of performance information. Policy/management information was shared more often than patient care information. Similarly, medical specialists differ in the degree of responsibility the take for specific clinical governance tasks. Almost all were involved in managing complication registries (99 per cent), while few managed hospital accreditation (55 per cent). Research limitations/implications – With executive boards and medical specialists being increasingly dependent of a shared budget, they have an extra incentive to share information and to take up clinical governance tasks. The study showed that Dutch medical specialists are sharing many types of performance information with the executive board, but that this should be increased to comply with the codes. Thus far, few hospital managers in the study have formalised this in an information protocol, which is potentially the next step for other hospital staff to incorporate as well. Those who have an information protocol seem to be aware of the business case for quality. Originality/value – This study is the first attempt to explore to what extent Dutch medical specialists share performance information with their respective executive boards and take up clinical governance tasks.

Medical doctors in healthcare leadership: theoretical and practical challenges

“…Health insurers have to offer a universal package for everyone, regardless of age or health conditions, but may compete for price. Contrary to many other European systems, the Dutch government is responsible for the accessibility, quality and ultimate costs of the healthcare system, but not in charge of its management [ 8 ]. Private health insurers have a pivotal role since the Health Insurance Law in a system of managed competition.…”

“…Over the past decades, there have been main attempts in the Netherlands to integrate medical specialists in hospital governance [ 8 , 52 ]. Already in the 1980s, medical specialists were supposed to play a more crucial role by ‘getting involved in management tasks on a clinical- (organising care) and organisational-level (hospital as a whole)’ ([ 8 ] p. 325).…”

“…Over the past decades, there have been main attempts in the Netherlands to integrate medical specialists in hospital governance [ 8 , 52 ]. Already in the 1980s, medical specialists were supposed to play a more crucial role by ‘getting involved in management tasks on a clinical- (organising care) and organisational-level (hospital as a whole)’ ([ 8 ] p. 325). Such initiatives to engage medical doctors in leadership roles beyond immediate patient care were however accompanied by governmental policies to restrict their independent status as non-employees and related (higher) incomes [ 52 ].…”

“…Studies on health system performance and clinical governance emphasize the importance of strong clinical leadership to drive improvement efforts and initiatives [ 5 , 6 ]. Hospital performance is increasingly associated with medical specialists taking up tasks beyond direct patient care and develop their co-operation with executive boards [ 7 , 8 ]. Leadership and engagement of other professionals are also crucial for health system improvement; yet, the unique status and influence of the medical profession may require a specific focus of attention.…”

Rethinking clinical governance: healthcare professionals’ views: a Delphi study

“…First, unlike in countries such as the UK, Ireland and New Zealand, CG was not centrally introduced in the Netherlands. Consequently, there is no national CG policy, and healthcare organisations shape their own version of CG 34. Second, compared to countries such as Germany, Portugal, Greece and Poland, the complex interplay between various stakeholders means that the healthcare system within the Netherlands has to be highly coordinated, leading to rigid managerial procedures such as target setting based on performance indicators.…”