Emerging structural models for governance of public hospitals

Abstract

Purpose The purpose of this paper is to present the contemporary understanding and emerging structural models of organisational governance of public hospitals in order to provide evidence-based guidance to countries that are reforming their public hospital governance structures in line with best practice. Design/methodology/approach The paper uses the structural dimension of Cooper, Fusarelli and Randall’s policy model and institutional theory to review the legislative frameworks of four model countries supported by extant literature. Findings The paper conceptually distinguishes health system governance and organisational governance in the health system. It further visualises the emerging alternative legislative models of organisational governance and a hierarchy of governors applicable to public hospitals. Originality/value The paper provides critical knowledge for understanding organisational governance within health system governance framework and develops tools that can be used in reforming institutional mechanism of organisational governance of public hospitals.

Fitting in as an outsider: a resource dependence theory approach to outside boards

“…To resolve this agency problem, board members are delegated the task of monitoring and approving the managers' actions and to ensure that their actions are aligned with the interests of shareholders (Dalton et al, 2007). In the context of the NPHC industry, these shareholders consist of the patients of a healthcare community in which board members monitor their senior managers' commitments to the quality care requirements of their community (Lipunga et al, 2019). For instance, studies by Jiang et al (2012), Jha and Epstein (2010), Prybil et al (2010), Prybil et al (2013) and Ragland and Plante (2021) argue and/or find support that a hospital board's monitoring role can provide an oversight that improves the hospital's commitment to clinical quality.…”

“…This independence is explained in terms of outside board members (Dalton et al, 2007;Erwin et al, 2019;Fedaseyeu et al, 2018;Hillman et al, 2000;Kane et al, 2009;Romano, 2013;Rashid, 2018;Vandenbroucke et al, 2016;Young et al, 2000). Unlike inside board members who can be an organization's senior officers, such as a CEO (Dalton et al, 2007), physicians, hospital administrators and nurses (Erwin et al, 2019;Lipunga et al, 2019;Mazurenko et al, 2019;Ragland and Plante, 2021), outside board members consist of individuals who are "removed from day to day [hospital] operations" (Erwin, 2019, p. 151) and have no substantial relationship to senior management (Beecher-Monas, 2007;Erwin et al, 2019;Fedaseyeu et al, 2018;Kane et al, 2009;Rashid, 2018;Vandenbroucke et al, 2016 [1]; Young et al, 2000). More formally, Young et al (2000) define an outside board to consist of members "who were neither employees of the hospital, members of the medical staff, or individuals with likely professional ties to the hospital such as lawyers, accountants and consultants" (p. 286; see also Erwin et al, 2019;Vandenbroucke et al, 2016).…”

“…As board members play an important role in setting the strategic direction and identity of an NPHCO (Chambers et al, 2020;Erwin et al, 2019;Kane et al, 2009;Lipunga et al, 2019;Mazurenko et al, 2019;Ragland and Plante, 2021), the purpose of this study is to address this identity problem by examining the governance functions of board members. Amongst contemporary developments, agency theory (AT) has been the prevailing approach to explaining the monitoring role of NPHC boards (Chambers et al, 2020;Lipunga et al, 2019;Mazurenko et al, 2019;Ragland and Plante, 2021). Due to the passage of the Sarbanes-Oxley act and provisions in the affordable care act (ACA), this monitoring role has been delegated to "outside" board members (Alexander and Lee, 2006;Chambers et al, 2017;Erwin et al, 2019;Young et al, 2000).…”

Chasing the golden fleece

“…Emerging structural models for public hospitals may serve to support the move toward lean management. Lipunga, Tchereni and Bakuwa (2019), in their examination of organizational governance in the UK, New Zealand, Ghana and South Africa, explain that traditional hierarchical hospital management exemplifies a top-down decision-making model that ignores the needs of the various stakeholders and reduces clinicians' autonomy. This model focuses on implementation of pre-determined policy and may fail to acknowledge the best research evidence, basing decisions instead on tradition.…”

Good Hospital Governance at the Indonesian Hospital

“…The structure in which organizations are connected and regulated is governance (Stephen Owusu . Health governance can be divided into two: health sector governance and organizational governance (Lipunga, Tchereni, & Bakuwa, 2019). To achieve its operational objectives, every organization needs a level of governance structure (Stephen Owusu Afriyie, Kong, Danso, Ibn Musah, & Akomeah, 2019).…”