Intra-organizational dynamics as drivers of entrepreneurship among physicians and managers in hospitals of western countries

Koelewijn, Wout Theodoor; Ehrenhard, Michel Léon; Groen, Arend J.; Harten, Willem H. van

doi:10.1016/j.socscimed.2012.03.055

Cited by 22 publications

(19 citation statements)

References 45 publications

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“…A similar conclusion was drawn from a literature research of entrepreneurship in western hospitals. The authors identify ‘various responses’, including among others, a ‘transformative attitude towards traditional medical professionalism’ that supports entrepreneurial elements of healthcare [27,28]. …”

Section: Introductionmentioning

confidence: 99%

“A manager in the minds of doctors:” a comparison of new modes of control in European hospitals

Kuhlmann

Burau

Correia

et al. 2013

BMC Health Serv Res

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BackgroundHospital governance increasingly combines management and professional self-governance. This article maps the new emergent modes of control in a comparative perspective and aims to better understand the relationship between medicine and management as hybrid and context-dependent. Theoretically, we critically review approaches into the managerialism-professionalism relationship; methodologically, we expand cross-country comparison towards the meso-level of organisations; and empirically, the focus is on processes and actors in a range of European hospitals.MethodsThe research is explorative and was carried out as part of the FP7 COST action IS0903 Medicine and Management, Working Group 2. Comprising seven European countries, the focus is on doctors and public hospitals. We use a comparative case study design that primarily draws on expert information and document analysis as well as other secondary sources.ResultsThe findings reveal that managerial control is not simply an external force but increasingly integrated in medical professionalism. These processes of change are relevant in all countries but shaped by organisational settings, and therefore create different patterns of control: (1) ‘integrated’ control with high levels of coordination and coherent patterns for cost and quality controls; (2) ‘partly integrated’ control with diversity of coordination on hospital and department level and between cost and quality controls; and (3) ‘fragmented’ control with limited coordination and gaps between quality control more strongly dominated by medicine, and cost control by management.ConclusionsOur comparison highlights how organisations matter and brings the crucial relevance of ‘coordination’ of medicine and management across the levels (hospital/department) and the substance (cost/quality-safety) of control into perspective. Consequently, coordination may serve as a taxonomy of emergent modes of control, thus bringing new directions for cost-efficient and quality-effective hospital governance into perspective.

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Section: Introductionmentioning

confidence: 99%

“A manager in the minds of doctors:” a comparison of new modes of control in European hospitals

Kuhlmann

Burau

Correia

et al. 2013

BMC Health Serv Res

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“…These stand to threaten cultures. 39 For instance, innovations that accompany such major transitions as medical homes (or their next embodiment) with their less provider-centric focus to more team-based and patient centeredness, can threaten organizational culture, resulting in provider dissatisfaction with many aspects of the work and the workplace. 40 Understanding these and other threats to cultural stability that arise in entrepreneurial firms can lead to proactive means to manage expectations and relationships.…”

Section: Intra-organizational Constructsmentioning

confidence: 99%

“…29 Decades of research on EO of firms, teams, and organizational leaders have suggested robust relationships between entrepreneurialism and firm performance. 6,12,39,43,44 There appears to be direct linkages, but also mediators of the relationship between EO and performance, as in the case of absorptive capacity as a moderator of the relationship between EO and firm performance. 44 In other research, EO and sales growth is mediated by high performance work systems and a partnership philosophy.…”

Section: Intra-organizational Constructsmentioning

confidence: 99%

The emergence of the entrepreneurial hospital

Grazier¹

2015

IEH

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Abstract:In creating a vision of the emerging entrepreneurial hospital, this review looks briefly to selected theories used by researchers and practitioners to explore, define, explain, project, and guide hospitals into the future; and then moves directly to how scholars have used those theories to inform their empirical work and explain the findings from that work. The discourse then addresses briefly what might be needed -now -for hospitals to emerge "entrepreneurial" in the future. This article examines some of the academic, professional, and "gray" literature to consider the future of the "hospital". Much of the literature comes from researchers and thought leaders in organizational behavior, social capital, economics, finance, social welfare, health management, and marketing. The paper explores the external environment for hospitals; the effectors, those events and conditions that bear directly on the form and function of the emerging hospital; and the organization-specific and intra-organizational dynamics that help determine how and in what form the hospital will emerge as an entrepreneurial force. While the vision of the "hospital" of the future varies across observers, the theoretical and empirical research, popular discourse, and lessons from other industries and sectors of the economy, provide guidance on why and how knowing what we can know may bring us into the future more effectively and efficiently.

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“…A competitive value commitment may be either transformative or defensive in orientation [24]). In the hospital context, physicians holding a transformative oriented competitive value commitment favour the newly dominant business logic over the traditionally dominant medical logic.…”

Section: Introductionmentioning

confidence: 99%

“…In this study we define entrepreneurship as a form of radical change by physicians (also see, Koelewijn et al ., 2012) [24]. Hereby, entrepreneurship is defined as ‘new entries by physicians and hospital managers who discover, evaluate, and exploit opportunities to create future health services by bearing the risk of profit and loss’ [25-27].…”

Section: Introductionmentioning

confidence: 99%

Physician’ entrepreneurship explained: a case study of intra-organizational dynamics in Dutch hospitals and specialty clinics

2014

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BackgroundChallenges brought about by developments such as continuing market reforms and budget reductions have strained the relation between managers and physicians in hospitals. By applying neo-institutional theory, we research how intra-organizational dynamics between physicians and managers induce physicians to become entrepreneurs by starting a specialty clinic. In addition, we determine the nature of this change by analyzing the intra-organizational dynamics in both hospitals and clinics.MethodsFor our research, we interviewed a total of fifteen physicians and eight managers in four hospitals and twelve physicians and seven managers in twelve specialty clinics.ResultsWe found evidence that in becoming entrepreneurs, physicians are influenced by intra-organizational dynamics, including power dependence, interest dissatisfaction, and value commitments, between physicians and managers as well as among physicians’ groups. The precise motivation for starting a new clinic can vary depending on the medical or business logic in which the entrepreneurs are embedded, but also the presence of an entrepreneurial nature or nurture. Finally we found that the entrepreneurial process of starting a specialty clinic is a process of sedimented change or hybridized professionalism in which elements of the business logic are added to the existing logic of medical professionalism, leading to a hybrid logic.ConclusionsThese findings have implications for policy at both the national and hospital level. Shared ownership and aligned incentives may provide the additional cement in which the developing entrepreneurial values are ‘glued’ to the central medical logic.

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Intra-organizational dynamics as drivers of entrepreneurship among physicians and managers in hospitals of western countries

Cited by 22 publications

References 45 publications

“A manager in the minds of doctors:” a comparison of new modes of control in European hospitals

“A manager in the minds of doctors:” a comparison of new modes of control in European hospitals

The emergence of the entrepreneurial hospital

Physician’ entrepreneurship explained: a case study of intra-organizational dynamics in Dutch hospitals and specialty clinics

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