Medicine and management: looking inside the box of changing hospital governance

Abstract

BackgroundHealth policy has strengthened the demand for coordination between clinicians and managers and introduced new medical manager roles in hospitals to better connect medicine and management. These developments have created a scholarly debate of concepts and an increasing ‘hybridization’ of tasks and roles, yet the organizational effects are not well researched. This research introduces a multi-level governance approach and aims to explore the organizational needs of doctors using Sweden as a case study.MethodsWe apply an assessment framework focusing on macro-meso levels and managerial-professional modes of hospital governance (using document analysis, secondary sources, and expert information) and expand the analysis towards the micro-level. Qualitative explorative empirical material gathered in two different studies in Swedish hospitals serves to pilot research into actor-centred perceptions of clinical management from the viewpoint of the ‘managed’ and the ‘managing’ doctors in an organization.Results Sweden has developed a model of integrated hospital governance with complex structural coordination between medicine and management on the level of the organization. In terms of formal requirements, the professional background is less relevant for many management positions but in everyday work, medical managers are perceived primarily as colleagues and not as experts advising on managerial problems. The managers themselves seem to rely more on personal strength and medical knowledge than on management tools. Bringing doctors into management may hybridize formal roles and concepts, but it does not necessarily change the perceptions of doctors and improve managerial–professional coordination at the micro-level of the organization.ConclusionThis study brings gaps in hospital governance into view that may create organizational weaknesses and unmet management needs, thereby constraining more coordinated and integrated medical management.

Priorities and challenges for health leadership and workforce management globally: a rapid review

“…In addition, considering high turnover of executive leadership, healthcare organisations often rely on external talent for succession management which can reduce hospital efficiency [44, 66]. Other contributors to weakened hospital performance include: the lack of allocative efficiency and transparency [24, 30, 64, 67]; poor hospital processes that hamper the development of effective systems for the prevention and control of hospital acquired infections (HAIs) [53, 68]; and, payment reforms such as value-based funding and fee-for-service that encourage volume [18, 23, 24, 61, 62, 69, 70].…”

Medical leaders or masters?—A systematic review of medical leadership in hospital settings

“…The nature of the medical management function differed. In some studies, these positions were full-time affiliations in which the physicians ceased to perform clinical work [ 34 ], whereas in other cases, the positions were considered as a part-time jobs ‘on the side’, meaning that they will first and foremost be a physician [ 6 ], and finally, there were studies in which both full- and part-time variants were identified [ 31 , 41 ].…”

“…On the other hand, physicians must gain support and trust from the management world to obtain authority and responsibility and prevent exclusion from key decisions and strategy. In conclusion, support and trust form an important component of a medical manager’s power base [ 35 ] and are needed not only to become effective but also to prevent stress and working in isolation [ 41 ]. Paradoxical, a few authors [ 51 , 54 ] mentioned that in some cases, physicians explicitly did not want support because sharing their problems could lead to public failure and the loss of credibility and status.…”

What should be in hospital doctors' continuing professional development?

“…Empirical research has found that doctors with management roles may be isolated 'lone wolves' and lack organizational support. 8 It is therefore important for doctors to receive appropriate training and support for additional roles.…”