Abstract
We emphasize “governance” as setting the very ground rules within which society’s institutions, including hospitals, function—stretching across government, regulations and management. For a hospital, governance delineates the “licence to operate” of the organization. It operates at a variety of levels: micro, meso and macro. Key parameters for judging the space for governance are the technical capacity (outputs from inputs), managerial capacity (setting strategies and operational objectives) and degree of operational status. The latter in the form of degree of autonomy has led through ideas of new public management to differing corporate functional forms, but without clear criteria for assessing the result.
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Notes
- 1.
From being “almshouses”/“poor old people’s homes” without antisepsis, laboratory, radiology nor pharmacology and mostly structured as associations of senior physicians in the nineteenth century.
- 2.
The aggregate indicators and the disaggregated underlying source data are available at www.govindicators.org.
- 3.
The London School of Economics and McKinsey conducted over 40 interviews and studied almost 1200 hospitals in Canada, France, Germany, Italy, Sweden, the United Kingdom and the United States with rather inconclusive results. It seems that hospitals with the best management practices (analysed as if they made things happen rather than curing people per se) also ranked best on a standardized measure of medical success: death rates among emergency patients who had experienced heart attacks. The score works across countries and cultures, and has unambiguous results—see Dorgan S., D. Layton, et al., (2010), Management in healthcare: why good practice really matters, McKinsey and Comp and LSE.
- 4.
According to most theoretical frameworks, including the World Health Report 2000, the final outcomes produced by health systems are expected to be “improving health status of the population”, “protecting the population against the financial risk of health care costs” and “improving citizens’ satisfaction”. There is more debate about what intermediate results hospitals and other service providers should pursue towards achieving the final ones, but most frameworks coincide on the above-mentioned four objectives that we are using here).
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Durán, A., Saltman, R.B. (2020). Hospital Governance. In: Durán, A., Wright, S. (eds) Understanding Hospitals in Changing Health Systems. Palgrave Macmillan, Cham. https://doi.org/10.1007/978-3-030-28172-4_2
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