Rotar A M, Botje D, Klazinga N S, Lombarts K M, Groene O, Sunol R, Plochg T
Department of Public Health, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1100 DE, Amsterdam, The Netherlands.
Berenschot BV, Europalaan 40, 3526 KS, Utrecht, The Netherlands.
BMC Health Serv Res. 2016 May 24;16 Suppl 2(Suppl 2):160. doi: 10.1186/s12913-016-1396-4.
Hospital governance is broadening its orientation from cost and production controls towards 'improving performance on clinical outcomes'. Given this new focus one might assume that doctors are drawn into hospital management across OECD countries. Hospital performance in terms of patient health, quality of care and efficiency outcomes is supposed to benefit from their involvement. However, international comparative evidence supporting this idea is limited. Just a few studies indicate that there may be a positive relationship between medical doctors being part of hospital boards, and overall hospital performance. More importantly, the assumed relationship between these so-called doctor managers and hospital performance has remained a 'black-box' thus far. However, there is an increasing literature on the implementation of quality management systems in hospitals and their relation with improved performance. It seems therefore fair to assume that the relation between the involvement of doctors in hospital management and improved hospital performance is partly mediated via quality management systems. The threefold aim of this paper is to 1) perform a quick scan of the current situation with regard to doctor managers in hospital management in 19 OECD countries, 2) explore the phenomenon of doctor managers in depth in 7 OECD countries, and 3) investigate whether doctor involvement in hospital management is associated with more advanced implementation of quality management systems.
This study draws both on a quick scan amongst country coordinators in OECD's Health Care Quality Indicator program, and on the DUQuE project which focused on the implementation of quality management systems in European hospitals.
This paper reports two main findings. First, medical doctors fulfil a broad scope of managerial roles at departmental and hospital level but only partly accompanied by formal decision making responsibilities. Second, doctor managers having more formal decision making responsibilities in strategic hospital management areas is positively associated with the level of implementation of quality management systems.
Our findings suggest that doctors are increasingly involved in hospital management in OECD countries, and that this may lead to better implemented quality management systems, when doctors take up managerial roles and are involved in strategic management decision making.
医院治理正从成本和生产控制向“改善临床结果表现”拓展其方向。鉴于这一新重点，有人可能会认为经合组织国家的医生会参与到医院管理中。医院在患者健康、护理质量和效率结果方面的表现理应会因他们的参与而受益。然而，支持这一观点的国际比较证据有限。仅有少数研究表明，医生成为医院董事会成员与医院整体表现之间可能存在正相关关系。更重要的是，迄今为止，这些所谓的医生管理者与医院表现之间的假定关系仍是一个“黑匣子”。然而，关于医院质量管理体系的实施及其与改善表现之间关系的文献越来越多。因此，可以合理地假设，医生参与医院管理与改善医院表现之间的关系部分是通过质量管理体系来调节的。本文的三重目标是：1）快速审视19个经合组织国家医院管理中医生管理者的现状；2）深入探究7个经合组织国家的医生管理者现象；3）调查医生参与医院管理是否与质量管理体系的更先进实施相关。
本研究既借鉴了经合组织医疗保健质量指标项目中各国协调员的快速审视结果，也借鉴了聚焦于欧洲医院质量管理体系实施情况的DUQuE项目。
本文报告了两个主要发现。第一，医生在科室和医院层面履行广泛的管理职责，但仅有部分职责伴随着正式的决策责任。第二，在医院战略管理领域拥有更多正式决策责任的医生管理者与质量管理体系的实施水平呈正相关。
我们的研究结果表明，经合组织国家的医生越来越多地参与到医院管理中，并且当医生担任管理角色并参与战略管理决策时，这可能会导致质量管理体系得到更好的实施。
