Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, Netherlands.
J Health Organ Manag. 2020 May 7;ahead-of-print(ahead-of-print). doi: 10.1108/JHOM-03-2020-0067.
Despite the continuation of hospital mergers in many western countries, it is uncertain if and how hospital mergers impact the quality of care. This poses challenges for the regulation of mergers. The purpose of this paper is to understand: how regulators and hospitals frame the impact of merging on the quality and safety of care and how hospital mergers might be regulated, given their uncertain impact on quality and safety of care.
DESIGN/METHODOLOGY/APPROACH: This paper studies the regulation of hospital mergers in The Netherlands. In a qualitative study design, it draws on 30 semi-structured interviews with inspectors from the Dutch Health and Youth Care Inspectorate (Inspectorate) and respondents from three hospitals that merged between 2013 and 2015. This paper draws from literature on process-based regulation to understand how regulators can monitor hospital mergers.
This paper finds that inspectors and hospital respondents frame the process of merging as potentially disruptive to daily care practices. While inspectors emphasise the dangers of merging, hospital respondents report how merging stimulated them to reflect on their care practices and how it afforded learning between hospitals. Although the Inspectorate considers mergers a risk to quality of care, their regulatory practices are hesitant.
ORIGINALITY/VALUE: This qualitative study sheds light on how merging might affect key hospital processes and daily care practices. It offers opportunities for the regulation of hospital mergers that acknowledges rather than aims to dispel the uncertain and potentially ambiguous impact of mergers on quality and safety of care.
尽管在许多西方国家，医院合并仍在继续，但仍不确定医院合并是否以及如何影响医疗质量。这给合并的监管带来了挑战。本文旨在了解：监管机构和医院如何构建合并对护理质量和安全的影响，以及鉴于合并对护理质量和安全的不确定影响，如何对医院合并进行监管。
设计/方法/途径：本文研究了荷兰的医院合并监管。在一项定性研究设计中，它借鉴了荷兰卫生和青年保健监察局（监察局）的 30 名检查员和 2013 年至 2015 年期间合并的三家医院的 30 名受访者的 30 次半结构化访谈。本文借鉴了基于过程的监管文献，以了解监管机构如何监测医院合并。
本文发现，检查员和医院受访者将合并过程视为对日常护理实践具有潜在破坏性。虽然检查员强调合并的危险，但医院受访者报告了合并如何促使他们反思自己的护理实践，以及它如何为医院之间的学习提供机会。尽管监察局认为合并是对护理质量的威胁，但他们的监管做法犹豫不决。
原创性/价值：这项定性研究揭示了合并可能如何影响医院的关键流程和日常护理实践。它为医院合并的监管提供了机会，承认而不是试图消除合并对护理质量和安全的不确定和潜在模糊影响。
