Management Department, Hadassah Academic College, Jerusalem, Israel.
J Health Organ Manag. 2021 Oct 13;ahead-of-print(ahead-of-print). doi: 10.1108/JHOM-09-2021-0325.
Health systems function in an ecosystem that is turbulent and competitive because of demographic, economic, political, technological and lifestyle changes and sociopolitical influences, requiring hospitals to adopt comprehensive business strategies. Failure to do so may result in duplication, waste and deficits. This original article uses the prism of agency theory to examine differences in approach at two levels of hospital management and the consequent problems in the incorporation of necessary changes. Agency theory posits an inherent conflict of interest in organizations, including health organizations: the managers (agents) always aim to maximize their profit or personal interest instead of that of the owner or organization (principal), potentially causing difficulty in managing the organization. The aim is to generate recommendations for policymakers.
DESIGN/METHODOLOGY/APPROACH: The study is based on 30 semi-structured, in-depth interviews with key figures in the health system and on two levels of hospital management: senior managers and heads of selected departments. The analysis used a categorical qualitative methodology.
The main findings are five key themes: views of business behavior, asymmetry of interests, asymmetry of information, transparency and cooperation between various levels of management and ambivalence toward business in hospitals. The two levels of management are clearly divided in terms of interests, information and activity, leading to difficulty in cooperation, efficiency and achievement of organizational goals.
ORIGINALITY/VALUE: Using agency theory, this study provides a systemic and organizational view of hospitals' management and environmental adaptation. Understanding the processes and increasing cooperation at various managerial levels can help make the system more efficient and ensure its survival in a dynamic market.
由于人口、经济、政治、技术和生活方式的变化以及社会政治的影响，医疗系统在动荡和竞争的环境中运行，这要求医院采取全面的商业策略。如果不这样做，可能会导致重复、浪费和亏损。本文运用代理理论的棱镜，从两个层面的医院管理角度来考察方法上的差异，以及在纳入必要变革方面所产生的问题。代理理论认为，组织（包括卫生组织）存在内在的利益冲突：管理者（代理人）总是试图最大化自身的利益或个人利益，而不是所有者或组织（委托人）的利益，这可能导致管理组织的困难。目的是为政策制定者提出建议。
设计/方法/途径：本研究基于对卫生系统关键人物和医院两个管理层级（高级管理人员和选定部门负责人）的 30 次半结构化深入访谈。分析采用了分类定性方法。
主要发现有五个关键主题：商业行为观点、利益不对称、信息不对称、各级管理之间的透明度和合作以及医院对商业的矛盾态度。这两个管理层级在利益、信息和活动方面明显存在分歧，导致合作、效率和实现组织目标方面存在困难。
原创性/价值：本文运用代理理论，从系统和组织的角度对医院管理和环境适应进行了研究。了解各管理层面的流程并加强合作，可以帮助提高系统的效率，确保其在动态市场中的生存能力。
