Krenyacz Eva, Revesz Eva Erika
Corvinus University of Budapest, Budapest, Hungary.
J Health Organ Manag. 2025 Feb 28;39(9):177-191. doi: 10.1108/JHOM-08-2024-0358.
The objective of this paper is to investigate how top managers in public healthcare interpret and perceive their autonomy within a highly centralized system and how their roles and attitudes have evolved in response to centralization.
DESIGN/METHODOLOGY/APPROACH: The research examines how increased centralization and reduced organizational autonomy affect decision-making in hospitals, employing qualitative analysis through in-depth interviews with top managers. The study collected and analyzed data from 15 hospital managers in year 2015 and 2022 (eight interviews each year, one person interviewed twice), to capture changes following significant centralization efforts and the effects of the pandemic and health sector reforms.
Centralization has reduced financial and operational managerial autonomy for many institutions, leading to delays in decision-making, especially in financial matters and has also brought significant administrative and reporting burdens. Despite this, hospital managers reported retaining some professional autonomy in developing and managing their service portfolios, but this autonomy is primarily operational rather than strategic and is limited by financial constraints.
RESEARCH LIMITATIONS/IMPLICATIONS: This study examines the Hungarian healthcare system, influenced by unique political context, which also presents a methodological limitation concerning the transferability of findings.
Hospital top managers' professional autonomy is often obscured by heavy administrative and financial pressures; thus, enhancing their strategic mindset is essential.
Policymakers should adopt a comprehensive perspective in hospital maintaining, with a particular focus on balancing financial and medical perspectives.
ORIGINALITY/VALUE: The paper focuses on an under-explored area: the organizational autonomy of hospital top management in the context of centralization efforts, delivering a message to both hospital managers and policymakers by emphasizing organizational aspects.
本文旨在探讨公共医疗保健领域的高层管理人员如何在高度集权的系统中诠释和感知其自主权，以及他们的角色和态度如何因集权化而演变。
设计/方法/途径：该研究通过对高层管理人员进行深入访谈，采用定性分析方法，考察集权化加剧和组织自主权减少如何影响医院的决策。该研究在2015年和2022年收集并分析了15位医院管理人员的数据（每年8次访谈，1人接受了两次访谈），以了解重大集权化举措后的变化以及疫情和卫生部门改革的影响。
集权化减少了许多机构在财务和运营管理方面的自主权，导致决策延迟，尤其是在财务事项上，还带来了巨大的行政和报告负担。尽管如此，医院管理人员报告称在制定和管理服务组合方面仍保留了一些专业自主权，但这种自主权主要是操作性的而非战略性的，并且受到财务限制。
研究局限性/启示：本研究考察了受独特政治背景影响的匈牙利医疗保健系统，这在研究结果的可转移性方面也存在方法上的局限性。
医院高层管理人员的专业自主权常常被沉重的行政和财务压力所掩盖；因此，增强他们的战略思维至关重要。
政策制定者在医院管理中应采取全面的视角，尤其要注重平衡财务和医疗视角。
原创性/价值：本文聚焦于一个未被充分探索的领域：集权化背景下医院高层管理的组织自主权，通过强调组织方面向医院管理人员和政策制定者传递了信息。
