Wheeler J R, Zuckerman H S
Health Serv Res. 1984 Oct;19(4):499-518.
Previous studies have shown that external management by contract can improve the performance of managed hospitals. This article presents a conceptual framework which develops specific hypotheses concerning improved hospital operating efficiency, increased ability to meet hospital objectives, and increased ability to meet community objectives. Next, changes in the process and structure of management under contractual arrangements, based on observations from two not-for-profit hospital systems, are described. Finally, the effects of these management changes over time on hospital and community objectives are presented. These effects suggest progressive stages in the development of management contracts. The first stage focuses on stabilizing hospital financial performance. Stage two involves recruitment and retention efforts to secure necessary personnel. In the third stage, attention shifts to strategic planning and marketing.
先前的研究表明，通过合同进行外部管理可以提高被管理医院的绩效。本文提出了一个概念框架，该框架针对提高医院运营效率、增强实现医院目标的能力以及增强实现社区目标的能力提出了具体假设。接下来，基于对两个非营利性医院系统的观察，描述了合同安排下管理过程和结构的变化。最后，阐述了这些管理变化随着时间推移对医院和社区目标的影响。这些影响表明了管理合同发展的渐进阶段。第一阶段专注于稳定医院的财务绩效。第二阶段涉及招聘和留住必要人员的努力。在第三阶段，注意力转向战略规划和营销。
