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Structuring ambiguity in hospital governance

Author

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  • Gerard Scholten
  • Linda Muijsers‐Creemers
  • Jan Moen
  • Roland Bal

Abstract

This empirical, multicase research into developing governance structures highlights the strategies of four Dutch hospitals to strengthen their governability. The hospitals studied choose to commit themselves to duality as their starting point for structuring governance arrangements. All of them create positions of doctors and managers that are based on consensual decision making and common responsibility, in this way structuring governance at hospital level and unit level. Interestingly, they consciously choose to create ambiguous positions keeping formalization by rules and job descriptions low. Efficacy of dual hospital governance depends heavily on personal strength, mutual understanding, and trust of the incumbents, which offers new chances for governability but also harbors vulnerability to hospital governance.

Suggested Citation

  • Gerard Scholten & Linda Muijsers‐Creemers & Jan Moen & Roland Bal, 2019. "Structuring ambiguity in hospital governance," International Journal of Health Planning and Management, Wiley Blackwell, vol. 34(1), pages 443-457, January.
    • Handle: RePEc:bla:ijhplm:v:34:y:2019:i:1:p:443-457
    DOI: 10.1002/hpm.2693
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    References listed on IDEAS

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    1. Scholten, Gerard R.M. & Grinten, TED van der, 2005. "The integration of medical specialists in hospitals. Dutch hospitals and medical specialists on the road to joint regulation," Health Policy, Elsevier, vol. 72(2), pages 165-173, May.
    2. Charles Sabel, 2004. "Pragmatic Collaborations in Practice: A Response to Herrigel and Whitford and Zeitlin," Industry and Innovation, Taylor & Francis Journals, vol. 11(1-2), pages 81-87.
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    Cited by:

    1. Embuldeniya, Gayathri & Gutberg, Jennifer & Sibbald, Shannon S. & Wodchis, Walter P., 2021. "The beginnings of health system transformation: How Ontario Health Teams are implementing change in the context of uncertainty," Health Policy, Elsevier, vol. 125(12), pages 1543-1549.

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