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The purpose of this paper is to apply the image theory to the hospital context in order to add a perspective into the known complex relationship between physicians and hospital managers. This insight can enrich current intervention schemes used in health care to facilitate organisational change.

In this paper, the image theory of Alexander et al. on the known complex intergroup context of physicians and hospital managers is applied. The theory is operationalised in relative status, power, and goal incompatibility.

The data show the three variables are highly relevant and representative. Hospital managers see physicians as higher in professional status and power, and having different goals. Physicians see hospital managers to have higher power, lower status, and different goals. The study validates the applicability of the image theory in the Dutch hospital context. This results in a questionnaire suitable for performing a quick scan on the strength and direction of intergroup stereotyping within hospital organisations.

Data from the questionnaire give the opportunity to have insight in the way physicians and hospital managers perceive each other. This insight helps to focus attention on bottlenecks and possibilities in enhancing the co‐operation between physicians and hospital managers. Research on the relationship between physicians and hospital managers is scarce and mostly of a qualitative nature. This paper is executed in both qualitative and quantitative way, which enables us to empirically and statistically validate the data. The resulting questionnaire is applicable on an organisational intergroup level, while the focus in the extant literature is mostly on the interpersonal or intragroup level.

This chapter draws on a study conducted in the mid 1990s to compare management differences between three different groups of South African hospitals, in order to understand how these differences might have affected hospital functioning. The groups were public hospitals; contractor hospitals publicly funded but privately managed; and private hospitals owned and run by private companies. Public sector structures made effective management difficult and were highly centralized, with hospital managers enjoying little autonomy. In contrast, contractor and private groups emphasised efficient management and cost containment. These differences appeared to be reflected in cost and quality differences between the groups. The findings suggest that in the context of a country such as South Africa, with a relatively well-developed private sector, there is potential for the government to profit from the management expertise in the private sector by identifying lessons for its own management structures, and by contracting-out service management.

Hospitals are complex and complicated organizations and are prone to the conflict. The purpose of this paper is to identify the intensity and type of conflict experienced by hospital managers and explore their conflict management strategies in hospitals affiliated with Tehran University of Medical Sciences.

This quantitative, descriptive and cross-sectional study was conducted in 2015. A self-administered questionnaire was used to collect data from top, middle and front line managers. In total, 563 managers from 14 hospitals responded to the questionnaires. Data were analyzed using SPSS software version 19.

Hospital managers reported average level of conflict (2.73 score out of 5). Organizational factors produced more conflict for managers than personal factors. High workload, resource shortage, bureaucracy and differences in managers’ personality, knowledge, capabilities and skills were the main causes of organizational and personal conflict. Top managers experienced more conflict than middle and front line managers. Conflict was higher in specialized hospitals compared to general hospitals. Less conflict was observed in administrative and support departments than diagnostic and therapeutic departments. Conflict was meaningfully associated with management level, education, size of hospital, number of employees and willingness to leave the hospital. The dominant conflict management style of managers was collaborating. There were significant relationships between collaborating style and management level, manager’s age, work experience and management experience.

The nature of hospitals requires that managers use collaborating, compromising and accommodating styles to interact better with different stakeholders. Managers by acquiring necessary training and using the right conflict resolution strategies should keep the conflict in a constructive level in hospitals.

This is the first study conducted in Iran examining the level of conflict, its types and identifying managers’ dominant conflict resolution strategies at front line, middle and top management levels.

The purpose of this paper is to investigate the factors influencing the leadership effectiveness of hospital managers in Iran.

Top managers (15), middle managers (10) and operational managers (5) of public, private or social security hospitals in Tehran participated in a qualitative study using semi-structured in-depth interviews. Data were recorded, transcribed and then analyzed via MAXQDA 10 software.

The findings were categorized into two main themes of internal and external factors with eight sub-themes. The most important internal factors that had an influence on the leadership of the hospital managers were intra-organizational relations, manager’s personality traits, knowledge, attitude and skills of the manager. The most important external factors included extra-organizational relations, macro-level health policies, access to special financial resources, and social, economic and political factors.

The results call for a need to understand and analyze the socioeconomic factors influencing managers’ leadership while adopting appropriate strategies.

The results of the current study can help design training programs for hospital managers, and suggest criteria for appointing hospital managers across the country and this can enhance the effectiveness of their leadership. Health sector policymakers and decision makers should reform the programs that target training and empowerment of hospital managers so that the right people with the right competencies will hold such positions.

The results of this study showed that leadership effectiveness is also influenced by social and external factors. On the other hand, the effectiveness of management leadership can play a significant role in the quality of care provided to the community, patient satisfaction and in hospital social performance through the appropriate management of all hospital resources. Such factors should also be considered in training and appointing hospital managers.

Although there are several studies on hospital managers’ leadership worldwide, this study is the first to investigate the leadership effectiveness of hospital managers in Iran.

Lean implementations in hospitals tend to be lengthy or lack the desired results. In addressing the question, how can lean be implemented effectively in a hospital-wide setting, this paper aims to examine two opposing approaches.

The authors studied two Dutch university hospitals which engaged in different lean implementation approaches during the same four-year period: top-down vs bottom-up. Inductive qualitative analyses were made of 49 interviews; numerous documents; field notes; 13 frontline meeting observations; and objective hospital performance data. Longitudinally, the authors depict how the sequential events unfolded in both hospitals.

During the six implementation stages, the roles played by top, middle and frontline managers stood out. While the top managers of one hospital initiated the organization-wide implementation and then delegated it to others, the top managers of the other similar hospital merely tolerated the bottom-up lean activities. Eventually, only the hospital with the top-down approach achieved high organization-wide performance gains, but only in its fourth year after the top managers embraced lean in their own daily work practices and had started to co-create lean themselves. Then, the earlier developed lean infrastructure at the middle- and frontline ranks led to the desired hospital-wide lean implementation results.

Change-management insights, including basic tenets of social learning and goal-setting theory, are shown to advance the knowledge of effective lean implementation in hospitals. The authors found lean implementation “best-oiled” through role-modeling by top managers who use a phase-based process and engage in close cross-hierarchical or co-creative collaboration with middle and frontline managerial members.

This paper seeks to explore the legitimacy of budgets as management control processes in hospitals after comprehensive reforms were implemented in the Norwegian hospital sector in 2002.

The paper employs qualitative interviews with top level clinical managers in three large hospitals.

The study shows a variety of practices among the clinical managers as to management control adjustments. The managers use different strategies in order to cope with the budget frames.

This paper contributes to the current debate and research relating to the budgeting and performance management practices in hospital settings.

These findings contribute to contextual knowledge that is relevant in understanding the diverse practices of clinical managers in hospitals as complex service producing organizations.

The findings give information to decision makers as to the diversity in management practices within knowledge intensive organizations.

The paper challenges the idea that the strategies used by managers can be understood by the concepts of the means‐end rationality prescribed in most of the reforms introduced into the hospital sector.

Hospital nurse managers are in the middle. Their supervisors expect that they will monitor and discipline nurses who commit errors, while also asking them to create a culture that fosters reporting of errors. Their staff nurses expect the managers to support them after errors occur. Drawing on interviews with 20 nurse managers from three tertiary care hospitals, the study identifies key exemplars that illustrate how managers monitor nursing errors. The exemplars examine how nurse managers: (1) sent mixed messages to staff nurses about incident reporting, (2) kept two sets of books for recording errors, and (3) developed routines for classifying potentially harmful errors into non-reportable categories. These exemplars highlight two tensions: the application of bureaucratic rule-based standards to professional tasks, and maintaining accountability for errors while also learning from them. We discuss how these fundamental tensions influence organizational learning and suggest theoretical and practical research questions and a conceptual framework.

Hospitals need highly trained and competent managers to be responsible for the strategic development, overall operation and service provision. The identification and confirmation of core management competency requirements is a fundamental first step towards developing the competent management workforce for sustainable hospital service provision. This paper reports on the finding of a recent study focusing on identifying managerial competencies required by middle and senior-level managers in the public hospitals in Iran.

The qualitative research design included position description analysis and focus group discussions with middle and senior-level public hospital managers in Iran. When analysing the identified knowledge, skills and attitudes, the validated MCAP framework was used to guide the grouping of them into associating management competencies.

The study identified 11 to 13 key tasks required by middle and senior-level managers and confirmed that the position descriptions used by current Iranian hospitals might not truly reflect the actual core responsibilities of the management positions. The study also confirmed seven core managerial competencies required to perform these tasks effectively. These core competencies included evidence-informed decision-making; operations, administration and resource management; knowledge of healthcare environment and the organisation; interpersonal, communication qualities and relationship management; leading people and organisation; enabling and managing change and professionalism.

Competencies were identified based on managers' perceptions. Views and experiences of other stakeholders were not captured.

The seven core management competency identified in the current study provides a clear direction of competency development among senior and middle-level managers working at the Iranian public hospitals. The study also confirms that position descriptions do not reflect the actual responsibilities of current hospital managers, which are in need to urgent review.

This is the first study that has identified the core managerial competencies required by middle and senior-level hospital managers in Iran.

Mergers are important and challenging elements in hospital reforms. The authors study the social aspects of management and the roles of middle managers in the aftermath of a hospital merger. Especially, the purpose of this paper is to investigate how professional staff and middle managers perceive their relationships with top managers several years after the merger.

A survey was conducted among the professional staff in two merging hospitals’ units six years after a merger. Based on the main findings from this survey, a follow-up interview study was done with a group of middle managers.

The management practices were diagnostic with few interactive or communicative activities. The respondents expressed that mistrust developed between the staff and the top management, and a lack of involvement and interaction lead to decoupled and parallel organizations. Social controls, based on shared norms, had not been developed to create mutual commitment and engagement.

Policy makers should be aware of the need in profound change processes not only to change the tangible elements, but to take care of changing the less tangible elements such as norms and values. Professionals in hospitals are in powerful positions, and changes in such organizations are dependent on trust-building, bottom-up initiatives and evolutionary pathways.

The paper addresses the need to understand the dynamics of the social aspect in managing hospitals as knowledge-intensive organizations when comprehensive restructuring processes are taking place over several years.

The rate of turnover of hospital managers has been high in Sweden. Hospitals are regarded to be difficult to manage, which is connected with different discourses and action logics such as politics, medicine, care and management creating complex conditions for hospital management. The purpose of this paper is to analyse hospital managers' management conditions in conjunction with hospital mergers.

Two case studies concerning hospital mergers illustrate these management conditions by means of analysing how different actions are communicated by politicians, county council directors, and hospital managers. The author's own experiences as a hospital manager have been made use of, as have document studies. In the analysis, conducted with the support of several theoretical perspectives, certain themes emerge which touch upon these management conditions.

In connection with hospital mergers, leading hospital actors carry out communicative games controlled by different action logics. No one wants to get stuck with the losing card. The article demonstrates the difficulties of implementing radical organizational changes in hospitals. A challenge for hospital managers lies in creating a shared dialogue and a consensus with the professions, the politicians and the media. The crucial position of power held by the politicians and the professions in critical situations has to be dealt with. Otherwise the hospital manager has to resign.

The paper aims to clarify under which management conditions the hospital manager acts.