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Article
Publication date: 14 June 2019

Ralf Kirchhoff, Erlend Vik and Turid Aarseth

The purpose of this paper is to give a comprehensive and updated analysis of the available academic literature (2000–2016) on management and reforms in the Nordic hospital

Abstract

Purpose

The purpose of this paper is to give a comprehensive and updated analysis of the available academic literature (2000–2016) on management and reforms in the Nordic hospital landscape.

Design/methodology/approach

A systematic literature review was conducted by searching articles in Scopus database, as well as applicable journals.

Findings

The vast majority of the Nordic articles are relatively coherent on the following: first, the reforms have created a change in the manager role or rather there are new expectations about the content of the manager role. Second, the reforms entail tension between profession and administration. Doctors who are managers identify themselves primarily as doctors, implicating that the medical logic has not competed out by an administrative logic. Third, the reforms have brought new opportunities for nurses. Still, nurse managers perceive tension between the profession and administration. Fourth, new public management (NPM) is often the framework or background for understanding change in hospitals or manager roles in the articles. Fifth, the majority of the articles are focusing on management as a general key concept.

Research limitations/implications

The search was limited to the period 2000–2016 and have only included articles published in English. There are several limitations around these choices: first, research published in a language other than English (i.e. Norwegian, Swedish, Finnish or Danish) are excluded. Second, it may take years before consequences of hospital reforms have impact on management and manager roles. Some of the articles are published relatively shortly after the implementation of the reform. Third, many factors in a reform have impact on management or manager roles, thus it is challenging to give simple explanations.

Practical implications

The authors would welcome a more pluralistic approach, and contributions that are not quite so busy describing and criticizing the NPMization of hospitals and management. In particular, the authors look forward to more research on how other reform trends, such as NPG, affect management in hospitals.

Originality/value

This review summarizes the literature on how academic literature (2000–2016) – in a Nordic reform context – has dealt with management in hospitals. The study reflects upon the academic literature per se. There are tendencies to explore reforms and management with some conceptual equivalence.

Details

Journal of Health Organization and Management, vol. 33 no. 5
Type: Research Article
ISSN: 1477-7266

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Article
Publication date: 16 March 2021

Andrew Munthopa Lipunga, Betchani M.H. Tchereni and Rhoda Cythia Bakuwa

The purpose of this paper is to explore the nature of governance reforms also called conceptual innovation for public hospitals in Malawi.

Abstract

Purpose

The purpose of this paper is to explore the nature of governance reforms also called conceptual innovation for public hospitals in Malawi.

Design/methodology/approach

It focuses on the reforms for central and district hospitals. It uses semi-structured interviews to collect data and thematic approach to analyse it.

Findings

The results show that the reforms for central hospitals are structurally well characterised as aimed at corporatisation though they are termed as automatisation. The terminological seems not to pose any harm on the direction of the reforms due to the thorough structural characterisation. On the other hand, reforms for district hospitals are vague as such implementation is retrogressive, in that, instead of progressively moving the hospitals towards greater autonomy the opposite is happening.

Originality/value

The paper highlights the significance of characterisation of the intended outcome on the direction of the reforms and proposes a framework to guide conceptual innovation for public hospitals in a devolution-mediated environment.

Details

International Journal of Health Governance, vol. 26 no. 2
Type: Research Article
ISSN: 2059-4631

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Article
Publication date: 27 March 2019

Jixia Mei and Ian Kirkpatrick

The purpose of this paper is to explore how far plans to “modernize” hospital management in China are converging toward a global model of new public management (NPM) or…

Abstract

Purpose

The purpose of this paper is to explore how far plans to “modernize” hospital management in China are converging toward a global model of new public management (NPM) or represent a distinctive pathway.

Design/methodology/approach

This paper draws on a systematic review of available secondary sources published in English and Chinese to describe both the nature and trajectory of hospital management reforms in China.

Findings

In China, while public hospital reforms bear many of the hallmarks of the NPM, they are distinctive in two key respects. First, the thrust of current reforms is to partially reverse, not extend, the trend toward marketization in order to strengthen the public orientation of public hospitals. Second is a marked gap between the rhetoric and reality of empowering managers and freeing them from political control.

Practical implications

This paper develops a framework for understanding the drivers and obstacles to hospital management reforms in China that is useful for managers, clinicians and policy makers.

Originality/value

In China, few authors have considered NPM reform in relation to healthcare. This paper contributes in better understanding current reforms taking place in China’s expanding healthcare sector and locates these within broader theoretical and policy debates.

Details

International Journal of Public Sector Management, vol. 32 no. 4
Type: Research Article
ISSN: 0951-3558

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Article
Publication date: 20 March 2009

Kari Nyland, Inger Johanne Pettersen and Katarina Östergren

The purpose of this paper is to discuss the dilemma that exists between the aims of public sector reforms and the ways organisations adjust to the management control reforms.

Abstract

Purpose

The purpose of this paper is to discuss the dilemma that exists between the aims of public sector reforms and the ways organisations adjust to the management control reforms.

Design/methodology/approach

To study the research purpose, empirical data were collected from Norwegian Regional Hospital Enterprises. The aim was to describe how these institutions have chosen to implement formal and informal mechanisms of control for coordination and management of hospitals.

Findings

The results indicated a comprehensive map of the different formal and informal adjustments to radical institutional reform changes. The reform strategies were met with a mixture of intended adjustments, partly realised ambitions and ignorance in the organisations, and the change towards accrual accounting system was found to have reversed effects compared with the original ambitions.

Research limitations/implications

This study was based on a small sample of organisations and interviews. The dimensions were somewhat crude, and the findings can be generalised reliably only to the population studied here. More research is needed for further explorations of these findings. The study reveals as similar with prior macro level institutional research a complex view on the implications of government initiatives as only one of many potentially powerful actors in such regulatory processes.

Practical implications

This work adds to leaders' understanding of how intended governmental strategies follow diverse paths of implementation.

Originality/value

These results provide useful support of prior findings as to the deeper understanding of why organisations that are exposed to the same reform initiatives, turn out to behave differently.

Details

Journal of Accounting & Organizational Change, vol. 5 no. 1
Type: Research Article
ISSN: 1832-5912

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Article
Publication date: 2 March 2015

Kari Nyland and Inger Johanne Pettersen

The purpose of this paper is to discuss why public sector reforms hybridize during implementation processes, consequences on accountability relations and practitioners…

Abstract

Purpose

The purpose of this paper is to discuss why public sector reforms hybridize during implementation processes, consequences on accountability relations and practitioners’ and policymakers’ reactions to these changes.

Design/methodology/approach

The paper considers experiences from three initiatives related to the governance reform in the Norwegian hospital sector. Data were collected via interviews and document studies, and all three cases were longitudinal studies.

Findings

Unexpected consequences of reform initiatives and contextual changes are causing controls to hybridize and having profound effects on accountability relations. However, the gradually alignment of controls in a dynamic pattern of hybridization enables the balancing of conflicts in the chain of accountabilities. Hybrid controls are observed to emerge as stronger than the initial ideal control models. The longitudinal studies of control hybridization illuminate the sector’s survival in the long run, as they allow for adaptation to changes in contexts.

Practical implications

This work augments leaders’ understanding of how governmental strategies may follow diverse paths and yield results that diverge from intentions. Narrow accountability bases inhibit the government from implementing political decisions through agencies. Conversely, agents must relate to direct control from authorities. The predictability of agents’ decision space is reduced, and the control process becomes more ambiguous.

Originality/value

Through connecting what happens in agencies with accountabilities in the political level, it is possible to study the flexible nature of accountability relations and why controls hybridize. The paper underlines the need for longitudinal studies to describe complex patterns of reform initiatives.

Details

International Journal of Public Sector Management, vol. 28 no. 2
Type: Research Article
ISSN: 0951-3558

Keywords

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Book part
Publication date: 4 January 2016

Corinne Grenier and Johan Bernardini-Perinciolo

Adopting an agentic positioning, we question and compare competing logics hybridization within French hospitals and universities facing major reforms inspired by new…

Abstract

Adopting an agentic positioning, we question and compare competing logics hybridization within French hospitals and universities facing major reforms inspired by new public management. In addition to the resulting forms of hybridization exposed in the literature (accepted or refused), we observe four additional modes: instrumentalized, uncomfortable, reformulated, and suffered. They all reveal the varied manner with which each professional faces reform. However, we develop a new argument: the ways professionals hybridize (or do not) their prevailing logic depends on an overarching mode of hybridization that characterizes the way their organization deals with reform. We identify two contrasting modes: overarching strategic logics hybridization and overarching enforced logics hybridization. They give insight into how actors decouple structure from practices. We contribute to the literature on logics hybridization by first analyzing the role of specific actors who act as either a translator-actor or a closure-actor to respectively facilitate appropriation of the reforms or to protect professionals against the growing dominance of the new logic introduced by the law; and secondly by discussing importance of articulating higher and lower organizational levels all involved in hybridization.

Details

Towards a Comparative Institutionalism: Forms, Dynamics and Logics Across the Organizational Fields of Health Care and Higher Education
Type: Book
ISBN: 978-1-78560-274-0

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Article
Publication date: 20 September 2011

Inger Johanne Pettersen and Kari Nyland

The purpose of this paper is to provide insights into the process of the accounting system change as a part of a larger reform initiative taking place in Norway. The…

Abstract

Purpose

The purpose of this paper is to provide insights into the process of the accounting system change as a part of a larger reform initiative taking place in Norway. The research context is the national network of hospital enterprises.

Design/methodology/approach

The paper uses an archival‐based case approach of official documents (between 2000 and 2009) to study the formal layers of accounting practices.

Findings

The accrual accounting information signalled major management control problems, but the hospital owner, the state, did not take action to solve these problems during this period. The contracts between the state and hospital enterprises were characterised as principal‐agent relationships. However, different accounting techniques were mixed in the contracts between the parties, indicating hybridisation of accounting systems.

Research limitations/implications

The authors did not study the perceptions and practices of key actors and this is a limitation of the study.

Practical implications

The findings are likely to be useful for practitioners and researchers to gain knowledge on the implementation of management reforms in public sector service organisations.

Originality/value

This paper contributes to our understanding of the diverse processes within which public sector reforms are taking place. The main contribution is a discussion of the diversity in accounting system changes.

Details

Journal of Accounting & Organizational Change, vol. 7 no. 3
Type: Research Article
ISSN: 1832-5912

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Article
Publication date: 8 August 2008

Haldor Byrkjeflot and Simon Neby

This paper aims to discuss recent contributions to comparative healthcare systems research, which emphasise decentralisation as a major characteristic of Scandinavian…

Abstract

Purpose

This paper aims to discuss recent contributions to comparative healthcare systems research, which emphasise decentralisation as a major characteristic of Scandinavian hospital systems. Whether the idea of such a “decentralised Scandinavian model” is appropriate and useful, how and why it was created, and what the alternative is, are central questions approached through a perspective gathered from historical institutionalism.

Design/methodology/approach

The paper employs an analysis of primary and secondary sources on the history of Scandinavian hospital systems, a classification based on historical developments, and an explanatory framework based on historical institutionalism.

Findings

The paper concludes that the idea of a decentralised Scandinavian model for hospital systems has had limited validity, constrained to the years 1970‐2000. Historical trajectories and recent developments both indicate that the three systems are more different than commonly assumed, and that recently they seem to be moving in separate directions. The explanation for the developments is found in incremental dynamics, creating institutional change that to a large extent depends on national contexts.

Originality/value

The paper contributes to the current discussion and research relating to classification of health care systems, and aims at developing a more elaborate understanding of the role of the hospital sectors within the Scandinavian welfare states. It challenges the idea that a single model can capture the essence of such diverse systems, and proposes an alternative to such modelling, based on a historical‐institutional approach.

Details

Journal of Health Organization and Management, vol. 22 no. 4
Type: Research Article
ISSN: 1477-7266

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Article
Publication date: 28 January 2020

Anna Stephansen

The purpose of this paper is to propose an analytical approach that allows capturing a variety of outcomes of health care reforms. Specifically, by means of employing…

Abstract

Purpose

The purpose of this paper is to propose an analytical approach that allows capturing a variety of outcomes of health care reforms. Specifically, by means of employing neo-institutional perspective, it is suggested that scholars need to take a step back and analyze the interrelation between regulatory, organizational and professional norms (dimensions). This approach improves our understanding of the complex outcomes of health care reforms. To illustrate this point, the case of coordination reform in Norway is discussed. This reform has been one of the most complex health care reforms with ambitious goals of achieving perfectly integrated care between hospitals and municipalities. The analysis through the three sets of institutional norms (dimensions) provides more comprehensive understanding of the various outcomes of the reform. The conclusion is that in order to understand the vast complexity of the outcomes of different health care reforms, we need to carefully study the institutional characteristics of rules, clinical codes of conduct, organizational characteristics as well as interplay between them. Analysis based on the three dimensions, shows that the neo-institutional approach, is of highest relevance to understand the outcomes of the complex health reforms.

Design/methodology/approach

Discussion in this paper is inspired by author’s PhD dissertation that comprised a study of juridification, understood as legal regulation, in treatment practice in the field of specialized health services. Three dimensions described in this paper are derived from the analysis of two types of empirical material: legal regulations and administrative guidelines in the area of patients’ rights interviews with psychiatrists and psychologists in the region of Western Norway about how they practice the regulations. The aim of this empirical study was to explore the implications the new regulations have had for clinical practice after the patients’ rights regulations became binding for clinical reasoning in Norway. This paper presents a viewpoint that applies the three dimensions derived from the empirical analysis to the discussion about the outcomes of one of the most complex Norwegian health reforms, i.e. coordination re-form. It is argued that the observations can be relevant for the analysis of the implication of health reforms in general.

Findings

The observations presented in the discussion of the possible implications of regulations of coordination reform indicate the complexity and sometimes contradictory outcomes of health regulations. There is a complex interplay between the different kinds of regulatory tools, which might have different implications at different levels. The same regulations can both strengthen and weaken established institutional order. Implications of such processes need to be empirically explored and neo-institutional approach still is of highest relevance in helping scholars understand the complex outcomes of health regulations.

Practical implications

Outcomes of regulations will depend on the balance between regulations and other institutional dimensions. The significant aspect of it is that this balance between the dimensions is not a zero sum equation, which means that all dimensions can be strengthened or weakened simultaneously.

Originality/value

The institutional dimensions can be in different balance relation with each other. The point of departure in this paper is that the legal regulations have been strengthened, i.e. expanded with regard to the coordination in health services. This development has been called juridification. The outcomes of it will depend on the balance between regulations and other institutional dimensions at work. The significant aspect of it is that this balance is not a zero sum equation, which means that all dimensions can be strengthened or weakened simultaneously.

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Article
Publication date: 7 July 2014

Laila Nordstrand Berg and Haldor Byrkjeflot

The hospital sector has expanded in Norway with reforms and a strong demand for better management. The purpose of this paper is to examine: first, how this has affected…

Abstract

Purpose

The hospital sector has expanded in Norway with reforms and a strong demand for better management. The purpose of this paper is to examine: first, how this has affected physicians and nurses in management; second, how management roles in hospitals are changing; and third, how these two professions are tackling their new roles.

Design/methodology/approach

The paper presents a review of the secondary literature and a case study undertaken in the spring, 2012.

Findings

In Norway, two reforms have been introduced aimed at creating stronger management positions with less professional influence. The leader has full responsibility for a particular unit, which means that the jurisdiction of managers has expanded and that management has become more time consuming. Physicians – traditionally those in charge of hospitals – are facing competition from other professions, especially nursing, which has gained representation in top management positions, particularly at middle management level.

Originality/value

The originality of this paper is the comparison of the evolvement of management among physicians and nurses since the reforms. While the medical profession was critical of management to begin with, i.e. viewing management positions as a trap, it is gradually adapting to the new ideas. Physicians are facing competition from nurses, who readily adjust to the new conditions, and perceive management as a new career track.

Details

International Journal of Public Sector Management, vol. 27 no. 5
Type: Research Article
ISSN: 0951-3558

Keywords

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