Neo-liberal “reform” has in many countries shifted services across the boundary between the public and private sector. This policy re-opens the question of what structural…
Neo-liberal “reform” has in many countries shifted services across the boundary between the public and private sector. This policy re-opens the question of what structural and managerial differences, if any, differences of ownership make to healthcare providers. The purpose of this paper is to examine the connections between ownership, organisational structure and managerial regime within an elaboration of Donabedian’s reasoning about organisational structures. Using new data from England, it considers: how do the internal managerial regimes of differently owned healthcare providers differ, or not? In what respects did any such differences arise from differences in ownership or for other reasons?
An observational systematic qualitative comparison of differently owned providers was the strongest feasible research design. The authors systematically compared a maximum variety (by ownership) sample of community health services; out-of-hours primary care; and hospital planned orthopaedics and ophthalmology providers (n=12 cases). The framework of comparison was the ownership theory mentioned above.
The connection between ownership (on the one hand) and organisation structures and managerial regimes (on the other) differed at different organisational levels. Top-level governance structures diverged by organisational ownership and objectives among the case-study organisations. All the case-study organisations irrespective of ownership had hierarchical, bureaucratic structures and managerial regimes for coordinating everyday service production, but to differing extents. In doctor-owned organisations, the doctors’, but not other occupations’, work was controlled and coordinated in a more-or-less democratic, self-governing ways.
This study was empirically limited to just one sector in one country, although within that sector the case-study organisations were typical of their kinds. It focussed on formal structures, omitting to varying extents other technologies of power and the differences in care processes and patient experiences within differently owned organisations.
Type of ownership does appear, overall, to make a difference to at least some important aspects of an organisation’s governance structures and managerial regime. For the broader field of health organisational research, these findings highlight the importance of the owners’ agency in explaining organisational change. The findings also call into question the practice of copying managerial techniques (and “fads”) across the public–private boundary.
Ownership does make important differences to healthcare providers’ top-level governance structures and accountabilities and to work coordination activity, but with different patterns at different organisational levels. These findings have implications for understanding the legitimacy, governance and accountability of healthcare organisations, the distribution and use power within them, and system-wide policy interventions, for instance to improve care coordination and for the correspondingly required foci of healthcare organisational research.
This chapter reviews and integrates the empirical literature on the influence of organizational factors on hospital financial performance. Five categories of…
This chapter reviews and integrates the empirical literature on the influence of organizational factors on hospital financial performance. Five categories of organizational characteristics that research has addressed are identified and examined as part of the review: ownership, governance, integration, management strategy, and quality. With some exceptions, our review reveals a general lack of consistency and conclusiveness across studies in each area. Exceptions were found in the areas of governance (e.g., physician participation and board processes) and integration (e.g., horizontal system centralization). Despite the lack of conclusive findings across studies, our review suggests substantial opportunities for future work, including opportunities for qualitative and exploratory work. Additional implications for theory and management are discussed.
Investigates the differences in protocols between arbitral tribunals and courts, with particular emphasis on US, Greek and English law. Gives examples of each country and…
Investigates the differences in protocols between arbitral tribunals and courts, with particular emphasis on US, Greek and English law. Gives examples of each country and its way of using the law in specific circumstances, and shows the variations therein. Sums up that arbitration is much the better way to gok as it avoids delays and expenses, plus the vexation/frustration of normal litigation. Concludes that the US and Greek constitutions and common law tradition in England appear to allow involved parties to choose their own judge, who can thus be an arbitrator. Discusses e‐commerce and speculates on this for the future.
Keeping up to date with every new development in the world of information would be an impossible task, but we can at least do our best with those areas that should affect or he of professional interest to readers of The Electronic Library. So, no Lightbulb Joke or Dan Quayle home pages (which we have unearthed in the course of our researches), but in this and future columns we plan simply to list matters of interest that have come to our attention recently and which will be helpful to the electronic librarian.
The eChain type of bank accounting information system (eCBAS) is proposed to facilitate standard business document electronic exchanges between banks, central factories, and their satellite vendors in the virtual world. This framework integrates various software applications, running on a variety of platforms and/or frameworks facilitating the electronic exchange of standard business documents.
Instead of scrapping legacy systems, this framework takes advantage of web services, XBRL, web intelligent, pre‐warning systems and security technologies to improve the quality and accuracy of accounting information, supporting continuous monitoring and auditing.
Through eCBAS, financial institutes can now closely monitor the cash or production flows of their satellite vendors. Commercial banks can shorten the loan application periods and also offer quick loans with low‐cost capital to domestic small and medium satellite vendors at different operating stages.
This framework integrates a value chain product view to stress that all value chain activities be coupled together including account activities and fund capitalization. For concept verification, this paper presents a HNCB prototype bank accounting system based on the eCBAS framework. The successful implementation of eCBASs will provide banks/customers an increased level of comfort allowing transaction processing to be continued in an accurate, complete and highly controlled environment.
John D. Blair examines, in systematic detail, the challenges and opportunities that arise from the significantly different perspectives of context-specific versus context-free researchers and the literatures to which they contribute. He argues that reviews of one type or the other or both types of literatures may provide different understandings of the state of the art in a particular area of health care management. He also provides some detailed suggestions for writing quality reviews along with suggested topics for future reviews.
The development of electronic publishing heralds a new period in scientific communications. Besides the obvious advantages of an almost endless storage and transport…
The development of electronic publishing heralds a new period in scientific communications. Besides the obvious advantages of an almost endless storage and transport capacity, many new features come to the fore. As each technology finds its own expressions in the ways scientific communications take form, we analyse print on paper scientific articles in order to obtain the necessary ingredients for shaping a new model for electronic communications. A short historical overview shows that the typical form of the present‐day linear (essay‐type) scientific article is the result of a technological development over the centuries. The various characteristics of print on paper are discussed and the foreseeable changes to a more modular form of communication in an electronic environment are postulated. Subsequently we take the functions of the present‐day scientific article vis‐à‐vis the author and the reader as starting points. We then focus on the process of scientific information transfer and deal essentially with the information consumption by the reader. Different types of information, at present intermingled in the linear article, can be separated and stored in well‐defined, cognitive, textual modules. To serve the scientists better in finding their way through the information overload of today, we conclude that the electronic information transfer of the future will be, in essence, a transfer of well‐defined, cognitive information modules. In the last part of this article we outline the first steps towards a new heuristic model for such scientific information transfer.