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Book part
Publication date: 1 January 2008

Mostafa Kamal Hassan

Purpose – The paper explains how internal reporting systems, as embedded practices informing organizational actions and “know-how”, contributed to the inertia in…

Abstract

Purpose – The paper explains how internal reporting systems, as embedded practices informing organizational actions and “know-how”, contributed to the inertia in implementing a corporate form of governance in a transitional public organization in a developing country – Egypt.

Design/methodology/approach – The paper synthesizes an institutional theory framework in order to capture the case study mixed results. Drawing on DiMaggio and Powell's (1983) notions of isomorphic mechanisms, Ocasio (1999) and Burns and Scapens’ (2000) notions of organizations’ memory, history, cumulative actions and routines, Brunsson's (1994) notion of organizational institutional confusion as well as Carruthers's (1995) notion of “symbolic window-dressing” adoption of new practices, the paper explores the dynamic of a public hospital corporatization processes. Data collection methods include semi-structured interviews, documentary evidence and direct observation.

Findings – The case study evidence shows that the interplay between the new form of “corporate” governance and the intra-organizational power, routines and “know-how” created internal organizational confusion and changed organizational members’ narrative of risk and uncertainties.

Research limitations/implications – The paper does not reveal the role of reformers involved in the public sector “governance” reform in developing countries. Exploring such a role goes beyond the scope of this paper and represents an area of future research.

Originality/value – The paper provides a comprehensive account of public sector “governance” reform in a developing nation, while exploring the role of management accounting and costing systems in facilitating or otherwise that reform processes.

Details

Corporate Governance in Less Developed and Emerging Economies
Type: Book
ISBN: 978-1-84855-252-4

Article
Publication date: 27 June 2019

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

The purpose of this paper is to present the contemporary understanding and emerging structural models of organisational governance of public hospitals in order to provide…

Abstract

Purpose

The purpose of this paper is to present the contemporary understanding and emerging structural models of organisational governance of public hospitals in order to provide evidence-based guidance to countries that are reforming their public hospital governance structures in line with best practice.

Design/methodology/approach

The paper uses the structural dimension of Cooper, Fusarelli and Randall’s policy model and institutional theory to review the legislative frameworks of four model countries supported by extant literature.

Findings

The paper conceptually distinguishes health system governance and organisational governance in the health system. It further visualises the emerging alternative legislative models of organisational governance and a hierarchy of governors applicable to public hospitals.

Originality/value

The paper provides critical knowledge for understanding organisational governance within health system governance framework and develops tools that can be used in reforming institutional mechanism of organisational governance of public hospitals.

Details

International Journal of Health Governance, vol. 24 no. 2
Type: Research Article
ISSN: 2059-4631

Keywords

Article
Publication date: 29 April 2021

Andrew Munthopa Lipunga, Betchani Henry M. Tchereni and Rhoda Cynthia Bakuwa

Sound organisational governance does not occur naturally; it is a product of effective awareness. This study aims to examine the level of governance awareness among public

Abstract

Purpose

Sound organisational governance does not occur naturally; it is a product of effective awareness. This study aims to examine the level of governance awareness among public hospitals' governance actors in Malawi.

Design/methodology/approach

The study uses semi-structured interviews to collect data that are analysed thematically.

Findings

The study found that governance awareness among the actors was low. Although the majority of the actors displayed a broad perspective, they, however, failed to clearly affirm the nexus of the governing organs – hospital board (or its equivalent) and hospital management. Furthermore, most were not aware of the existence of the country's self-regulatory framework for organisational governance. A possible compounding factor to the low level of awareness is their educational background that hardly recognises organisational governance as an essential component of their professional identity.

Originality/value

This is the first study to explore in-depth governance awareness in the context of public hospitals in developing countries. It highlights the need to develop strategies for creating effective governance awareness amongst the actors, which is often overlooked when carrying governance reforms.

Details

International Journal of Public Leadership, vol. 18 no. 1
Type: Research Article
ISSN: 2056-4929

Keywords

Article
Publication date: 8 February 2008

Patience Aseweh Abor, Gordon Abekah‐Nkrumah and Joshua Abor

The purpose of this paper is to examine the nature of governance structures in Ghanaian hospitals by comparing the governance systems in public and private hospitals.

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Abstract

Purpose

The purpose of this paper is to examine the nature of governance structures in Ghanaian hospitals by comparing the governance systems in public and private hospitals.

Design/methodology/approach

This study employs a comparative case methodology. It compares the governance structures in private hospitals to that of public hospitals in Ghana to ascertain whether they exhibit different or similar governance systems. The results obtained are analyzed and discussed to ascertain the extent to which the governance structures in these hospitals conform to Taylor's principles of good governance.

Findings

The results of the study revealed numerous differences in the governance structures in private and public hospitals in Ghana. From the review of Taylor's principles of good governance and the comparative case analysis, it was observed that some of the principles are not present in the current hospital governance systems.

Originality/value

The findings of this paper have important implications for proper governance and management of the Ghanaian health institutions.

Details

Leadership in Health Services, vol. 21 no. 1
Type: Research Article
ISSN: 1751-1879

Keywords

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

Keywords

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

Keywords

Article
Publication date: 9 October 2017

Rachel Canaway, Marie Bismark, David Dunt and Margaret Kelaher

The purpose of this paper is to understand the concerns and factors that impact on hospital quality and safety, particularly related to use of performance data, within a…

1121

Abstract

Purpose

The purpose of this paper is to understand the concerns and factors that impact on hospital quality and safety, particularly related to use of performance data, within a setting of devolved governance.

Design/methodology/approach

This qualitative study used thematic analysis of interviews with public hospital medical directors. For additional context, findings were framed by themes from a review of hospital safety and quality in the same jurisdiction.

Findings

Varying approaches and levels of complexity were described about what and how performance data are reviewed, prioritised, and quality improvements implemented. Although no consistent narrative emerged, facilitators of improvement were suggested relating to organisational culture, governance, resources, education, and technologies. These hospital-level perspectives articulate with and expand on the system-level themes in a state-wide review of hospital safety and quality.

Research limitations/implications

The findings are not generalisable, but point to an underlying absence of system-wide agreement on how to perceive, retrieve, analyse, prioritise and action hospital performance data.

Practical implications

Lack of electronic medical records and an inefficient incident reporting system limits the extent to which performance and incident data can be analysed, linked and shared, thus limiting hospital performance improvement, oversight and learning.

Social implications

Variable approaches to quality and safety, standards of care, and hospital record keeping and reporting, mean that healthcare consumers might expect inconsistency across Victorian hospitals.

Originality/value

The views of medical directors have been little researched. This work uses their voice to better understand contextual factors that situate and impact on hospital quality and safety towards understanding the mixed effectiveness of hospital quality improvement strategies.

Details

Journal of Health Organization and Management, vol. 31 no. 7/8
Type: Research Article
ISSN: 1477-7266

Keywords

Article
Publication date: 14 February 2020

Alison Brown

The importance of hospital board engagement in the work of governing healthcare quality has been demonstrated in the literature. Research into influences on effective…

8113

Abstract

Purpose

The importance of hospital board engagement in the work of governing healthcare quality has been demonstrated in the literature. Research into influences on effective corporate governance has traditionally focused on board architecture. Emerging research is bringing to light the importance of governance dynamics. This paper contributes to emerging research through highlighting how communication and leadership underpin effective engagement in governing healthcare quality.

Design/methodology/approach

A comparative case study of eight Australian public hospitals was undertaken involving document review, interviews and observations. Case studies were allocated into high- or low-engagement categories based on evidence of governance processes being undertaken, in order to compare and contrast influencing factors. Thematic analysis was undertaken to explore how communication and leadership influence healthcare governance.

Findings

Several key components of communication and leadership are shown to influence healthcare quality governance. Clear logical narratives in reporting, open communication, effective questioning and challenge from board members are important elements of communication found to influence engagement. Leadership that has a focus on healthcare excellence and quality improvement are aligned and promote effective meeting processes is also found to foster governance engagement. Effective engagement in these communication and leadership processes facilitate valuable reflexivity at the governance level.

Practical implications

The findings highlight the way in which boards and senior managers can strengthen governance effectiveness through attention to key aspects of communication and leadership.

Originality/value

The case study approach allows the exploration of communication and leadership in greater depth than previously undertaken at the corporate governance level in the healthcare setting.

Details

Journal of Health Organization and Management, vol. 34 no. 2
Type: Research Article
ISSN: 1477-7266

Keywords

Article
Publication date: 7 July 2014

Didier Vinot

The perpose of this paper is to analyse recent changes in the management of French public hospitals, following a reform enacted in 2009 and aimed at bolstering the…

Abstract

Purpose

The perpose of this paper is to analyse recent changes in the management of French public hospitals, following a reform enacted in 2009 and aimed at bolstering the managerial roles of doctors.

Design/methodology/approach

The paper is exploratory and is based on both the analysis of French literature dealing with the results of the 2009 reform, and ten semi-directed interviews with clinical managers and top leaders in the public hospital sector.

Findings

The author reports on the major hospital management reforms of 2009 and analyse the implications for the medical profession and management. The author shows that the involvement of the classical clinical leaders has become less regulated as the units no longer have a clear legal basis. The governance of the newly introduced “medical poles” appears to be shaped by various factors: there is high correlation between centrality, prestige and “clan involvement”, which suggests that professionals holding new responsibilities obtain power and legitimacy by consolidating pre-existing networks. While it is often argued that high-quality clinical leadership is a key factor of organisational success, the findings suggest that the performance of clinical managers relies on this network and legitimacy acquired from it.

Originality/value

Drawing on the “sociology of translation” and actor-network theory (Callon and Latour, 1991), this paper provides a new conceptual framework for the analysis of the transformation of the role of clinical leaders, arguing that this transformation depends highly on their abilities to build and use networks. The findings challenge the French tradition of public management that presupposes a clear division of power between doctors and administrative staff.

Details

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

Keywords

Article
Publication date: 24 August 2021

Desmond Ng and Nima Khodakarami

This study draws on resource dependence theory (RDT) to explain a board's governance function in the United States (US) nonprofit healthcare industry. Specifically, while…

Abstract

Purpose

This study draws on resource dependence theory (RDT) to explain a board's governance function in the United States (US) nonprofit healthcare industry. Specifically, while various nonprofit research studies have appealed to agency theory (AT) to explain the monitoring role of an outside board, RDT offers an alternative explanation that emphasizes an outside board's resource gathering role.

Design/methodology/approach

In drawing on the nonprofit GuideStar database, a fixed effect (FE) panel estimation was conducted on a sample of 230 US Non Profit Healthcare Organizations (NPHCOs). This panel estimation examines the relationship between the composition of an outside board and an NPHCO’s revenue and public support performance.

Findings

A key finding of this study is that the composition of an outside board involving its' number, compensation and gender impacts an NPHCO’s revenue and public support.

Research limitations/implications

This study shows that the composition of an outside board impacts an NPHCO’s ability to gain access to external resources. As NPHCOs face increasing pressure to seek external forms of revenue support, this study suggests that boards should favor a larger number, compensation and female representation of outside members.

Practical implications

The composition of an outsider board can offer external sources of revenue support that lower the poor's requirements for financial assistance and thus affirm an NPHCO’s identity as a charitable organization.

Originality/value

As an NPHCO’s identity as a charitable organization is dependent on serving the medical needs of the poor, an outside board not only introduces a resource gathering function that is absent in the monitoring explanations of AT, but that this resource gathering function is important to affirming this identity.

Details

Journal of Health Organization and Management, vol. 36 no. 2
Type: Research Article
ISSN: 1477-7266

Keywords

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