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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.

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

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Article
Publication date: 22 May 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

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Article
Publication date: 6 June 2016

Heru Fahlevi

This paper aims to understand why an expected enhanced role of accounting in Indonesian public hospitals has not occurred, although serial organizational changes and…

Abstract

Purpose

This paper aims to understand why an expected enhanced role of accounting in Indonesian public hospitals has not occurred, although serial organizational changes and reform of hospital payment systems have taken place.

Design/methodology/approach

This study adopts a multiple case study research approach. It was carried out in two Indonesian public hospitals. Interviews were the main tool used for collecting data. The primary interviewees were the top managers, accountants and senior physicians in the hospitals surveyed.

Findings

Insights from the interviews revealed that the owners’ traditional role of funding deficits plus the conventional mindsets of managements and physicians who are only interested in health outcomes have hindered the infiltration of economic and accounting logic into the management of these two public hospitals. Consequently, the expected accounting innovations, i.e. an enhanced role of accounting in the hospitals’ daily activities did not emerge.

Research limitations/implications

This case study is not a longitudinal study and the interviewees, particularly senior physicians, were selected based on their availability and willingness to participate in the interviews. Thus, the findings should be treated with caution.

Practical implications

An enhanced role of accounting and other accounting innovations would indicate that the hospitals are responding as expected to the institutional and financial reforms.

Originality/value

Contingency theory and institutional theory have been used together in this study which aims to not only discuss the reasons for accounting changes occurring or not occurring, but also to understand the motivations behind the accounting changes or lack of change. Thus, a more comprehensive understanding of accounting innovations is expected.

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Book part
Publication date: 10 November 2005

Anne Mills and Jonathan Broomberg

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…

Abstract

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.

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International Health Care Management
Type: Book
ISBN: 978-0-76231-228-3

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Article
Publication date: 4 November 2019

Qiwen Jiang, Xiaojing Luo, Sibo Wang and Shi-Jie (Gary) Chen

Public hospitals in China usually rely on revenues from medical services and medications to compensate for major costs given their nonprofit nature. The lack of government…

Abstract

Purpose

Public hospitals in China usually rely on revenues from medical services and medications to compensate for major costs given their nonprofit nature. The lack of government subsidies and unreasonable prices of medical services have led to high medical costs and unbalanced reimbursement system for public hospitals. There is a critical need of research on improvement of reimbursement system that will create positive effect on China’s health-care system. This paper aims to focus on four dimensions of stakeholders (government, patients, medical insurance agencies and social organization) and six major expenditures to explore reimbursement scheme for public hospitals in China with the purpose of relieving unbalanced income and expenditure of hospitals, avoiding medication markups and reducing medical expenses from patients.

Design/methodology/approach

In this paper, the authors study reimbursement scheme for public hospitals from the perspective of four dimensions of stakeholders and how stakeholders reimburse six major expenditures of hospitals. A total of 128 effective samples were collected from financial data of 32 public hospitals through 2009-2012. This paper analyzes the econometric models of the selected revenue and expenditure. This paper analyzes the econometric models of the selected revenue and expenditure using linear regression. The linear relationship between each cost and different types of incomes (i.e. reimbursements from government, patients, insurance agencies and social organization) is analyzed before and after cancelling the medication markups.

Findings

Results from empirical research verify that government reimbursement is insufficient, and using medication markups to compensate for medical service costs has become a serious problem for China’s public hospitals. To avoid the medication markups and improve the reimbursement scheme, government should reimburse labor cost, fixed assets cost and research cost; patients and medical insurance agencies should reimburse the costs of medical service, medication and administration/operations; and social organization should supplement the fixed assets cost.

Originality/value

In this study, the authors defined and classified stakeholders of reimbursement scheme for public hospitals in China, which help understand the roles and effects that different stakeholders can play in compensation. Along with the proposed reimbursement scheme framework, this study will help make effective implementation of new health-care reform program in China.

Details

Chinese Management Studies, vol. 13 no. 4
Type: Research Article
ISSN: 1750-614X

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Article
Publication date: 13 November 2017

Sui Pheng Low, Shang Gao and Gina Qi Er Wong

Singapore’s health-care infrastructure is suffering from increasing pressure due to population growth and a rapidly ageing population. This paper aims to assess the…

Abstract

Purpose

Singapore’s health-care infrastructure is suffering from increasing pressure due to population growth and a rapidly ageing population. This paper aims to assess the resilience of hospital facilities in Singapore’s health-care industry. The main attribute of resilience is adaptive capacity, which is also associated with vulnerability. Vulnerability is defined as the system’s susceptibility to threats that cause damage and affect its normal performance, while resilience is defined as the ability to anticipate and the capacity to change before a setback becomes obvious.

Design/methodology/approach

A questionnaire survey was adopted for the study, with respondents drawn randomly from both the health-care professionals as well as the public. The questionnaire survey results from 83 respondents, consisting of 31 health-care professionals and 52 members of the public, are analysed in this pilot study.

Findings

Ninety-one per cent of the respondents perceived bed shortage as an indication of vulnerability. The survey results showed that bed shortages, high bed-occupancy and long waiting hours were perceived as indications of vulnerability. The top three vulnerabilities identified were Singapore’s ageing population, the fast-growing population and the increasing trend of chronic diseases in its population. From the results, respondents appeared doubtful about the resilience of Singapore’s public hospitals. On a positive note, Singapore residents are still, relatively speaking, confident of the quality of Singapore’s health-care delivery system, which can be translated as one with relatively strong community resilience.

Originality/value

In conclusion, it appears fair to say that the public perceive hospital facilities in Singapore’s health-care industry to be reasonably resilient, but expect further improvements to ensure continuous delivery of quality health-care services.

Details

International Journal of Disaster Resilience in the Built Environment, vol. 8 no. 5
Type: Research Article
ISSN: 1759-5908

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Article
Publication date: 13 May 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: 11 April 2020

Rocio Rodriguez, Carmen Otero-Neira and Göran Svensson

The research aims to describe the foundation of healthcare organizations’ past and present sustainability endeavors; describe the direction of a health-care organizations…

Abstract

Purpose

The research aims to describe the foundation of healthcare organizations’ past and present sustainability endeavors; describe the direction of a health-care organizations’ sustainable development; reveal and characterize what determines the foundation and direction in a public health-care sector; and provide some insights into social marketing for sustainability endeavors.

Design/methodology/approach

Based on a semi-inductive approach, judgmental sampling was applied to select relevant health-care organizations. Informants were identified according to their knowledge of their organizations’ sustainability initiatives.

Findings

Offer insights into the foundation of sustainability endeavors and the direction of sustainable development for upstream social marketing in the studied public sector. The social marketing perspective is a common factor of relevance for the studied public hospitals.

Research limitations/implications

The foundations of sustainability endeavors undertaken across the studied health-care organizations have not so far been homogenous. The direction of sustainable development has also varied across the studied public healthcare organizations and there is a need to move beyond individuals and shift from a micro to a macro/structural environment of sustainable development, so as to observe the effectiveness of any social marketing intervention.

Practical implications

This study highlights the importance of applying an upstream social marketing approach and programs, as part of a social marketing strategy, to promote and stimulate sustainable change in health-care organizations.

Social implications

Contrary to the common sense predominating in many societies nowadays regarding sustainability endeavors and sustainable development, we conclude that neither the foundation of such endeavors nor the direction of sustainable development has progressed adequately in the studied public healthcare sector. As social marketing is intended to benefit society and foster social change, the macro level of intervention of the upstream approach clearly reveals its usefulness in the public health area.

Originality/value

Reveals two axes based on a social marketing approach. One is of micro and macro determinants characterizing the direction of sustainable development in a public sector. Another is of homogeneous and heterogeneous foundations of sustainability endeavors.

Details

Journal of Social Marketing, vol. 10 no. 2
Type: Research Article
ISSN: 2042-6763

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Article
Publication date: 8 October 2018

Rocio Rodriguez, Göran Svensson and David Eriksson

The purpose of this paper is to examine the logic and differentiators of organizational positioning and planning of sustainability initiatives between private and public

Abstract

Purpose

The purpose of this paper is to examine the logic and differentiators of organizational positioning and planning of sustainability initiatives between private and public organizations in the healthcare industry. Sustainability initiatives refer to organizations’ economic, social and environmental actions.

Design/methodology/approach

This study is based on an inductive approach judgmental sampling and in-depth interviews of executives at private and public hospitals in Spain have been used. Data were collected from the directors of communication at private hospitals, and from the executive in charge of corporate social responsibility in public hospitals. An empirical discourse analysis is used.

Findings

The positioning and planning of sustainability initiatives differs between private and public hospitals. The former consider sustainability as an option that is required mainly for social reasons, a bottom-up positioning and planning. It emerges merely spontaneously within the organization, while the sustainability initiatives in public hospitals are compulsory. They are imposed by the healthcare system within which the public hospital, operates and constitutes a top-down positioning and planning that is structured to accomplish set sustainability goals.

Research limitations/implications

A limitation of this study is that it is undertaken exclusively in Spanish organizations from one industry. This study differs from previous ones in terms of exploring the positioning and planning of the sustainability initiatives, which focus on the organizational logic of such sustainability initiatives. There are both common denominators and differentiators between private and public hospitals.

Practical implications

The logic of determining the positioning and planning of the sustainability initiatives is mainly about satisfying organizational needs and societal demands. Nowadays, organizations tend to engage in sustainability initiatives, so it is essential to understand the logic of how organizations position and plan such efforts.

Originality/value

This study investigates the path that follows sustainability initiatives in public and private organizations. It reports mainly differentiators between private and public organizations. It also contributes to explaining the organizational reasoning as to why companies make decisions about sustainability initiatives, an issue which has not been addressed sufficiently in existing theory studies.

Details

International Journal of Public Sector Management, vol. 31 no. 7
Type: Research Article
ISSN: 0951-3558

Keywords

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Article
Publication date: 1 March 2003

Julie E.M. Scott, Jill L. McKinnon and Graeme L. Harrison

This study traces the development of financial reporting in two publicly funded hospitals in New South Wales over the period 1857 to post‐1975, with particular focus on…

Abstract

This study traces the development of financial reporting in two publicly funded hospitals in New South Wales over the period 1857 to post‐1975, with particular focus on the use of cash and accrual accounting. The historical analysis draws on process and contextual change and stakeholder theory, and uses both primary and secondary data, to describe patterns of change (and non‐change) in the hospitals’ financial reporting and to identify the social and political influences associated with such reporting. The study provides historical context for recent developments in public sector reporting and accountability in Australia, particularly the (re)introduction of accrual accounting, and provides insights into the nature of accounting change both in public sector organizations and generally.

Details

Accounting, Auditing & Accountability Journal, vol. 16 no. 1
Type: Research Article
ISSN: 0951-3574

Keywords

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