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首页> 外文期刊>BMC Health Services Research >The involvement of medical doctors in hospital governance and implications for quality management: a quick scan in 19 and an in depth study in 7 OECD countries
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The involvement of medical doctors in hospital governance and implications for quality management: a quick scan in 19 and an in depth study in 7 OECD countries

机译：医生参与医院治理及其对质量管理的影响：在19个国家中进行了快速扫描，并在7个经合组织国家中进行了深入研究

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Background Hospital governance is broadening its orientation from cost and production controls towards ‘improving performance on clinical outcomes’. Given this new focus one might assume that doctors are drawn into hospital management across OECD countries. Hospital performance in terms of patient health, quality of care and efficiency outcomes is supposed to benefit from their involvement. However, international comparative evidence supporting this idea is limited. Just a few studies indicate that there may be a positive relationship between medical doctors being part of hospital boards, and overall hospital performance. More importantly, the assumed relationship between these so-called doctor managers and hospital performance has remained a ‘black-box’ thus far. However, there is an increasing literature on the implementation of quality management systems in hospitals and their relation with improved performance. It seems therefore fair to assume that the relation between the involvement of doctors in hospital management and improved hospital performance is partly mediated via quality management systems. The threefold aim of this paper is to 1) perform a quick scan of the current situation with regard to doctor managers in hospital management in 19 OECD countries, 2) explore the phenomenon of doctor managers in depth in 7 OECD countries, and 3) investigate whether doctor involvement in hospital management is associated with more advanced implementation of quality management systems. Methods This study draws both on a quick scan amongst country coordinators in OECD’s Health Care Quality Indicator program, and on the DUQuE project which focused on the implementation of quality management systems in European hospitals. Results This paper reports two main findings. First, medical doctors fulfil a broad scope of managerial roles at departmental and hospital level but only partly accompanied by formal decision making responsibilities. Second, doctor managers having more formal decision making responsibilities in strategic hospital management areas is positively associated with the level of implementation of quality management systems. Conclusions Our findings suggest that doctors are increasingly involved in hospital management in OECD countries, and that this may lead to better implemented quality management systems, when doctors take up managerial roles and are involved in strategic management decision making.
机译：背景技术医院治理正在将其方向从成本和生产控制扩展到“改善临床效果”。鉴于这种新的关注点，人们可能会认为医生已被OECD国家中的医院管理所吸引。他们的参与应该使医院在患者健康，护理质量和效率结果方面的表现受益。但是，支持这种想法的国际比较证据有限。仅有几项研究表明，作为医院董事会成员的医生与医院整体绩效之间可能存在正相关关系。更重要的是，到目前为止，这些所谓的医生经理和医院绩效之间的假定关系一直是“黑匣子”。然而，关于医院中质量管理体系的实施及其与绩效改善之间关系的文献越来越多。因此，可以合理地假设，医生参与医院管理与医院绩效的改善之间的关系部分是通过质量管理体系来调节的。本文的三个目的是：1）对19个经合组织国家医院管理中的医生管理人员的现状进行快速扫描，2）在7个经合组织国家中深入研究医生管理人员的现象，以及3）调查医生参与医院管理是否与质量管理体系的更高级实施相关联。方法本研究借鉴了经合组织（OECD）的“医疗质量指标”计划中的国家协调员进行的快速扫描，以及以欧洲医院中质量管理体系的实施为重点的DUQuE项目。结果本文报告了两个主要发现。首先，医生在部门和医院级别履行广泛的管理职责，但仅部分地承担正式的决策责任。其次，在战略医院管理领域中，具有更正式决策权的医生经理与质量管理体系的实施水平呈正相关。结论我们的发现表明，在经合组织国家，医生越来越多地参与医院管理，当医生担任管理职务并参与战略管理决策时，这可能会导致更好地实施质量管理体系。

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