Unintended responses to performance management in dutch hospital care: Bringing together the managerial and professional perspectives (original) (raw)
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BMC Health Services Research, 2022
Background Governments worldwide are reforming healthcare systems to achieve high quality and safe patient care while maintaining costs. Self-employed physicians reorganise into novel organisations to meet reconfiguration demands, impacting their work environment and practice. This study explores what strategies these novel organisations use to address physicians’ professional performance and what they encounter when executing these strategies to achieve high quality and safe care. Methods This constructivist exploratory qualitative study used focus groups to answer our research question. Between October 2018 and May 2019, we performed eight focus group sessions with purposively sampled Medical Specialist Companies (MSCs), which are novel physician-led organisations in the Netherlands. In each session, board members of an MSC participated (n = 33). Results MSCs used five strategies to address physicians’ professional performance: 1) actively managing and monitoring performance, 2) b...
Physicians in health care management: 2. Managing performance: who, what, how and when?
Canadian Medical Association Journal
Physicians are becoming more involved in performance management as hospitals restructure to increase effectiveness. Although physicians are not hospital employees, they are subject to performance appraisals because the hospitals are accountable to patients and the community for the quality of hospital services. The performance of a health care professional may be appraised by the appropriate departmental manager, by other professionals in a team or program or by peers, based on prior agreement on expectations. Appraisal approaches vary.
Expert Review of Molecular Diagnostics - EXPERT REV MOL DIAGN, 1996
In January 1985, the author of this study was employed as a scientific staff member at CBO, the Dutch National Organisation for Quality Assurance in Hospitals. His main job was to support peer review committees of medical specialists in hospitals. The task proved to be challenging and was broadened to an active involvement in the consensus development programme run by CBO'S scientific council. Both peer review and guideline development through consensus conferences turned out to be far more complex activities than might be expected at first sight. Hence over the years the ambition emerged to study these phenomena more thoroughly. From the beginning it was clear that peer review and guideline development are only two of the various systematic activities the medical profession has developed to manage the quality of specialist care. This study is rooted in the curiosity to understand these activities and in its essence the study tries to provide an answer to two questions: • What ...
Doctors and managers. Problems in Dutch hospitals resemble those in British hospitals
BMJ, 2003
Agreeing objectives could help doctors and managers work well together Editor-Doctors and managers obviously need to work together. To have two powerful groups not working together is likely to frustrate the efforts of both and to damage the service offered to patients. Why then is the relationship between doctors and managers often strained and currently perceived to be at a low ebb? Why is it that two groups, both protesting a desire to put patients at the centre of decision making, often find it difficult to find common ground? Although doctors and managers apparently agree about the objectives of the NHS, the reality is that the views of the medical profession about its purpose are different from those of managers. This is not surprising given the different backgrounds of doctors and managers. Doctors are trained in medicine; they tend to be numerate and are trained in the scientific method. They are socialised into a professional model that values both individual and professional autonomy. Many value medicine more highly than they do the NHS. Some perceive themselves as advocates for their patients in the face of governmental and managerial intervention. Contrast this with managers, who are essentially selected for various characteristics, including good communication skills, ability to create change, and assertiveness, as well as a knowledge and experience of how the NHS functions. Managers have a clear sense of hierarchy and are less concerned with personal or professional autonomy.
BMC health services research, 2016
Hospitals are under increasing pressure to share indicator-based performance information. These indicators can also serve as a means to promote quality improvement and boost hospital performance. Our aim was to explore hospitals' use of performance indicators for internal quality management activities. We conducted a qualitative interview study among 72 health professionals and quality managers in 14 acute care hospitals in The Netherlands. Concentrating on orthopaedic and oncology departments, our goal was to gain insight into data collection and use of performance indicators for two conditions: knee and hip replacement surgery and breast cancer surgery. The semi-structured interviews were recorded and summarised. Based on the data, themes were synthesised and the analyses were executed systematically by two analysts independently. The findings were validated through comparison. The hospitals we investigated collect data for performance indicators in different ways. Similarly, ...
Hospital performance: Competing or shared values
Health Policy, 2008
Objective: To find out which are the emerging views on hospital performance and to analyze how these views vary among hospital stakeholders. Methods: Study setting: Three hospital stakeholder groups (physicians, caregivers, and administrative staff) in a large Paris teaching hospital.
Diagnosis-Related Groups (DRG) and Hospital Business Performance Management
Studies in Logic, Grammar and Rhetoric, 2014
The goal of this article is to present the possibility of using Diagnosis-Related Groups (DRG) in the hospital management process and to analyse the need for business performance management on the part of hospital management staff. The following research methods were used: literature analysis, case studies, and poll analysis. It is not possible to increase the effectiveness of operation of healthcare entities without increasing the importance of IT systems and using DRG more effectively in the management process. Training users in IT and the use of DRGs is important to achieving hospital effectiveness. The increased importance of analyses and planning in a hospital should be reflected in the organisational structure of service providers. Hospital controllers should have a similar role to those present in most companies in other industries.
Cadernos de saúde pública, 2014
This article explores some effects of the British payment for performance model on general practitioners' principles and practice, which may contribute to issues related to financial incentive modalities and quality of primary healthcare services in low and middle-income countries. Aiming to investigate what general practitioners have to say about the effect of the British payment for performance on their professional ethos we carried out semi-structured interviews with 13 general practitioner educators and leaders working in academic medicine across the UK. The results show a shift towards a more biomedical practice model and fragmented care with nurse practitioners and other health care staff focused more on specific disease conditions. There has also been an increased medicalisation of the patient experience both through labelling and the tendency to prescribe medications rather than non-pharmacological interventions. Thus, the British payment for performance has gradually st...
Health Policy, 2013
Introduction: Changing health care systems and market competition requires hospital boards to shift their focus towards a systematic governance of the quality of care. The objective of our study was to describe hospital governance and the quality orientation in the Netherlands. Also we wished to investigate the relationship with hospital performance. Materials and methods: The chairs of both the boards of trustees and the management boards from all 97 Dutch hospitals were asked to participate in a cross-sectional study between November 2010 and February 2011. In this period data on their quality orientation were collected using a web-based survey. Data on hospital performance over the year 2010 were obtained in July 2011. Results: A mixture of reforms and national guidelines increased the emphasis on quality governance in Dutch hospitals. Our results show that boards of trustees and management boards had a reasonable quality orientation. Boards were familiar with quality guidelines, received a reasonable amount of information related to quality and used this for monitoring quality and policy-making. However, we found no association between their quality orientation and hospital performance. Conclusion: There was a growing awareness of the quality of care among boards of trustees and management boards; yet some boards still lagged behind. Quality orientation is an important asset because receiving, reviewing and responding to the quality of their performance should provide opportunities to improve quality. However, we were not able to find a relationship between quality orientation and hospital performance. Future research should investigate how boards can develop quality management systems which in turn could enable medical professionals to optimise their delivery of care and thus its quality.