ISSN:0749-6753    

DOI:10.1002/hpm.4740050102

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1990

数据来源: WILEY

摘要:

AbstractThe realm of public policy (including health policy) is, in many ways, more complex than that of decision‐making within the corporate organisations found in the private sector. The range of stakeholders is generally wider; many of the ways of influencing action are more subtle and indirect; and, arrangements for representation, accountability and consultation are correspondingly more elaborate. A future of this complexity in healthcare systems is the presence of numerous organisational and managerial interfaces. The paper considers three key sectors and the interfaces between them: primary health care, hospital care, and community care. Proposals for reforming the British National Health Service and community care services are destined to multiply the interfaces to be managed since they are predicated upon a split between purchasing services and providing them. The intention is to encourage a plurality of providers who will compete for contracts. The paper argues that the challenge posed by interface management is probably greater than any other in healthcare management. The requisite skills for successful interface management are reviewed. The paper concludes that these network skills are in short supply and that those responsible for management development in the NHS must tackle this lacuna as a matter of some urgenc

ISSN:0749-6753    

DOI:10.1002/hpm.4740050103

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1990

数据来源: WILEY

摘要:

AbstractOne of the basic assumptions of governmental health planning policy is that the government can effectively take final responsibility for the development of the health care system. Failure to reach policy goals is explained in terms of inadequate planning technology and instruments to control implementation. In this article an alternative explanation is offered, based on the theory of strategic organizational behavior. According to this theory, the government must be seen as but one actor in a complex interorganizational network. From this, a different perspective on effective health planning policy is developed. Policies will fail if they are not based on a valid analysis of the policy space of health care institutions and the interdependencies between government and health care organizations.This article starts with an outline of the nature of the central‐local relationship as seen from the perspective of strategic organizational behavior theory. Next, this theory is used to frame two cases in which Dutch health care institutions successfully pursued their own strategies that ran counter to the existing health planning policies. The article ends with a discussion of the implications of the theory of strategic organizational behavior for the development of effective central health care policies. This development starts with a thorough analysis of the policy space and interdependencies of all relevant actors in the health system, the government included. Following, policy makers can set the governmental goals and then have to start negotiations with health care institutions about mutual adaptation of their strategies and the governmental goals. The result is a negotiated health care orde

ISSN:0749-6753    

DOI:10.1002/hpm.4740050104

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1990

数据来源: WILEY

摘要:

AbstractOne of the distinguishing characteristics of national health care systems is the degree of public involvement in service provision, funding and policy making. In international comparisons the Nordic countries are usually seen as a uniform group. Yet, the countries do have important differences, and a descriptive model was sought to demonstrate these, and, at the same time, to differentiate the concept of public control. Using the central‐local dichotomy, differences within the public framework were demonstrated between the countries, e.g. in methods of funding, financial regulation, formal planning instruments, and control of resource allocation. Financial control and planning were identified as two distinct components of public control. An analysis of the degree of centralisation along both dimensions separated the Nordic countries, which are otherwise homogenous as to public sector dominanc

ISSN:0749-6753    

DOI:10.1002/hpm.4740050105

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1990

数据来源: WILEY

摘要:

AbstractThis article addresses the problem of managing change at the local level, by focusing on the experience of the research and action project ‘Tipping the Balance Towards Primary Health Care’. The experience of this project and case studies in other countries is abstracted. It includes some characteristics of the actors and forces under which local services operate, pointing to some opportunities and constraints in managing change and development, as well as organizational relationships in the field of primary health care. In this article it is argued that the ongoing structural reform is a necessary prerequisite, but it is not the unique key, for solving local health services problems. If the mission of the health sector is to satisfy the real and the perceived needs of the population, skilled professionals, appropriate technology, and enough financial resources must be allocated to the local le

ISSN:0749-6753    

DOI:10.1002/hpm.4740050106

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1990

数据来源: WILEY

摘要:

AbstractHospitals in the Netherlands are now operating in a rapidly changing environment. Most changes directly result from government's policy to achieve effective cost containment in health care. Some of them basically affect the existence and functioning of hospitals. These changing environmental conditions inspire hospitals to undertake innovative activities to protect or even strengthen their position. This will be illustrated below by a case in which a small acute hospital attempted to establish a close relationship with primary health care in order to protect its position. Our focus will be upon this innovative initiative and upon some management problems that must then be resolved.

ISSN:0749-6753    

DOI:10.1002/hpm.4740050107

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1990

数据来源: WILEY

摘要:

AbstractCost containment policy in health implies changes in hospital management and regional planning. There is a movement in France towards the strategic management of hospitals and towards a new way of planning. That calls for new models and the paper presents, as an example, regional arrangements of neonatal care. Hospital managers and local authorities set up a model and an information system to allow the best way possible for involving hospitals in the building of a regional scheme, leading to the negotiation of contracts. This experiment is conducted by the National School of Public Health with the aim of gaining experience in bringing together professionals and teachers, doing research and producing materials for management development.

ISSN:0749-6753    

DOI:10.1002/hpm.4740050108

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1990

数据来源: WILEY

摘要:

AbstractThe aim of this article is to examine, by means of an empirical study, the: a) relationship between formal and cultural structures; b) similarities and differences between professional subcultures (medical, nursing and managerial); and, c) the effects of the social assumptions of the work teams on development activities in one large primary health care organization. The results show that different professional groups have created quite different sets of social values, norms and assumptions, which have significant consequences, both for patient care and organizational performance.

ISSN:0749-6753    

DOI:10.1002/hpm.4740050109

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1990

数据来源: WILEY

摘要:

AbstractManagement teams have been introduced as a means of solving conflicts and providing highly required co‐ordination between professional groups, sub‐units and their individual leaders in large, complex organizations such as hospitals. This study examines the motivational patterns of the three members of management teams of four clinical departments at a large university hospital. A strong professionalism was the dominant motivational orientation of all nurse managers (nursing directors of the clinics) and to a great extent also of the physician managers (head physicians of the clinics). The business managers' dominant motivational pattern was hierarchy in two out of the four teams, and professionalism in two teams. The respective comparison groups had rather similar motivational patterns in common with their leaders: ordinary physicians and nurses had a professional and administrative staff hierarchic orientation. The comparison group of mid‐level managers from private firms was also hierarchically oriented, although task orientation was also often high in their motivational pattern. The results are consistent with the educational background and differences in the tasks of the groups studied. The role of different professional cultures in determining and designing efficiently functioning management teams is an important task for further res

ISSN:0749-6753    

DOI:10.1002/hpm.4740050110

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1990

数据来源: WILEY

ISSN:0749-6753    

DOI:10.1002/hpm.4740050111

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1990

数据来源: WILEY