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Hospital management: Integrating the dual hierarchy?
Author(s) -
Pool Jeroen
Publication year - 1991
Publication title -
the international journal of health planning and management
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.672
H-Index - 41
eISSN - 1099-1751
pISSN - 0749-6753
DOI - 10.1002/hpm.4740060304
Subject(s) - hierarchy , legislation , dual (grammatical number) , business , position (finance) , political science , public relations , medicine , operations management , public administration , finance , engineering , law , art , literature
Traditionally, hospitals are seen as dual hierarchies: in addition to the formal administrative pyramid, the professional medical system forms a second line of authority. Equally traditional, this poses substantial problems for hospital management. The present study reported in this article took place as part of a larger research project on Industrial Democracy in Europe (IDE‐2), aimed at studying changes in industrial relations and internal relations in metal and insurance companies. In the Netherlands, this project was enlarged to include hospitals. A number of significant changes have taken place in the past decade in Dutch general hospitals. As a reaction to environmental changes, e.g. in legislation, planning and financing, organizational structures have shown interesting developments. Examples are an increased hospital size due to mergers, the emergence of mid‐level management, divisionalization (inpatient vs outpatient wards), and integration of medical specialists in the organization. As a result, several changes in power positions have occurred, mainly at the strategic decision level: middle and top management have gained while the medical profession has lost some influence. The Works Council has established its position, and made a significant gain in influence on strategic decision making.