title: 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.
abstract: 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.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
authors.affiliation: Department of Public Health, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1100 DE, Amsterdam, The Netherlands.
authors.forename: A M
authors.initials: AM
authors.lastname: Rotar
authors.affiliation: Berenschot BV, Europalaan 40, 3526 KS, Utrecht, The Netherlands.
authors.forename: D
authors.initials: D
authors.lastname: Botje
authors.affiliation: Department of Public Health, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1100 DE, Amsterdam, The Netherlands.
authors.forename: N S
authors.initials: NS
authors.lastname: Klazinga
authors.affiliation: Professional Performance research group, Center for Evidence-Based Education, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: K M
authors.initials: KM
authors.lastname: Lombarts
authors.affiliation: Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK.|Optimedis AG, Hamburg, Germany.
authors.forename: O
authors.initials: O
authors.lastname: Groene
authors.affiliation: Avedis Donabedian Research Institute (FAD), Universitat Autonoma de Barcelona, Barcelona, Spain.
authors.forename: R
authors.initials: R
authors.lastname: Sunol
authors.affiliation: Department of Public Health, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1100 DE, Amsterdam, The Netherlands. t.plochg@amc.uva.nl.
authors.forename: T
authors.initials: T
authors.lastname: Plochg
mesh_terms: D054976:Clinical Governance / Q000458:organization & administration*; D015510:Clinical Medicine; D005060:Europe; D005260:Female; D006739:Hospital Administration; D006779:Hospitals, Public / Q000592:standards*; D006784:Hospitals, Teaching / Q000592:standards*; D006801:Humans; D008297:Male; D008875:Middle Aged; D066150:Organisation for Economic Co-Operation and Development; D010819:Physician's Role; D010820:Physicians / Q000458:organization & administration*; D011216:Practice Management, Medical / Q000458:organization & administration / Q000592:standards; D011364:Professional Practice / Q000458:organization & administration / Q000592:standards; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care
keywords: Doctors in management; European comparison; Hospital governance; Professionalism; Quality management