Purpose The purpose of this paper is to present the contemporary understanding and emerging structural models of organisational governance of public hospitals in order to provide evidence-based guidance to countries that are reforming their public hospital governance structures in line with best practice. Design/methodology/approach The paper uses the structural dimension of Cooper, Fusarelli and Randall’s policy model and institutional theory to review the legislative frameworks of four model countries supported by extant literature. Findings The paper conceptually distinguishes health system governance and organisational governance in the health system. It further visualises the emerging alternative legislative models of organisational governance and a hierarchy of governors applicable to public hospitals. Originality/value The paper provides critical knowledge for understanding organisational governance within health system governance framework and develops tools that can be used in reforming institutional mechanism of organisational governance of public hospitals.
PurposeThe purpose of this paper is to explore the nature of governance reforms also called conceptual innovation for public hospitals in Malawi.Design/methodology/approachIt focuses on the reforms for central and district hospitals. It uses semi-structured interviews to collect data and thematic approach to analyse it.FindingsThe results show that the reforms for central hospitals are structurally well characterised as aimed at corporatisation though they are termed as automatisation. The terminological seems not to pose any harm on the direction of the reforms due to the thorough structural characterisation. On the other hand, reforms for district hospitals are vague as such implementation is retrogressive, in that, instead of progressively moving the hospitals towards greater autonomy the opposite is happening.Originality/valueThe paper highlights the significance of characterisation of the intended outcome on the direction of the reforms and proposes a framework to guide conceptual innovation for public hospitals in a devolution-mediated environment.
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