Is the new health-care executive an entrepreneur?

Abstract

Many countries are working on the realization of a new sort of public management, which is less governmental and more market oriented. As a consequence the role of health-care managers is changing. They are increasingly addressed as (social) entrepreneurs. This article is based on the results of a survey sent to Dutch health-care executives. The aim of the survey was to explore how the new discourse affects the practice of management. The results show that entrepreneurship is a construction and a contested concept. Nevertheless, executives are very sensitive to the concept. It certainly confuses them and can make them feel more vulnerable. However, new expectations can also perform an important function as a catalyst for executives to rethink their role and their position. From that point of view the phase of multiinterpretable expectations and vague discourse can be seen as a necessary phase in realizing health-care reform.

Innovation in the Public Sector

“…Initial steps were made 20 years ago, and today the Dutch health care sector is driven by a mix of market forces and governmental planning, budgeting and price control (Dijstelbloem et al, 2004;van der Scheer, 2007). It is not clear whether this mix will evolve towards more market elements, as this strongly depends on the colour of governmental coalitions.…”

“…Plans are concrete, feasible, and have a clear beginning and end. The aim is to ensure organizational continuity by strengthening the competitive position of the organization (see for further elaboration Drucker, 1985;Terry, 1990;Osborne and Brown, 2005;van der Scheer, 2007;Exton, 2008). In this business model, new services (products) are developed in order to attract more patients (customers).…”

“…During decades the central government took direct responsibility for the development of the sector by means of elaborate planning, budgeting and tariff control of independent health professionals. Not-for-profit health care providers and insurers (sick funds) acted as quasi-governmental organizations, implementing governmental policy and regulations (Helderman, 2007;van der Scheer, 2007). Successful management of these organizations required public administration competencies.…”

“…As a consequence, executives of health care organizations are facing a situation in which their management routines -the rules of the game that belong to the public administration management tradition -rapidly become obsolete in substantial parts of their work (Pollitt and Bouckaert, 2000;Grit and Meurs, 2005;Goodwin, 2006;Kirby, 2006;Noordegraaf, 2007). The emerging market conditions require other, more business-like knowledge and competencies of executives in health care (van der Scheer, 2007;Noordegraaf and van der Meulen, 2008). In order to retain legitimacy it makes sense for executives to adapt to the new logic and incorporate the new entrepreneurial way to go about things and engage entrepreneurial innovations (Clarke and Newman, 1997).…”

“…At the same time market conditions are becoming incorporated in the way the sector functions and develops. New logics of appropriate actions are disseminated through government guidelines, legislation, and practices of inspection and audit regimes (Noordegraaf et al, 2005;van der Scheer, 2007). Entrepreneurial risk is created for providers and insurers.…”