Leadership and governance in seven developed health systems

Smith, Peter; Anell, Anders; Busse, Reinhard; Crivelli, Luca; Healy, Judith; Lindahl, Anne Karin; Westert, Gert P.; Kene, Tobechukwu

doi:10.1016/j.healthpol.2011.12.009

Cited by 101 publications

(107 citation statements)

References 12 publications

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“…terms of the way in which they fund, provide and govern services (Smith et al, 2012). Mechanic and Roquefort (1996) argued that whilst health systems are converging in their responses to similar technological, economic, demographic and scientific challenges, this does not mean that they will not exhibit differences due to their individual historical political and social characteristics.…”

mentioning

confidence: 99%

Polish and UK doctors’ engagement with hospital management

Hartley

Kautsch

2014

International Journal of Public Sector Management

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Purpose – The purpose of this paper is to present the findings of a short research project, conducted in 2010 as part of a larger EU funded action investigating the participation and impact of doctors in management. The authors sought to compare the ways in which hospital doctors in the UK and Poland – countries with distinct histories – participate in management; whether they are converging and whether the type of participation found results from changes in the governance and management of these systems. Design/methodology/approach – First, a review of existing evidence and an analysis of policy documents and healthcare statistics were conducted. Identifying a lack of empirical data in the Polish context, and a potentially changing situation in the UK, the authors proceeded to collect some exploratory data in Poland, via interviews with expert informants, and to draw on data collected alongside this study in the UK from qualified doctors participating in research on management and leadership development. Findings – Hospital doctors currently hold similar types of management role in both systems, but there are signs that change is underway. In Poland, different types of medical manager and role are now emerging, whereas in the UK younger doctors appear to be expecting greater management responsibility in the future, and are starting to take up the management training now on offer. Research limitations/implications – The potential implications of these changes for the profession and policymakers in both Poland and the UK are discussed, with opportunities for further research highlighted. Originality/value – The paper provides a comparison of how medical engagement within two systems with different histories is occurring, and also of the changes underway. It provides some much needed initial insight via interviews with expert informants within the polish system, which has been under-researched in relation to the involvement of medicine in management.

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mentioning

confidence: 99%

Polish and UK doctors’ engagement with hospital management

Hartley

Kautsch

2014

International Journal of Public Sector Management

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“…Occasionally, other entities, such as the MOW, the Medical Council and insurance companies, have parallel but uncoordinated plans in cooperation or in opposition to the MOH, which restrict its supervisory capacities [29]. Nevertheless, for a health system to overcome traditional "top-down" governance, it might be necessary to engage the state in networked governance across different organizations [31]. This network should provide the grounds for participation of all relevant stakeholders from both the state and non-state agencies in designing policies [32].…”

Section: Discussionmentioning

confidence: 99%

Framework for assessing stewardship of the oral health system in Islamic Republic of Iran

Tahani¹,

Yazdani²,

Khoshnevisan³

et al. 2014

East Mediterr Health J

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This study designed a framework for assessing the stewardship function of the oral health system in Islamic Republic of Iran. The modified RAND Corporation/University of California Los Angeles (RAND-UCLA) Appropriateness Method was used in a 2-step process that combined literature evidence and the collective judgement of experts. After a comprehensive literature review, policy instruments related to stewardship components were extracted as candidate standards and categorized according to the 6 sub-functions of stewardship (accountability; defining strategic direction; alignment of policy objectives and organizational structure; regulation; intersectoral leadership; and generation of intelligence). Five key informants then rated the appropriateness of the 85 standards on a 5-point Likert scale. The 38 highest ranked standards, including at least 2 standards in each of the 6 sub-functions, formed a set of proposed standards for evaluating the current stewardship of oral health system. Piloting of the instrument will be reported separately. RÉSUMÉ La présente étude a conçu un cadre d'évaluation de la fonction de gouvernance du système de santé bucco-dentaire en République islamique d'Iran. La Méthode modifiée de détermination de la pertinence des indications de la Rand Corporation et de l'Université de Californie Los Angeles (Rand/UCIA) a été utilisée, dans un processus en deux étapes, combinant les données probantes de la littérature et le point de vue collectif d'experts. Après un examen exhaustif de la littérature, des instruments de politiques liés aux composantes de gouvernance ont été extraits en tant que normes candidates puis classés en catégories selon les six sousfonctions de gouvernance (responsabilisation, définition d'une orientation stratégique, harmonisation des objectifs politiques et de la structure organisationnelle, réglementation, direction intersectorielle et production de données). Cinq informateurs clés ont ensuite attribué une note à la pertinence de 85 normes sur l'échelle de Likert en cinq points. Les 38 normes les mieux notées, dont au moins deux normes dans chacune des six sousfonctions, ont formé un ensemble proposé pour l'évaluation de la gouvernance actuelle du système de santé bucco-dentaire. Le pilotage de l'instrument fera l'objet d'un rapport distinct.

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“…Here, commentators have described the shift away from a hierarchical 'command and control' approach towards the use of data, targets, networks and markets in order to 'govern at a distance' (Rose and Miller, 1992;Huges and Griffiths, 1999;Smith, Anell, Busse, Crivelli, Healy, Lindahl, Westert and Kene, 2012). In their comparative study of health systems operating in seven different countries, Smith et al describe how 'In a typically complex health system no one actor has all the knowledge and power required to get things done and the state must therefore necessarily engage in networked governance across many organisations' (Smith et al, 2012, p.38).…”

Section: Policy Network and Policy Implementationmentioning

confidence: 99%