The Translation of Hospital Management Models in European Health Systems: A Framework for Comparison

Abstract

In this paper we develop a framework for comparing changes in the management of public hospitals across different national health systems, drawing on insights from institutional theory. Using a range of secondary sources we show how one particular form of hospital management, pioneered originally at the Johns Hopkins Hospital in Baltimore, has been translated differently in four health systems: England, Denmark, Italy and France. This analysis builds on the notion of editing rules, which derive from the institutional context, and illustrates how these rules broaden our understanding of variable translations of global templates for hospital management. The paper concludes by highlighting wider implications for theory and policy.

Health care policy at a crossroads? A discursive study of patient agency in national health quality strategies between 1993 and 2015

“…However, although the reform processes would indicate an international trend of health care management, Kirkpatrick, Bullinger, Lega, and Dent () warn us of ‘risks of overstating convergence’ as they point to the importance of noting differences in how ‘similar management ideas and models have been implemented differently across health systems’ (Kirkpatrick et al., , p. S48). We therefore find it important to take a closer look at the Danish health care system to explore how the Danish health authorities have administered health care in the field of tension between New Public Management and welfare state provisions.…”

Evidence translation: an exploration of policy makers’ use of evidence

“…Translation is a form of power (Barry, 2013: 2). However, local history, traditions and institutions form an important backdrop to how actors in a given setting engage with ideas (Kirkpatrick et al, 2013). For example, officials noted that their influence could be limited and considered Universal Credit to be driven by ideology, which not only framed the search for evidence but also constrained its use:…”

Exploring regionalism in public management reforms: the case of the Italian hospital sector

“…Governments have responded to this in different ways, although a common focus has been on seeking to enhance the management capabilities of hospitals and other provider organisations. Specifically this has led to the development of what Kirkpatrick et al (2013) describe as 'corporate style' models of public hospital management.…”

“…In these respects Italy has followed the path of many other countries in seeking to develop the management capabilities of public hospitals (Kirkpatrick et al, 2013). However, of central concern to us in this paper is the regional dimension of these reforms.…”

“…Lastly, we focus on the size of the administrative staff of hospitals (relative to clinical, operational staff) as a proxy for the level of commitment to the development of management capabilities within hospitals (Kirkpatrick et al, 2013;Ackroyd et al, 2007). Although a number of factors may influence staffing levels (Andrews and Boyne, 2014), we argue that an increase in the proportion of administrators is indicative of wider organisational changes in public hospitals.…”