PDF(Pubmed)
Abstract：
Policy-makers and hospital boards throughout the world have implemented different measures to create and sustain effective hospital-physician relationships. The \'integrated funding\' policy reform in the Netherlands was aimed at increasing hospital-physician alignment and led to the unforeseen formation of medical specialist enterprises (MSEs): a fiscal entity representing all self-employed physicians in a hospital. It is unknown how hospitals and MSEs perceive their alignment and how they govern the relationship. This study explores the hospital-MSE relationship, and how governance styles influence perceived alignment in this relationship.
A multiple case study of five non-academic hospitals in the Netherlands was performed. Data was derived from two sources: (1) analysis of hospital-MSE contracts and (2) semi-structured interviews with hospital and MSE board members. Contracts were analysed using a predefined contract analysis template. Interview recordings were transcribed and subsequently coded using the sensitizing concepts approach.
Contracts, relational characteristics, governance styles and perceived alignment differed substantially between cases. Two out of five contracts were prevention contracts, one was a mixed type, and two were promotion contracts. However, in all cases the contract played no role in the relationship. The use of incentives varied widely between the hospitals; most incentives were financial penalties. The governance style varied between contractual for two hospitals, mixed for one hospital and predominantly relational for two hospitals. Development of a shared business strategy was identified as an important driver of relational governance, which was perceived to boost alignment.
Large variation was observed regarding relational characteristics, governance and perceived alignment. MSE formation was perceived to have contributed to hospital-physician alignment by uniting physicians, boosting physicians\' managerial responsibilities, increasing financial alignment and developing shared business strategies. Relational governance was found to promote intensive collaboration between hospital and MSE, and thus may improve alignment in the hospital-physician relationship.
A multiple case study of five non-academic hospitals in the Netherlands was performed. Data was derived from two sources: (1) analysis of hospital-MSE contracts and (2) semi-structured interviews with hospital and MSE board members. Contracts were analysed using a predefined contract analysis template. Interview recordings were transcribed and subsequently coded using the sensitizing concepts approach.
Contracts, relational characteristics, governance styles and perceived alignment differed substantially between cases. Two out of five contracts were prevention contracts, one was a mixed type, and two were promotion contracts. However, in all cases the contract played no role in the relationship. The use of incentives varied widely between the hospitals; most incentives were financial penalties. The governance style varied between contractual for two hospitals, mixed for one hospital and predominantly relational for two hospitals. Development of a shared business strategy was identified as an important driver of relational governance, which was perceived to boost alignment.
Large variation was observed regarding relational characteristics, governance and perceived alignment. MSE formation was perceived to have contributed to hospital-physician alignment by uniting physicians, boosting physicians\' managerial responsibilities, increasing financial alignment and developing shared business strategies. Relational governance was found to promote intensive collaboration between hospital and MSE, and thus may improve alignment in the hospital-physician relationship.
摘要：
背景：世界各地的政策制定者和医院董事会已经采取了不同的措施来建立和维持有效的医院与医生的关系。荷兰的“综合资金”政策改革旨在提高医院与医生的一致性，并导致无法预见的医学专业企业（MSE）的形成：代表医院中所有自雇医生的财政实体。尚不清楚医院和MSEs如何看待他们的联盟以及他们如何管理这种关系。本研究探讨了医院与MSE的关系，以及治理风格如何影响这种关系中感知的一致性。
方法：对荷兰五家非学术医院进行了多案例研究。数据来自两个来源：（1）医院-MSE合同分析和（2）对医院和MSE董事会成员的半结构化访谈。使用预定义的合同分析模板对合同进行了分析。采访录音被转录，随后使用敏感概念方法进行编码。
结果：合同，关系特征，不同案例之间的治理风格和感知一致性有很大差异。五份合约中有两份是预防合约,一个是混合型的，还有两个是促销合同。然而,在所有情况下，合同在这种关系中都没有作用。医院之间激励措施的使用差异很大；大多数激励措施是经济处罚。两家医院的治理风格在合同之间有所不同，混合为一家医院，主要为两家医院。制定共享业务战略被认为是关系治理的重要驱动力，这被认为可以促进对齐。
结论：在关系特征方面观察到很大的变化，治理和感知的一致性。MSE的形成被认为是通过团结医生促进了医院-医生的对齐，提高医生的管理责任，加强财务协调，制定共享业务战略。发现关系治理促进了医院和MSE之间的密集合作，因此可以改善医院与医生关系的一致性。
方法：对荷兰五家非学术医院进行了多案例研究。数据来自两个来源：（1）医院-MSE合同分析和（2）对医院和MSE董事会成员的半结构化访谈。使用预定义的合同分析模板对合同进行了分析。采访录音被转录，随后使用敏感概念方法进行编码。
结果：合同，关系特征，不同案例之间的治理风格和感知一致性有很大差异。五份合约中有两份是预防合约,一个是混合型的，还有两个是促销合同。然而,在所有情况下，合同在这种关系中都没有作用。医院之间激励措施的使用差异很大；大多数激励措施是经济处罚。两家医院的治理风格在合同之间有所不同，混合为一家医院，主要为两家医院。制定共享业务战略被认为是关系治理的重要驱动力，这被认为可以促进对齐。
结论：在关系特征方面观察到很大的变化，治理和感知的一致性。MSE的形成被认为是通过团结医生促进了医院-医生的对齐，提高医生的管理责任，加强财务协调，制定共享业务战略。发现关系治理促进了医院和MSE之间的密集合作，因此可以改善医院与医生关系的一致性。
