Academic medical centres in the Netherlands: muddling through or radical change?

Autor:	Cardinaal EMM; Radboud University Medical Centre, Nijmegen, Netherlands., Tjan MJH; Radboud University Medical Centre, Nijmegen, Netherlands., Jeurissen PPT; Radboud Institute of Health Sciences (RIHS), Nijmegen, Netherlands., Berden H; Radboud Institute of Health Sciences (RIHS), Nijmegen, Netherlands.
Jazyk:	angličtina
Zdroj:	Frontiers in public health [Front Public Health] 2024 Jan 04; Vol. 11, pp. 1252977. Date of Electronic Publication: 2024 Jan 04 (Print Publication: 2023).
DOI:	10.3389/fpubh.2023.1252977
Abstrakt:	Introduction: Academic medical centres (AMCs) are designed to perform multiple tasks within a single organisation. This institutional complexity gives rise to intricate governance challenges and promotes incrementalism and muddling. Method: In this study, we hypothesised that radical change could provide a solution to the current incrementalism and we explored the conditions under which such changes could or could not be achieved. Results: We conducted unstructured interviews with various high-level stakeholders and identified issues that negatively affected the governance of Dutch AMCs, which include: 1) negative undercurrents and unspoken issues due to conflicts of interests, 2) organisational complexity due to relationships with a university and academic medical specialists, 3) lack of sufficient government direction, 4) competition between AMCs due to perverse systemic incentives, 5) different interests, focus, and organisational culture, 6) concentration of care, which does not always lead to enhanced quality and efficiency as the provision of less complex care is of utmost importance for education and research, 7) the infeasibility of public and regional functions of an AMC, 8) the inefficiency of managing three core tasks within the same organisation and, 9) healthcare market regulation. Discussion: Our hypothesis that radical change offers a solution to the current incrementalism in AMCs could not be adequately explored. Indeed, our exploration of the conditions under which radical change could potentially take place revealed that there are factors currently at play that make a substantive conversation between stakeholders about radical change difficult, if not impossible. The results also show that the government is in a position to take the lead and create conditions that foster mutual trust and common interests among AMCs, as well as between AMCs and other hospitals. Competing Interests: 3.3.1All participants noted that conflicts of interest between AMCs prevented collaboration and decisions that might benefit Dutch society as a whole. AMC directors indicated that if they had to choose, they felt a responsibility to put the interests of their own organisation first. They also noted that collaboration with regional hospitals was hampered by differences in values, vision, and organisational culture. Other interviewees underlined this and noted that these differences are often the unspoken reason (undercurrent) why collaboration between these parties is difficult. The remarks made by Participant 1, the chairman of the board of directors of an AMC, were illustrative: ‘But before we get there (one AMC instead of the current eight, red.), the management style we are used to will not work. That is certainly a cultural thing. And it also has to do with favours and people’. ‘I have seen the battle between Utrecht, Rotterdam, Amsterdam, and Leiden over the children’s hospital (concentration of pediatric oncology red.). We are in each other’s way. Between dream and deed stand laws and practical objections’.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. (Copyright © 2024 Cardinaal, Tjan, Jeurissen and Berden.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu