For hospital governance to be effective, it must incorporate two powerful and
well-developed lines of health sector logic: on the one hand, national health
policy and objectives; on the other, operational hospital management. One
sphere is political, the other is technical. One is subjective and value based, the
other is objective, with performance that can be measured both clinically and
financially. The challenge for hospital-level governance is to integrate these two
disparate logics into a coherent and effective institutional-level strategy.
This study explores key developments in public hospital governance in Europe.
In doing so, it highlights the central role of hospital-level decision-making and
how it is shaped by the various participants and stakeholders. In particular,
it examines the degree to which granting an individual hospital the ability
to make its own strategic, financial and clinical decisions - to become
semi-autonomous within the public sector - may improve institutional-level
functioning and outcomes.
In the initial chapters of this study, we draw on a substantial body of literature
in a number of related health policy, public management and institutional
governance arenas. How these different concepts might apply to public
hospitals is the subject of considerable discussion here. It is in the interface of
these differing conceptual approaches, with the evidence and experience seen in
the eight country cases, that we catch a glimpse of the future of public hospital
governance in Europe. We hope that this study can serve as a solid conceptual
and practical contribution to future quantitative as well as qualitative research
on this important subject.