Physician’ entrepreneurship explained: a case study of intra-organizational dynamics in Dutch hospitals and specialty clinics

Human Resources for Health

Wim H van Harten²  Michel L Ehrenhard¹  Matthijs de Rover²  Wout T Koelewijn² 

[1]Netherlands Institute for Knowledge Intensive Entrepreneurship (NIKOS), School of Management and Governance, University of Twente, Drienerlolaan 5, Enschede 7522, NB, The Netherlands

[2]Department of Health Technology and Services Research, School of Management and Governance, University of Twente, Drienerlolaan 5, Enschede 7522, NB, The Netherlands

关键词: Entrepreneurship;    Managers;    Physicians;    Specialty clinics;    Hospitals;   

Others  :  821675
DOI  :  10.1186/1478-4491-12-28

 received in 2013-10-18, accepted in 2014-05-02,  发布年份 2014

【 摘 要 】

Background

Challenges brought about by developments such as continuing market reforms and budget reductions have strained the relation between managers and physicians in hospitals. By applying neo-institutional theory, we research how intra-organizational dynamics between physicians and managers induce physicians to become entrepreneurs by starting a specialty clinic. In addition, we determine the nature of this change by analyzing the intra-organizational dynamics in both hospitals and clinics.

Methods

For our research, we interviewed a total of fifteen physicians and eight managers in four hospitals and twelve physicians and seven managers in twelve specialty clinics.

Results

We found evidence that in becoming entrepreneurs, physicians are influenced by intra-organizational dynamics, including power dependence, interest dissatisfaction, and value commitments, between physicians and managers as well as among physicians’ groups. The precise motivation for starting a new clinic can vary depending on the medical or business logic in which the entrepreneurs are embedded, but also the presence of an entrepreneurial nature or nurture. Finally we found that the entrepreneurial process of starting a specialty clinic is a process of sedimented change or hybridized professionalism in which elements of the business logic are added to the existing logic of medical professionalism, leading to a hybrid logic.

Conclusions

These findings have implications for policy at both the national and hospital level. Shared ownership and aligned incentives may provide the additional cement in which the developing entrepreneurial values are ‘glued’ to the central medical logic.

【 授权许可】

   
2014 Koelewijn et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]NZA: ZBC Monitor: Een kwalitatieve en kwantitatieve analyse . Utrecht: Dutch Healthcare; 2012. Authority
• [2]Health Care Inspectorate IGZ: Het resultaat telt - particuliere klinieken 2009 . Utrecht; 2010.
• [3]Health Care Inspectorate IGZ: Het resultaat telt - Particuliere Klinieken 2012 . Utrecht; 2013.
• [4]Bruinsma J: Zelfstandige kliniek als heipaal onder het ziekenhuis. De Volkskrant 2010, 20-21.
• [5]Bruinsma J: Privéklinieken doen nu volledig mee. De Volkskrant 2011, 2-3.
• [6]Piersma J: Privékliniek komt snel uit de marge van de zorgmarkt. Het Financieele Dagblad 2009, 3.
• [7]Walburg L: Lijfarts. Het Financieele Dagblad 2011, 11-13.
• [8]Hopstaken L: Ongericht ondernemen, ziekenhuizen in verwarring. Zorgvisie 2008, 38:12.
• [9]Kiers B: ‘Wij dien dit niet uit geldwolverij’-Specialisten belemmerd in hun ondernemingszin. Zorgvisie 2008, 38:26-31.
• [10]Saltman RB, Busse R, Mossialos E: Regulating Entrepreneurial Behaviour in European Health Care Systems. PA: Open University Press Philadelphia; 2002.
• [11]Kuhlmann E, Burau V, Larsen C, Lewandowski R, Lionis C, Repullo J: Medicine and management in European healthcare systems: how do they matter in the control of clinical practice? Int J Clin Pract 2011, 65:722-724.
• [12]Ranawat AS, Koenig JH, Thomas AJ, Krna CD, Shapiro LA: Aligning physician and hospital incentives: the approach at hospital for special surgery. Clin Orthop Relat Res 2009, 467:2535-2541.
• [13]Cohn KH, Gill SL, Schwartz RW: Gaining hospital administrators’ attention: ways to improve physician-hospital management dialogue. Surgery 2005, 137:132-140.
• [14]OECD: Health: Spending Continues to Outpace Economic Growth in Most OECD Countries. OECD Health Data. 2011. [http://www.oecd.org/newsroom/healthspendingcontinuestooutpaceeconomicgrowthinmostoecdcountries.htm webcite]
• [15]Klopper-Kes AHJ, Siesling S, Meerdink N, Wilderom CPM, van Harten WH: Quantifying culture gaps between physicians and managers in Dutch hospitals: a survey. BMC Health Serv Res 2010, 10:86-96. BioMed Central Full Text
• [16]Kaissi A: Manager-physician relationships: an organizational theory perspective. Health Care Manag (Frederick) 2005, 24:165-176.
• [17]Reay T, Hinings CR: Managing the rivalry of competing institutional logics. Organ Stud 2009, 30:629-652.
• [18]Scott WR: Institutions and Organizations. 2nd edition. Thousand Oaks: Sage Publications; 2001.
• [19]Witman Y, Smid GAC, Meurs PL, Willems DL: Doctor in the lead: balancing between two worlds. Organization 2011, 18:477-495.
• [20]Andrews R: Organizational social capital, structure and performance. Hum Relat 2010, 63:583-608.
• [21]Bode I: Processing institutional change in public service provision. Public Organ Rev 2013, 13:323-339.
• [22]Degeling P, Zhang K, Coyle B, Xu L, Meng Q, Qu J, Hill M: Clinicians and the governance of hospitals: a cross-cultural perspective on relations between profession and management. Soc Sci Med 2006, 63:757-775.
• [23]Greenwood R, Hinings CR: Understanding radical organizational change: bringing together the old and the new institutionalism. Acad Manag Rev 1996, 21:1022-1054.
• [24]Koelewijn WT, Ehrenhard ML, Groen AJ, van Harten WH: Intra-organizational dynamics as drivers of entrepreneurship among physicians and managers in hospitals of western countries. Soc Sci Med 2012, 75:795-800.
• [25]Burgelman RA: A process model of internal corporate venturing in the diversified major firm. Adm Sci Q 1983, 28:223-244.
• [26]Hisrich RD, Peters MP: Entrepreneurship: Starting, Developing, and Managing a New Enterprise: Homewood. McGraw-Hill/Irwin: IL; 1992.
• [27]Shane S, Venkataraman S: The promise of entrepreneurship as a field of research. Acad Manag Rev 2000, 25:217-226.
• [28]Cooper DJ, Hinings B, Greenwood R, Brown JL: Sedimentation and transformation in organizational change: the case of Canadian law firms. Organ Stud 1996, 17:623-647.
• [29]Pinnington A, Morris T: Archetype change in professional organizations: survey evidence from large law firms. Br J Manag 2003, 14:85-99.
• [30]Kitchener M: Quasi-market transformation: an institutionalist approach to change in UK hospitals. Public Adm 1998, 76:73-95.
• [31]Addicott R, Furlie E: Sedimented Archetype Change in Public Sector Organisations the Example of Managed Clinical Networks for Cancer. Lindfield, NSW: Australian and New Zealand Academy of Management; 2006.
• [32]Noordegraaf M: From ‘Pure’ to ‘Hybrid’ professionalism - Present-day professionalism in ambiguous public domains. Adm Soc 2007, 39:761-785.
• [33]Evetts J: The sociological analysis of professionalism - Occupational change in the modern world. Int Sociol 2003, 18:395-415.
• [34]Goodall AH: Physician-leaders and hospital performance: is there an association? Soc Sci Med 2011, 73:535-539.
• [35]Abernethy MA, Vagnoni E: Power, organization design and managerial behaviour. Acc Organ Soc 2004, 29:207-225.
• [36]Scholten G, Van der Grinten T: Integrating medical specialists and hospitals. The growing relevance of collective organisation of medical specialists for Dutch hospital governance. Health Policy 2002, 62:131-139.
• [37]Edwards N: Doctors and managers: poor relationships may be damaging patients - what can be done? Qual Saf Health Care 2003, 12:i21-i24.
• [38]Klopper-Kes AHJ, Meerdink N, Wilderom CPM, Van Harten WH: Effective cooperation influencing performance: a study in Dutch hospitals. Int J Qual Health Care 2010, 23:94-99.
• [39]Walston SL, Chou AF: Healthcare restructuring and hierarchical alignment - Why do staff and managers perceive change outcomes differently? Med Care 2006, 44:879-889.
• [40]Mintzberg H: Structure in 5's: A Synthesis of the Research on Organization Design. Management Science 1980, 26:322-341.
• [41]Marquis C, Lounsbury M: Vive la résistance: competing logics and the consolidation of US community banking. Acad Manag J 2007, 50:799-820.
• [42]Stuart TE, Sorenson O: Liquidity events and the geographic distribution of entrepreneurial activity. Administrative Science Quarterly 2003, 175-201.
• [43]Calciolari S, Cantu E, Fattore G: Performance management and goal ambiguity: managerial implications in a single payer system. Health Care Manag Rev 2011, 36:164-174.
• [44]Ommen O, Driller E, Koehler T, Kowalski C, Ernstmann N, Neumann M, Steffen P, Pfaff H: The relationship between social capital in hospitals and physician job satisfaction. BMC Health Serv Res 2009, 9:81. BioMed Central Full Text
• [45]Mache S, Vitzthum K, Klapp BF, Groneberg DA: Improving quality of medical treatment and care: are surgeons’ working conditions and job satisfaction associated to patient satisfaction? Langenbecks Arch Surg 2012, 397:973-982.
• [46]Purdy JM, Gray B: Conflicting logics, mechanisms of diffusion, and multilevel dynamics in emerging institutional fields. Acad Manag J 2009, 52:355-380.
• [47]Kearney RC, Sinha C: Professionalism and bureaucratic responsiveness - conflict or compatibility. Public Adm Rev 1988, 48:571-579.
• [48]Farrell C, Morris J: The ‘neo-bureaucratic’ state: professionals, managers and professional managers in schools, general practices and social work. Organization 2003, 10:129-156.