Governing Public Hospitals: Reform Strategies and the Movement Towards Institutional Autonomy

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.