Table 1 Hospital governance in European countries

Denmark

decentralised, network-based governance embedded in hierarchy; little market & strong patient involvement

troika structure (medical, nursing, admin. directors) at top level indicative of all levels of management

mixed DRG system; centralised framework with some flexibility at all levels

strong bottom-up controls with integrated medical power on all levels; e.g. monitoring, quality reports, patient safety

important, but strongly integrated on all levels (see managerial governance)

Germany

decentralised corporatist-style governance; weak hierarchy & weak direct patient involvement; some market

troika structure at top level with some flexibility; little systematic implementation at department level & strong medical power

mixed DRG system, with some flexibility & strong involvement of doctor at all levels

mix of top-down & bottom-up controls with integrated medical power; high flexibility of doctors on department level

important on all levels, but strongest at department level; integrated with some flexibility of doctors, esp. quality & safety

Greece

hierarchy (some decentralisation) with market & corporatism; lack of patient involvement

appointed (Ministry) director with multi-prof. board, but lack of coordination with lower tiers; integration of doctors highly flexible

no DRG system; budget strongly hierarchical with little flexibility at department level; limited involvement of doctors

strongly top-down at the macro-level but limited between levels; new emergent quality controls primarily controlled by doctors

important and strongest at the department level; medical power separated & strong in the area of quality

Netherlands

mix of corporatism, hierarchy, market, with decentralisation & patient involvement; increasing market with strong insurers

partnership governance between administration & doctors with strong medical power on all levels

mixed DRG system; some diversity, increasingly moving towards performance-based cost controls

connected to benchmarks & public control with strong integrated medical power; increasingly demand-led

important in all areas; strongly integrated, e.g. education, new emergent specialty of medical management

Poland

centralised corporatism with some hierarchy & market; weak patient involvement

general director & co-directors (medicine, nursing, finance, logistics); some flexibility & diversity on the department level

DRG-based, some involvement of doctors but increasingly stronger hierarchy (centralised & hospital level)

top-down integration of doctors coexist with separation; connection to bottom-up controls is weak & highly diverse at department level

strong in clinical practice but weaker in cost controls; highly dependent on the level & subject; some voluntary efforts, e.g. guidelines

Portugal

hierarchy with corporatised public sector; some market, little patient involvement

troika structure at top level with some flexibility; little systematic implementation at department level; strong medical power

DRG system with strong involvement of doctors; some flexibility at all levels of the organisation

some top down controls but weak & poorly connected with bottom-up controls; lack of transparency; highly diverse

strong & decentralised; little compulsory performance management but voluntary efforts

Spain

strong (regional) hierarchy with incomplete integration of medical power; little patient involvement; increasing privatisation

troika structure relevant on all levels; but double structure of general & ‘doctors only’ boards assures flexibility & medical power

budget fixed by regional authority with some flexibility of hospitals; strong medical power at level of departments

top-down with some bottom-up controls; troika structure expanding, but quality mainly managed by doctors; weak coordination & flexibility

important, strongest in the area of quality & department level, e.g. CPD, guidelines; integration & separation are combined strategically