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Table 1 Summary of policy change in Portuguese hospitals

From: Hybrid management, organizational configuration, and medical professionalism: evidence from the establishment of a clinical directorate in Portugal

Policy change Examples
Decentralization of competencies • Purchaser/provider split: public organizations turned into public corporations and afterwards into public enterprises
• Flexible models of human resources management (individual labour contracts; appraisal system; culture of meritocracy)
• Accounts controlled by a single supervisor (board of directors) appointed by the Ministry of Health
• Directors of departments appointed among the most qualified doctors by the hospital’s board of directors
Financing control • Performance-based funding (DRGs)
• Non-compliance with contracted activity penalizes the following year’s budget
• Budget control tools at the organizational and ward levels
• Evaluation in accordance with quantitative criteria
Managerial control • Evidence-based procedures (cost/benefit ratio)
• Clinical guidelines (for monitoring and assessing incentives and sanctions)
• Administrative approval of medical decisions
• Opening of management positions in departments (middle-level structures of control)
• Hiring of general managers
Deregulation of the labour market • Rise in individual contracts, short-term contracts, and service provision
• Freezing of professional careers
• Increase in wage variation within health professions
Quality and safety controls • Monitoring technological tools
• Quality reports
• Internal and external audits and benchmarking
• Procedures to monitor malpractice
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