Table 2 Characteristics of the included studies in the scoping review in the order of publication date
From: Hospital governance accountability structure: a scoping review
Authors, country, year | Objective/Focus | setting | Document type/Methodology | Key points |
|---|---|---|---|---|
Goeschel [48] USA 2010 | review these responsibilities, describe opportunities for boards and medical staffs to collaborate as leaders, and offer recommendations for how boards and medical staff members can address the challenges of shared responsibility for quality of care. | US hospitals | Peer review article/ literature review | Boards need to hold CEOs and medical staff leaders accountable for improvements on both kinds of measures and ensure that the institution has the resources and will to improve |
Dixon [52] England 2010 | To map and describe the formal accountability relationships of foundation trusts in England | Six acute trusts | Peer review article/qualitative | Directors of foundation trusts perceive strong accountable to their regulator, Monitor, particularly for financial performance, but there is some confusion about where accountability for quality of care rests. Horizontal lines of accountability to the local population (through Local Involvement Networks and local government Overview and Scrutiny Committees) remain weak. |
Connor [81] world 2011 | define and describe accountability as a key component of clinical governance and a responsive, fair and transparent health culture. | Healthcare systems | Peer review article/literature review | such resolution enables the individual and organization to learn and patients, families and communities to continue to trust in the healthcare system |
Jiang [53] United States 2012 | provide an update to prior research by exploring the role and practices of governing boards in quality oversight through the lens of agency theory and comparing hospital quality performance in relation to the adoption of those practices | 445 public and private not-for-profit hospitals | Peer review article/quantitative | Hospital governing boards should examine their current practices and consider adopting those that would enhance the accountability of the Board itself, management, and the medical staff. |
Ahlin [1] USA 2012 | establishes the broad vision and goals of the organization. | Ontario Hospital Association | Report | The Board of Directors must include the CEO, the President of the medical staff, the Chair of the Medical Advisory Committee and the Chief Nursing Executive. |
World Health Organization [60] world 2012 | Identify innovations for healthcare governance in 21 centuries | Health system | report | Healthcare governance should be accountable and health governance should contain community representee |
Mattei [46] Germany, Norway and Denmark 2013 | the impact of hospital reforms on accountability relations in three health systems by focusing on investment decisions within healthcare. The link between accountability form | public hospitals | Peer review article/literature review | National governments have tightened their control over the overall trajectory of their hospital systems, but have also shifted significant responsibility downward to the hospital level |
Kaini [59] Nepal 2013 | focus on regulation and accountability aspects of the healthcare governance agenda | Nepal healthcare | Peer review article/qualitative | the concept of healthcare governance has to be formally introduced by the government and other health authorities including professional bodies and councils in Nepal by introducing healthcare governance strategies and policies. |
Jha [54] USA England 2013 | How do the governance practices among the boards overseeing English hospitals differ from those of boards of directors of US hospitals? How does a trust's having foundation status affect governance practices in English hospitals? And third, are the associations between engaged governance and higher quality performance that are seen in US hospitals also apparent in England? | 171 board chairs in public hospital | Peer review article/quantitative | there is room for improvement in both countries to bolster board expertise and focus on key quality metrics, and to hold managers accountable for the delivery of safe, effective health care |
Zenty [50] USA 2014 | anticipate the dramatic changes of healthcare reform | University Hospitals Health System | Peer review article/review | thoughtful governance, effective plan design, customized data analytics, physician networks and incentives, innovative patient engagement, and supplemental coordination resources |
Vaughn [51] USA 2014 | Do governing boards, C-suites, and clinical management possess different perceptions regarding structures, processes, and quality related activities in their hospital? | 300 hospitals were linked to performance on the Centers for Medicare & Medicaid Services (CMS) | Peer review article/quantitative | major organizational drivers of quality and safety: (1) commitment of senior leaders, (2) a vision of exemplary quality, (3) a supportive culture, (4) accountable leadership, (5) appropriate organizational structures, and (6) adaptive capability. |
MacDonald [49] England 2014 | explore the experience of service user governors in foundation trusts and their capacity to hold boards to account | National Health Foundation Trusts | Peer review article/qualitative | emerged concerned: the role of a governor, conduct and content of meetings, agenda setting, relationships and representation. |
Government of the Northwest Territories [67] Canada, 2014 | overall accountability framework that outlines performance reporting requirements for key target audiences, including timing, indicators, and data collection responsibilities, and creation of an action plan to implement the accountability framework and performance measurement system. | Health and Social Service Authorities | report | Guiding the development of the performance indicators was the understanding that they were meant to be at the “system” level rather than the HSSA level |
The Healthcare Governance & Transparency Association Egypt 2014 [36] Egypt 2014 | Guide offers Principles and Guidelines to facilitate the incorporation of corporate governance practices in hospitals in Egypt | hospitals in Egypt | report | This Guide supports individual hospitals in responsibly and sustainably increasing their performance through the incorporation of corporate governance practices |
Szekendi [58] USA 2015 | governance structures and practices, influence health care quality. | US academic medical centers | Peer review article/qualitative | All hospitals, even those with the highest quality ratings, had major gaps in their use of best practices for CEO and board assessments. the relationship between use of these practices and organizational performance, based on the University HealthSystem Consortium’s Quality & Accountability rankings |
Pascal [82]France 2015 | History of Hospital Reform and Accountability in France | Hospitals in France | Peer review article/narrative review | reconciliation between economic and medical requires the establishment of “mediconomic” tools permitting the evaluation, in a language understood by all, by means of quantitative and qualitative medical and economic indicators built from collective understanding of workplace realities |
Nyland [45] Norway 2015 | why public sector reforms hybridize during implementation processes, consequences on accountability relations and practitioners’ and policymakers’ reactions to these changes | Norwegian hospital sector | Peer review article/case study | the gradually alignment of controls in a dynamic pattern of hybridization enables the balancing of conflicts in the chain of accountabilities. Hybrid controls are observed to emerge as stronger than the initial ideal control models |
Mutigand [26] Finland 2015 | Analyses the impact of the institutionalization of governance and budgetary Policies on the accountability of organizational actors | Two public hospitals | Peer review article/critical realism | The political and the technical. Accountability practices depend on how the institutionalized policies have reduced or increased the gaps between the real, the actual and the empirical domains of reality of the organizational actors involved and the governance policy that prevails at a given domain of reality |
Askim [69] Norway 2015 | How are administrative and managerial accountability combined, and to what extent does it depend on agency characteristics? | five state agencies in Norway in the area of hospital administration, welfare administration, and immigration. | Peer review article/case study | more insight into the differences between administrative and managerial accountability and the interplay between them. |
Jones [56] England 2016 | how boards govern for quality improvement | 15 healthcare provider organizations | Peer review article/qualitative | boards with higher levels of maturity in relation to governing for QI had the following characteristics: explicitly prioritizing QI; balancing short-term (external) priorities with long-term (internal) investment in QI; using data for QI, not just quality assurance; engaging staff and patients in QI; and encouraging a culture of continuous improvement. |
George [64] Nigeria 2016 | develop a framework that highlights mutually reinforcing dimensions of accountability in health systems along three counterbalancing axes | Nigeria primarily serves | Peer review article/qualitative | Reframing accountability as a means of sparking, supporting and steering change can highlight different dimensions of health systems that need reform, particularly depending on the positionality of the viewpoints consulted. |
Health Service Executive Ireland 2016 [66] | performance accountability framework for the health services | Dr. Steeven’s Hospital | report | introduce Accountability levels, Accountability Suite (Plans, Agreements and Reports) , Accountability processes, Escalation and Intervention Framework 2016 |
Rosen [83]USA 2017 | Creating a Pediatric Joint Council to Promote Patient Safety and Quality, | Johns Hopkins Medicine | Peer review article/case study | a focused structure for coordinated efforts across disparate pediatric entities, ensuring horizontal peer learning and entity-specific improvements, as well as vertical lines of accountability and central oversight with shared governance |
Pronovost [42] USA 2017 | offer six principles that health system leaders can apply to establish a governance and management system for the quality of care and patient safety. | Johns Hopkins Medicine | Peer review article/qualitative | ensure there is oversight for quality everywhere care is delivered under the health system; create a framework to organize and report the work; identify care areas where quality is ambiguous or underdeveloped (i.e., islands of quality) and work to ensure there is reporting and accountability for quality measures; create a consolidated quality statement similar to a financial statement; ensure the integrity of the data used to measure and report quality and safety performance; and transparently report performance and create an explicit accountability model |
Mannion [84] England 2017 | validate the structure of an established ‘Board competencies’ self-assessment instrument in the English NHS relationships between (a) Board competencies and staff perceptions about how well their organization deals with quality and safety issues; Board competencies and a raft of patient safety and quality measures at organization level | 95 acute hospitals | Peer review article/quantitative | better Board competencies were correlated in consistent ways with beneficial staff attitudes to the reporting and handling of quality and safety issues (using routinely collected data from the NHS National Staff Survey). |
Geyndt [68] Iran Tunisia Zambia Dominican Republic Uganda Ecuador Indonesia Malaysia Kenya 2017 | (a) synthesize the experience of eleven countries at granting autonomy to their public hospitals and the obstacles encountered; (b) deduce which autonomy policies have or have not been effective documenting successes and failures; and (c) propose evidence-based recommendations to policy makers. | Public autonomous hospital | Peer review article/comparative | Governance of autonomized hospitals by Boards however is obstructed by the resistance of central level entities to have their authority diminished. The Ministry of Finance tends to maintain control over revenues and expenditures. Decentralizing decision making to the operational level has had limited success. |
Austin [43] United States 2017 | How the Application of Financial Structures to Safety and Quality Can Drive Accountability in a Large Health Care System | John Hopkins Medicine | Peer review article/literature review | The four components implemented by Johns Hopkins Medicine were governance, accountability, reporting of consolidated quality performance statements, and auditing. |
Reich [71] USA 2018 | introduces a simplified model for assessing and designing the governance of global health public–private partnerships | PPP in global health | Peer review article/review the literature | The matrix is proposed to improve conceptual clarity and help identify concrete options for action in planning, assessing, and adjusting PPP governance. |
Rechel [62] EU 2018 | the brief explores: • ownership and legal form of hospitals (private or public, organized as a trust, for-profit or not-for-profit, etc.) • strategic planning of hospital infrastructure and capital investment at the national, regional or subregional government level • degree of decentralization of hospital governance (hospital governance layers between the Ministry of Health and the hospitals; political representation versus administrative responsibility; extent of direct managerial control by higher administrative structures). | 10 European countries: Denmark, England, Finland, France, Germany, Italy, Netherlands, Scotland, Spain and Sweden. | Policy Brief/rapid review | here are two basic types of decentralized system. Many countries in Europe already have decentralized health systems where hospital governance is the responsibility of subnational bodies. This is the result of long-standing historical processes rather than explicit policy-making. In other countries, health systems have been actively decentralized, either as part of wider political changes or as part of a specific package of reforms. |
Botje [19] Netherlands 2013 | describe hospital governance and the quality orientation in the Netherlands. Also we wished to investigate the relationship with hospital performance. | Dutch hospitals | Peer review article/cross-sectional | boards of trustees and management boards had a reasonable quality orientation. Boards were familiar with quality guidelines, received a reasonable amount of information related to quality and used this for monitoring quality and policy-making. |
Bonde [85] Denmark 2018 | analyses an experiment into healthcare governance in Denmark inspired by principles of value-based healthcare and intended to reorient the focus of healthcare governance from 'productivity' to 'value for the patient' | 9 hospital departments | Peer review article/experimental study | the locally developed indicators facilitated what we call 'dialogical accountability', and we discuss whether this represents a feasible way forward for value-based health care. |
Kuhlmanna [55] Russia 2019 | the role of physicians within the managerial structure of Russian hospitals. | 19 public hospitals | Peer review article/qualitative | three major problems of hospital management in the Russian Fed-eration. First, hospitals exhibit a leaky system of coordination with a lack of structures for horizontal exchange of information within the hospitals (meso-level). Second, at the macrolevel, the governance system includes implementation gaps, lacking mechanisms for coordination between hospitals that may reinforce existing inequalities in service provision. Third, there is little evidence of a learning culture, and consequently, a risk that the same mistakes could be made repeatedly |
Glenngrd [47] Sweden 2019 | contribute to knowledge about what is regarded as an appropriate governance model in welfare markets in healthcare, from the perspective of government. | Swedish primary care | Peer review article/literature review | Using management controls in a way that improves the providers’ attitude toward and capacity to achieve the assigned task of delivering high-quality healthcare was described as central |
Vian [61] world 2020 | summarize concepts, frameworks, and approaches used to identify corruption risks and consequences of corruption on health systems and outcomes. | critical review based on a systematic search of literature | Peer review article/critical review | show how anti-corruption strategies such as transparency, accountability, and civic participation can affect corruption risk. Ghost workers and absenteeism Dual practice and corruption risks |
Uddin [44] Japan 2020 | examine healthcare governance and its implementation in the historical, institutional and cultural context of Japan | Japanese public hospital | Peer review article/data triangulation conducting documentary research, observations and semistructured interviews | The role of healthcare professionals is crucial in execution of NPM reform in Japan - Western centric governance reform departed significantly from its idealized form - The power of medical school and the ikyoku shape the governance process - Corporate Board maintains harmony instead of seeking accountability |
AlMubarak, [80] KSA 2020 | explore the perceptions of different stakeholders about the privatization of the Saudi health care system. | a public hospital | Peer review article/qualitative case study | The first was pertinent to the changes in the governance structure, with gradually increased autonomy from the government. The second reflected the necessity to introduce accountability within hospitals. The third described the cooperative relationship among the E1-Cluster hospitals as well as its competitive relationship with the private sector |
Local Health Integration Network [65] Canada 2020 | contractual performance targets | Middlesex Hospital Alliance | Report | stipulates accountability and performance obligations for planning, integration and delivery of programs and services. |
Alhothaly [86] KSA 2021 | identify the accountability in health care organization from patients | King Abdullah Medical City (KAMC) | Peer review article/Cross-Sectional Design | there is significant relationship between accountability in healthcare and dimensions such as professionals in healthcare, Government actions, legal and ethical concerns, and administration and management actions. The correlation matrix and regression analysis show that all the four dimensions have strong correlation with accountability in healthcare settings |
Fayed [57] Egypt 2021 | compare the governance structures and practices in for profit and nonnon-for-profit hospitals in Alexandria, Egypt. | For-profit and nonnon-for profit hospitals | Peer review article/e/ descriptive cross-sectional study | As for private hospitals, Board existed in only 72 hospitals (82.75%5 %). Almost all boards have CEO duality. Board members were as few as two members in some boards and up to twenty members in others. Some hospital boards did not have an orientation manual or program. |
Kesale [63] Tanzania 2022 | analyze the status of accountability of Health Facility Governing Committees in Tanzania under the Direct Health Facility Financing setting as perceived by the supply side. | 32 different health institutions | Peer review article/qualitative and quantitative | The health facility governance committee’s responsibility was shown to be substantially connected with the health planning component (p = 0.0048) and the financial management aspect (p = 0.0045). |