Joined in 2023 
82 
63 About this deal
Both authors participated fully in the writing of this article. Both authors read and approved the final manuscript. Author information Mintzberg H. Cited by G. Best, in NHS management surfeit or shortage. Health Director (Journal of the National Association of Health Authorities and Trusts). 1996;25:16–7. Nigel Edwards is Chief Executive of the Nuffield Trust in London. Prior to becoming Chief Executive in 2014, he was an expert advisor with KPMG’s Global Centre of Excellence for Health and Life Sciences and a Senior Fellow at The King’s Fund. Previously he was Policy Director of the NHS Confederation for 11 years. He holds a Ph.D in Health Economics from London School of Economics, where he is an honorary visiting professor. Brown was in San Francisco last week during a summit of Asian-Pacific nations, where the biggest development was a four-hour meeting between President Joe Biden and his Chinese counterpart, Xi Jinping. It was the first time the leaders of the two largest economies have spoken, much less met face-to-face, in a full year. Domberger S, Jenson P. Contracting out by the Public Sector: Theory, evidence, prospects. Oxf Rev Econ Policy. 1997;13(4):67–78.
Hollnagel E, Braithwaite J, Wears RL, editors. Resilient Health Care. Surrey, England: Ashgate Publishing; 2013.
The Latest
It also is important to recognize that the 3 + 3 framework is not a formula for discovering what organizational theorists sometimes derisively refer to as “magic bullets”. Instead it is a call to apply the basic core lessons of traditional hands-on, shop-floor-level management. Among other elements, this approach will mean accepting different management styles and approaches in different institutions, indeed in different parts of the same institution. Operational flexibility, not centralized standardization, will need to become the policy watchword. Importantly, the political role in public hospitals will need to fade further, while the managerial role will necessarily grow in prominence. Sutherland K, Leatherman S. Regulation and quality improvement: a review of the literature. London: The Health Foundation; 2006. The second contextual limitation is a set of specific market failures in public hospitals, which limit the scope of the standard financial incentives and reform measures. These mechanisms are also often in conflict with the role of professional medical authority (which has been already discussed above as the second structural limitation in hospitals). Helpful comments from the journal’s three reviewers and Ruth Thorlby at the Nuffield Trust are greatly appreciated. Funding Moreover, all of these analytic frameworks may have different (usually implicit) assumptions about the nature of human behavior and motivation. For example, readings of how far policymakers view staff and managers as ‘knights’ or ‘knaves,’ to use Le Grand’s typology [ 40]. In other words, the extent to which it is possible to rely on intrinsic motivation, professionalism and good intentions (‘knightly’ behaviors) rather than having to use a variety of incentives, sanctions, inspection and other methods to control self-interest and less noble motives. Three structural sources of public hospital resistance to change
Busse R, Geissler A, Quentin W, Wiley M, editors. Diagnosis-Related Groups in Europe: Moving toward Transparency, Efficiency, and Quality in Hospitals. Maidenhead: McGraw-Hill/Open University Press; 2011. Enthoven AC. Internal market reform of the British National Health Service. Health Aff. 1991;10(3):60–70. Menzies-Lyth IEP. Containing Anxiety in Institutions: Selected Essays, vol. 1. London: Free Association Press; 1988 (January 1).Reposo VMR, Harfouche APJ. Portugal. In: Saltman RB, Duran A, Dubois HWF, editors. Governing Public Hospitals: Recent Strategies and the Movement Toward Institutional Autonomy. Brussels: European Observatory on Health Systems and Policies; 2011. p. 217–40. Both are unconventional personalities, and their aversion to the tribalism that’s rampant in Washington is perhaps even more pronounced now that their careers in elected office are likely done. (Brown served a total of 16 years as California governor; Schwarzenegger, 76, served seven years and batted down any suggestion he might run for the U.S. Senate on Friday at a luncheon event in the state capital. “I’m totally ruling it out; it’s not even in there,” he said.) Saltman RB, Bankauskaite V, Vrangbaek K, editors. Decentralization in Health Care: Strategies and Outcomes. European Observatory on Health Systems and Policies Series. Berkshire: Open University Press/McGraw-Hill Education; 2007. the conflict between expanding curative and primary care coverage areas as against staying within financial and budgetary limitations
The third area of organizational dysfunction that public hospitals suffer from reflects the explicit political character of policy and management decision-making in these institutions. There is no shortage of literature that describes the non-linear, non-optimizing, and sometimes seemingly non-rational elements that compose typical politically structured decision-making in all sectors of public policy (see for example [ 67, 68]). To suggest that public sector decision-making is broadly dysfunctional when viewed from the perspective of health provider and/or service organizations as well as of the staff working in those institutions is not novel.
Join the Conversation
Further, these three structural dimensions come together in an institutional environment shaped by a set of three external contextual factors that further constrain effective management and reform of public hospitals. Dixon-Woods M, Agarwal S, Jones D, Young B, Sutton A. Synthesizing qualitative and quantitative evidence: a review of possible methods. J Health Serv Res Policy. 2005;10(1):45–53B.
Great Deal 
New Comment