Abstract
BackgroundPolitical and managerial reforms affect the health sector by translating into governance tensions. As identified in the public management literature, these tensions come from the diffusion of management principles and practices from the business world. These tensions manifest at four levels: institutional, organisational, managerial and instrumental. The aim of this research is to understand how these tensions are expressed in healthcare organisations of different status.MethodsWe conduct a contrasting case study exploring the cases of two French healthcare organisations, one private for-profit (clinic) and one public not-for-profit (cancer treatment centre). Our analyses are mainly based on the content analysis of 32 semi-structured interviews conducted with staff (nurses, doctors, management and administrative staff) of these two organisations.ResultsOur results show that these tensions can be distinguished into three categories (tensions on professional values, standards and practices) which are expressed differently depending on the type of healthcare organisation and its main management characteristics.ConclusionsUnexpectedly, in the for-profit organisation, the most intense tensions concern professional standards, whereas they concern professional practices in the not-for-profit organisation. These analyses can help guide policy makers and healthcare managers to better integrate these tensions into their political and managerial decisions.
Highlights
In OECD countries since the early 1970s, political, administrative and economic reform programmes have been underway and some of them are leading to major changes in implementation of public policies
The research question we are addressing here is: in the context of political and managerial reforms in health, are governance tensions expressed in healthcare organisations in any way? Can we identify differences in their manifestation according to the status of the organisation?
Conceptual framework of the study: Public Governance Tensions (PGTs) Conceptual approaches that focus on tensions within national organisations and governance systems offer very interesting analytical potential for the management of public organisations [18, 19] and that of healthcare organisations [20]
Summary
In OECD countries since the early 1970s, political, administrative and economic reform programmes have been underway and some of them are leading to major changes in implementation of public policies. Tensions in healthcare organisations show in particular the importance of creating alliances and joint communication between the micro, meso and macro levels of health systems [23]. Since the late 1990s, reforms applied to public health organisations have led to significant changes in national systems of public governance [2] These tensions are expressed in particular between national policy priorities and local views and priorities [25]. Exploring the effects of reforms on the governance of public organisations, Hudon and Mazouz [17] show that these tensions affect these organisations at four levels: public values, architecture of organisational structures, formal management frameworks and management instruments [16, 17] (Fig. 1). They identify four categories of tensions on the roles, functions and responsibilities of public managers: ethical tensions, organisational tensions, managerial tensions and artefactual tensions (Fig. 1)
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