Management and reforms in the Nordic hospital landscape

Abstract

The purpose of this paper is to give a comprehensive and updated analysis of the available academic literature (2000-2016) on management and reforms in the Nordic hospital landscape. A systematic literature review was conducted by searching articles in Scopus database, as well as applicable journals. The vast majority of the Nordic articles are relatively coherent on the following: first, the reforms have created a change in the manager role or rather there are new expectations about the content of the manager role. Second, the reforms entail tension between profession and administration. Doctors who are managers identify themselves primarily as doctors, implicating that the medical logic has not competed out by an administrative logic. Third, the reforms have brought new opportunities for nurses. Still, nurse managers perceive tension between the profession and administration. Fourth, new public management (NPM) is often the framework or background for understanding change in hospitals or manager roles in the articles. Fifth, the majority of the articles are focusing on management as a general key concept. The search was limited to the period 2000-2016 and have only included articles published in English. There are several limitations around these choices: first, research published in a language other than English (i.e. Norwegian, Swedish, Finnish or Danish) are excluded. Second, it may take years before consequences of hospital reforms have impact on management and manager roles. Some of the articles are published relatively shortly after the implementation of the reform. Third, many factors in a reform have impact on management or manager roles, thus it is challenging to give simple explanations. The authors would welcome a more pluralistic approach, and contributions that are not quite so busy describing and criticizing the NPMization of hospitals and management. In particular, the authors look forward to more research on how other reform trends, such as NPG, affect management in hospitals. This review summarizes the literature on how academic literature (2000-2016) - in a Nordic reform context - has dealt with management in hospitals. The study reflects upon the academic literature per se. There are tendencies to explore reforms and management with some conceptual equivalence.