Abstract

BackgroundChallenges brought about by developments such as continuing market reforms and budget reductions have strained the relation between managers and physicians in hospitals. By applying neo-institutional theory, we research how intra-organizational dynamics between physicians and managers induce physicians to become entrepreneurs by starting a specialty clinic. In addition, we determine the nature of this change by analyzing the intra-organizational dynamics in both hospitals and clinics.MethodsFor our research, we interviewed a total of fifteen physicians and eight managers in four hospitals and twelve physicians and seven managers in twelve specialty clinics.ResultsWe found evidence that in becoming entrepreneurs, physicians are influenced by intra-organizational dynamics, including power dependence, interest dissatisfaction, and value commitments, between physicians and managers as well as among physicians’ groups. The precise motivation for starting a new clinic can vary depending on the medical or business logic in which the entrepreneurs are embedded, but also the presence of an entrepreneurial nature or nurture. Finally we found that the entrepreneurial process of starting a specialty clinic is a process of sedimented change or hybridized professionalism in which elements of the business logic are added to the existing logic of medical professionalism, leading to a hybrid logic.ConclusionsThese findings have implications for policy at both the national and hospital level. Shared ownership and aligned incentives may provide the additional cement in which the developing entrepreneurial values are ‘glued’ to the central medical logic.

Highlights

  • Challenges brought about by developments such as continuing market reforms and budget reductions have strained the relation between managers and physicians in hospitals

  • These developments were supported by the Dutch Healthcare Authority, which advocated more specialty clinics because of their substantially lower charges compared to hospitals [1], while in addition, the Dutch Health Care Inspectorate pointed at the positive developments with regard to the quality of care provided by specialty clinics [2,3]

  • First, we will establish the nature of intra-organizational dynamics in hospitals and in clinics

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Summary

Introduction

Challenges brought about by developments such as continuing market reforms and budget reductions have strained the relation between managers and physicians in hospitals. We determine the nature of this change by analyzing the intra-organizational dynamics in both hospitals and clinics. 2010, while the total revenue of these clinics tripled to 315 million euros, equaling roughly 2.5% of the total hospital budget [1]. These developments were supported by the Dutch Healthcare Authority, which advocated more specialty clinics because of their substantially lower charges compared to hospitals [1], while in addition, the Dutch Health Care Inspectorate pointed at the positive developments with regard to the quality of care provided by specialty clinics [2,3]. In the media as well, specialty clinics were being welcomed as efficient providers, providing fast access to patient-oriented care [4,5,6,7]

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