Structure, Governance, and Organizational Dynamics of University Medical Centers in the Netherlands

Abstract

The Netherlands, a country of 16 million people, is home to eight university medical centers (UMCs), institutions that are closely analogous to U.S. academic health centers and play in important role in Dutch society. The authors' purpose was to test the extent to which an analytical framework developed in one setting can be transferred to another and to yield fresh insights into the value and limitations of different theoretical perspectives on organizational design in the specific context of the academic-clinical enterprise. The authors applied a conceptual framework originally developed in the U.S. context to analyze UMC structure, governance, and organizational dynamics. Three UMCs, selected for their differences, were used as case studies, and data were gathered through interviews and document review. A multilevel approach is used to present the data. At the highest level, an overview of the composition, functions, and accountabilities of UMC boards is provided. Below this, the authors describe how functional integration for delivery of the tripartite mission is achieved at the sub-board level. Finally, the authors describe some of the detailed mechanisms used to bind together different interest groups within the UMCs. The authors found that the U.S.-derived framework for analysis required modification for the context of the Netherlands, but that the study validates the view that many challenges involved in the management of the academic-clinical enterprise are international.