Danish Hospital Sector Research Articles

Distributed leadership and performance‐related employee outcomes in public sector organizations

AbstractDistributed leadership is the sharing of leadership tasks between managers and employees. This article demonstrates how a distributed leadership perspective adds to the public administration literature by including an important sensitivity to planned and nonplanned leadership. We propose a theoretical model that explains the impact of distributed leadership on employee outcomes which have a direct or indirect impact on organizational performance in public organizations contingent on alignment with individual leadership capacity and organizational goals. Our empirical analysis in the Danish hospital sector shows initial support for the expected relationships between distributed leadership and performance‐related employee outcomes such as job satisfaction and innovative behavior. This indicates that the distributed leadership perspective holds the potential to strengthen service delivery in complex public service organizations while there is weaker support for the notion that the positive impact of distributed leadership depends on individual leadership capacity and their support for organizational goals.

The curse of bureaucratisation or the blessings of professionalisation? Nurses’ engaged adoption of quality management in hybrid managerial positions

The paper concerns how new quality management in the Danish hospital sector has created new career and professionalisation opportunities for nurses. While the well-known dualism between the logics of professionalism and managerialism is challenged in the literature, not much is known about how engagement in the tighter steering of practice may converge with professional identities and meaningfulness in work. The paper applies a Bourdieusian and ethnographic approach to the examination of nurses’ enthusiastic involvement in quality management as they take up hybrid managerial positions in an acute care department. The findings demonstrate the importance of the material and symbolic value of scientific-bureaucratic knowledge in legitimizing quality management, achieving meaningfulness in practice and bolstering the professional role of nurses.

Buy-in to a Credible Vision! Why Leaders Make Prospector Responses to Learning-Oriented Performance Reform

The implementation of learning-oriented performance reforms that seek to replace performance regimes based on external accountability is an important phenomenon. This article examines how leaders respond to such reforms and what factors make leaders pursue a prospector response. The article conceptualizes and examines the phenomenon through a mixed method study in the Danish hospital sector and find that some leaders respond in a prospector way and that reactor responses disappear over time. The key result is that leader buy-in to the vision of learning-oriented performance reform and the perception of higher level commitment to the reform further prospector responses.

Do follow-on therapeutic substitutes induce price competition between hospital medicines? Evidence from the Danish hospital sector

ObjectiveThe pricing of follow-on drugs, that offer only limited health benefits over existing therapeutic alternatives, is a recurring health policy debate. This study investigates whether follow-on therapeutic substitutes create price competition between branded hospital medicines. MethodsNew follow-on drugs and their incumbent therapeutic competitors were identified from Danish sales and product registration data on hospital pharmaceuticals using medically relevant criteria. We examined whether follow-on drugs adopt lower prices than their incumbent competitors, and whether incumbent competitors react to entry of follow-ons through price adjustments using a random intercept panel model. ResultsWe found no evidence that follow-on drugs adopt lower prices than their incumbent competitors. Furthermore, potentially due to low sample size, we found no evidence that prices for incumbent pioneer products were significantly reduced as a reaction to competition from follow-on drugs. ConclusionCompetition between patented therapeutic substitutes did not seem to increase price competition and containment of pharmaceutical expenditures in the Danish hospital market. Strengthening hospitals’ incentives to consider the price of alternative treatment options paired with a more active formulary management may increase price competition between therapeutic substitutes in the Danish hospital sector in the future.

The Economic Burden of Head and Neck Cancers in Denmark

Introduction: The incidence of head and neck cancers has increased markedly over the last decade. A Danish study of the costs of head and neck cancers has not been undertaken. Such studies have again become relevant due to the development of the HPV vaccines, as some cases are attributable to high-risk HPV 16 or 18. The objective of study was to estimate the incidence of head and neck cancers and their health care costs. Methods: Data on incidence and health care use related to head and neck cancer were obtained from Danish health care registers. New cancer patients were identified in the Danish National Cancer Register. Resource use per year in the hospital sector was estimated using data from the National Patient Register applying charges as cost estimates. Health care consumption by cancer patients was compared with that by an age- and sex-matched cohort without cancer. Results: We found that nearly 1000 new cases of oral cavity, oropharyngeal, hypopharyngeal and laryngeal cancer are diagnosed annually. In total the cost of these cancers to the Danish hospital sector constituted 31.6 million Euros per year, with the majority of costs (74%) occurring in men. The total costs associated with HPV16/18-related head and neck cancers were estimated to be 6.1 million Euros per year. Conclusion: This study provides the first Danish estimates of the costs associated with non-cervical and non-genital HPV-related cancers based on very reliable, individual-based data. It is expected that the current HPV vaccination programme will reduce this burden.

Incidence and cost of anal, penile, vaginal and vulvar cancer in Denmark

BackgroundBesides being a causative agent for genital warts and cervical cancer, human papillomavirus (HPV) contributes to 40-85% of cases of anal, penile, vaginal and vulvar cancer and precancerous lesions. HPV types 16 & 18 in particular contribute to 74-93% of these cases. Overall the number of new cases of these four cancers may be relatively high implying notable health care cost to society. The aim of this study was to estimate the incidence and the health care sector costs of anal, penile, vaginal and vulvar cancer.MethodsNew anogenital cancer patients were identified from the Danish National Cancer Register using ICD-10 diagnosis codes. Resource use in the health care sector was estimated for the year prior to diagnosis, and for the first, second and third years after diagnosis. Hospital resource use was defined in terms of registered hospital contacts, using DRG (Diagnosis Related Groups) and DAGS (Danish Outpatient Groups System) charges as cost estimates for inpatient and outpatient contacts, respectively. Health care consumption by cancer patients diagnosed in 2004–2007 was compared with that by an age- and sex-matched cohort without cancer. Hospital costs attributable to four anogenital cancers were estimated using regression analysis.ResultsThe annual incidence of anal cancer in Denmark is 1.9 per 100,000 persons. The corresponding incidence rates for penile, vaginal and vulvar cancer are 1.7, 0.9 and 3.6 per 100,000 males/females, respectively. The total number of new cases of these four cancers in Denmark is about 270 per year. In comparison, the total number of new cases cervical cancer is around 390 per year. The total cost of anogenital cancer to the hospital sector was estimated to be 7.6 million Euros per year. Costs associated with anal and vulvar cancer constituted the majority of the costs.ConclusionsAnogenital cancer incurs considerable costs to the Danish hospital sector. It is expected that the current HPV vaccination program will markedly reduce this burden.

Economies of scale and scope in the Danish hospital sector prior to radical restructuring plans

ObjectiveThe Danish hospital sector faces a significant rebuilding program driven by recent regional reform and guidelines for acute admission hospitals. Within the next 5–10 years, the number of public hospitals offering acute admission will be reduced from 35 to approximately 20 larger hospitals. As the administrative data may be biased during the middle of a restructuring process our objective was to analyze whether the configuration of Danish public hospitals was subject to economies of scale and scope prior to the restructuring plans. MethodsWe estimated a quadratic cost function using panel data on the total costs for somatic treatment, casemix adjusted DRG-production values, and other cost drivers for the three years before the 2007 reforms. A short-run cost function was used to derive estimates of a long-run cost function by applying the envelope condition. Next, we estimated economies of scale and scope. ResultsWe identified moderate-to-significant economies of scale and scope. This indicates that the Danish hospital sector was characterized by unexploited gains from consolidation. ConclusionsOur results suggest that the proposed plans have the potential to result in hospitals that are more efficient. However, post-restructuring studies elsewhere show that the strategy of horizontal integration has failed.

The contested terrain of hospital management: Professional projects and healthcare reforms in Denmark

Although much has been written on the changing management of professional services organizations, only limited attention has been given to the way in which management itself might represent a contested terrain. Drawing on concepts from the sociology of professions, this article develops this idea in relation to the Danish hospital sector. The analysis of secondary sources reveals how, from the mid-1980s, both the nursing and medical professions in Denmark actively sought to lay claim to the jurisdiction of hospital management. The result of this struggle was to further reinforce the dominant position of doctors in the clinical division of labour although the position of nurses has also been enhanced. Such findings point to the need to give more attention to the way broader changes in hospital governance are mediated by interprofessional struggles and rivalries. Such struggles, in turn, have implications not only for the division of labour and status order between professions but also for the way management work itself is enacted.

Potential gains from hospital mergers in Denmark

The Danish hospital sector faces a major rebuilding program to centralize activity in fewer and larger hospitals. We aim to conduct an efficiency analysis of hospitals and to estimate the potential cost savings from the planned hospital mergers. We use Data Envelopment Analysis (DEA) to estimate a cost frontier. Based on this analysis, we calculate an efficiency score for each hospital and estimate the potential gains from the proposed mergers by comparing individual efficiencies with the efficiency of the combined hospitals. Furthermore, we apply a decomposition algorithm to split merger gains into technical efficiency, size (scale) and harmony (mix) gains. The motivation for this decomposition is that some of the apparent merger gains may actually be available with less than a full-scale merger, e.g., by sharing best practices and reallocating certain resources and tasks. Our results suggest that many hospitals are technically inefficient, and the expected "best practice" hospitals are quite efficient. Also, some mergers do not seem to lower costs. This finding indicates that some merged hospitals become too large and therefore experience diseconomies of scale. Other mergers lead to considerable cost reductions; we find potential gains resulting from learning better practices and the exploitation of economies of scope. To ensure robustness, we conduct a sensitivity analysis using two alternative returns-to-scale assumptions and two alternative estimation approaches. We consistently find potential gains from improving the technical efficiency and the exploitation of economies of scope from mergers.

Variable prospective financing in the Danish hospital sector and the development of a Danish case-mix system

This article aims to describe and assess the Danish case-mix system, the cost accounting applied in setting national tariffs and the introduction of variable, prospective payment in the Danish hospital sector. The tariffs are calculated as a national average from hospital data gathered in a national cost database. However, uncertainty, mainly resulting from the definition of cost centres at the individual hospital, implies that the cost weights may not fully reflect the hospital treatment cost. As variable prospective payment of hospitals currently only applies to 20% of a hospital's budget, the incentives and the effects on productivity, quality and equality are still limited.

Doing mini–health technology assessments in hospitals: A new concept of decision support in health care?

The purpose of this project was to evaluate local decision support tools used in the Danish hospital sector from a theoretical and an empirical point of view. The use of local decision support was evaluated through questionnaires sent to all county health directors, all hospital managers, and all heads of clinical departments in cardiology, orthopedic surgery, and intensive care. In addition, respondents were asked to submit whatever decision support tools they were using (including mini-HTAs, other forms or checklists, and special procedures for decision making concerning new health technologies). A theoretical analysis of the decision support tools (decision theory) was performed as well as a comparison with the business case method used in private companies. Finally, the Danish mini-HTA was compared with foreign production and use of HTA and HTA-like assessments as local decision support. The response rate was high (87 percent, 94 percent, 85 percent, respectively). We collected sixty different forms (of which forty-nine were mini-HTAs) and twenty variants of written procedures. We found theoretical and empirical evidence that local involvement in the process of making the HTA could be important for the use of the results from the HTA and for the process of implementing the new technology. Doing mini-HTA in hospitals seems to balance the need for quality and depth with the limited time and resources for assessment.

The rise, heyday, and incipient decline of specialization: hospitals in Denmark, 1930-1990.

Between 1930 and 1990 Denmark's hospital sector and hospital policy underwent radical changes. In 1930 the sector was dominated by many small hospitals, with care as the central task. By 1990 the number of hospitals had almost halved, specialization had developed, and diagnostic and therapeutic procedures were hospitals' most important functions. There have been many claims that the shape of the health care sector is determined by the development of medicine. This article demonstrates that changes in other areas of society have greatly influenced the development of the Danish hospital sector. In the 1930s and 1940s, the focus was on equity and specialization; in the 1950s, on growth, rationalization, and division of labor; in the 1960s, on growth and planning; and during the last decades, on management, productivity, and cost containment. Since 1980 the specialization, growth, and political acceptability of the specialized hospital sector have decreased, a change that can be characterized as the incipient decline of the specialized hospital sector.