Governance in Dutch hospitals

Abstract

In this article we have characterised Dutch hospitals as organizational networks. They operate in a blurred context, which is the interference of principles from market and hierarchy. Based on these principles we questioned the optimal way governance can be organised. The context for governance is explained along two pathways: First, specific issues of the Dutch healthcare system and current trends in society force hospitals to react and respond in a certain way. Second, the typical organisational position of physicians in Dutch healthcare makes governance a challenge. In this context one can look at governance twofold: control or learn. We argue that each type of risk should be countered with the best applicable instrument. This means, that control or learn never can be the only convenient governance instrument. The board's choice for the proper action therefore is always ambivalent. However, the profound role of control and the neglected role of learning principles is obvious. Notwithstanding the effect...