1st Edition
Management Control in Hospitals A Breakthrough Approach to Improving Performance and Efficiency
For years, problems related to health-care efficiency have been at the top of the priorities of many hospitals systems and governments. The growing cost of health care, and particularly hospitals, is a significant factor in the increasing pressure for improvement of hospitals’ efficiency while maintaining a high quality of services. Hospitals are recognized as organizations in which waste, unnecessary administrative burdens, failures of care coordination, failures in execution of care processes, and even fraud and abuse are frequently identified as causes.
Adoption of management control as a response to hospital problems is consistent with the conviction that control is a critical management function that has the greatest impact on organizational performance. Research proves that the lack of adequate control, adapted to modern organizational solutions, causes many harmful consequences, such as faulty services, dissatisfied patients and employees, inability to effectively compete on market, low flexibility and innovativeness, and, consequently, poor performance of the organization.
This book comprehensively presents issues related to management control and develops a breakthrough theory about management control in hospitals. It is the result of many years of research and outlines the concept of control and related theories, which are discussed in detail, taking into account the unique characteristics of medical services, the health-care market, and hospitals as public organizations.
Research has shown that the main elements of management control in hospitals are information systems, diagnostic control, interactive control, innovativeness, manager’s trust in physicians, and perceived uncertainty. And that proper relationships between these elements positively influence the hospital’s performance. This book describes how the success of the entire control process is based on the hospital’s top management and its interaction with clinical managers, department heads, and directors of other medical departments as well as clinicians. After reading this book, the implementation of the solutions suggested will help hospitals improve their performance, including the quality and effectiveness of the provided medical services and patient care.
Dedication
About the Author
Introduction
1. THE ESSENCE AND NATURE OF HOSPITALS AND THEIR ENVIRONMENT
1.1. Characteristics of hospitals
1.2. Hospitals’ structure and management
1.3. Medical profession and professional bureaucracy
1.4. Past efforts to improve hospital efficiency
2. CONTROL IN MANAGEMENT SCIENCES
2.1. Origins and definitions of control in the literature
2.2. Management control at the operational and strategic levels
2.3. The concept of levers of control
2.4. Levers of control in hospitals - an assessment of the results of the previous research
2.5. Management control from an institutional perspective
2.6. Operational definition of management control
3. MAIN ELEMENTS OF THE MANAGEMENT CONTROL MODEL
3.1. Information system in management control
3.2. Measurement of a hospital performance
3.3. Evaluation and reward of hospital employees
3.4. Innovations and innovativeness in hospitals
3.5. Trust between managers and physicians
3.6. Environmental uncertainty
4. RESEARCH METHODS
4.1. Mixed methods research design
4.2. Qualitative research strategy
4.3. Measurement instruments for latent variables
4.4. Selection and characteristics of the sample in quantitative research
4.5. Justification for choosing a path model estimator
5. RESULTS OF QUALITATIVE RESEARCH ON MANAGEMENT CONTROL IN HOSPITALS
5.1. Information systems
5.2. Hospital performance from the perspective of its director
5.3. Diagnostic use of information system
5.4. Rewarding employees
5.5. Interactive use of information system
5.6. The role of innovativeness in management control
5.7. Environmental uncertainty
5.8. Director’s trust in physicians
5.9. Institutional logics and decoupling of formal structures from day-to-day practices
5.10. Conceptual model of management control in hospitals
6. STRUCTURAL MODELING OF MANAGEMENT CONTROL IN HOSPITALS
6.1. Operationalization of variables
6.2. Validation of the measurement model
6.3. Evaluating the structural model of management control in hospitals
6.4. Evaluation of the modified management control model in hospitals
6.5 Analysis of the predictive power of the model
6.5. Non-linear relationships between constructs and data heterogeneity
7. DISCUSSION OF RESEARCH RESULTS
7.1. Quantitative research findings in the context of qualitative research and implications for theory and practice
7.2. Conclusions
7.3. Limitations of the model and directions for further research
ENDING / SUMMARY
REFERENCES
ANNEXES
Biography
Roman Andrzej Lewandowski is an Assistant Professor at the University of Warmia and Mazury in Olsztyn, Faculty of Economics, Institute of Management and Quality Science and director of Voivodesship Rehabilitation Hospital for Children in Ameryka, Olsztynek, Poland. With his primary research interests in management control in healthcare, performance management systems, person-centered care implementation, trust, hybridity, and quality, Roman combines his extensive real-world management experience with academic expertise to explain fundamental management and control theories, concepts, methods, and tools, and how to apply them in healthcare organizations.
Roman has published over 60 studies, including two books on management control, and is a recognized expert in his field. He has contributed to several international projects, including the COST Action IS0903: Enhancing the role of medicine in the management of European health systems - implications for control, innovation, and user voice; the COST Action TD1405: European Network for the Joint Evaluation of Connected Health Technologies (ENJECT); and the Polish National Science Centre project: The model, the typology and methods of measurement of control systems in public hospitals – where he served as the Principal Investigator. He was involved in the Artificial Intelligence, Enhanced Person Centred Care in Neurosurgery project, which was financed by the Ministry of Health of Montenegro. Roman has also served as Vice Chair for the European Network for cost containment and improved quality of health care (COST Action CA15222) and is a member of the governing council of the Polish Federation of Hospitals, which is part of the European Hospital & Healthcare Federation (HOPE).
Overall, Roman is a researcher and expert in his field, with a passion for improving healthcare systems and patient outcomes through his research, teaching, and involvement in international projects and organizations.
