1. A new role for the doctor- manager? About the changing role of the medical hospital director in a more competitive and politicized environment Wilma van der Scheer, Kim Putters  Erasmus University Rotterdam  The Netherlands

2. Outline 1.The Dutch case 2.Theories used 3.Methods 4.Quantitative outcomes 5.Qualitative outcomes 6. Conclusions and discussion

3. Hospital governance 1.Integration Act (2000): executive board has final responsibility 2.In practice (since mid 1990s): continuous negotiation between Staff Executive and Executive Board 3.Health Insurance Act (2006): new governance-structures

4. Changes in governance 1.More competition 2.Separation between policy and implementation 3.Negotiations over means and ends are left to field parties 4.→ displacement of politics, politicization of management (Beck 1994, Bovens 1995)

5. Theoretical point of departure Hospital as a negotiated order (Abbott 1988) With different interests (public, private, professional and patient) Negotiating between different worlds (cure, care, community and control) (Glouberman and Mintzberg 2001)

6. Methods Survey (n = 200, response = 35%) Interviews in 10 organizations with: 5 hospital directors, 4 staff executives, 3 chairpersons of the supervisory board of: organizations with a med.dir. from ‘inside’, organizations with a med.dir. from ‘outside’, organizations without a med.dir. and: 2 executive searchers

7. Conclusions quantitative study 1.Very experienced managers, broad educated, but with little experience ‘outside’ health-care 2.Act on the boarder of internal affairs and external affairs, but with more attention for internal affairs 3.Feel very responsible for matters of care/quality than for finances 4.Little attention for entrepreneurial activities 5.Take less part in the public debate about health care

8. Conclusions qualitative study 1.Natural distribution of roles 2.Medical background alone is not enough 3.Different argumentations (cultural, relational, knowledge-based, principle) 4.Different perspectives, different expectations

9. Different perspectives, different expectations (1) Executives: med. dir. is a connector, he/she is likely to realize more support from medical staff for hospital policy Medical director: we are not different form other directors, only we understand doctors better

10. Different perspectives, different expectations (2) Staff executive: med. dir. is a representative, who understands our interests Sup. board: med. dir. is a risk manager, who can prevent problems between executive board and medical staff

11. Different perspectives, different expectations (3) Exec. searcher: med. dir. can build bridges between managerial and medical world (but communication skills are more important)

12. Conclusions 1.More attention for educating/training doctors in management 2.Different perspectives, different expectations 3.Dominance of complicated relationship doctors- managers 4.Towards a different role? (e.g. from managing professionals to managing patient experiences?) 5.Requires: expectation management!