Overcoming Governance and Cost Challenges for Australian Public Hospitals: The Foundation Trust Alternative (pdf) by Peter Phelan and Jeremy Sammut (Centre for Independent Studies)
(p6) State-wide industrial agreements that mandate staffing levels is poor management and inherently inefficient, but are much loved by nursing unions as they allow the unions to determine the size of the nursing workforce (and expand union membership).
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(p8) The authors concluded that two factors explain why a competitive environment drove higher management scores. CEOs are more likely to try harder when faced with competition as the rewards are higher, as are the risks associated with failing to improve productivity and financial performance. Poorly managed hospitals are likely to fail and either close down or be taken over. Hospitals with clinically qualified CEOs were better managed, and those that acquired clinically qualified CEOs during the course of the study improved their management performance. Clinically trained managers were found to better understand clinical challenges, could communicate with clinical staff in a common language, and enjoyed greater credibility than non-clinical managers.
Higher performing hospitals had CEOs with higher levels of autonomy—meaning full operational authority and financial responsibility, combined with appropriate accountabilities. The better hospitals devolved decision-making wherever possible to middle managers with direct responsibility for patient care.
More autonomy for CEOs?
Why Are Hospital CEOs Paid So Well?
So why do so many U.S. hospitals have a helicopter? Again, the answer lies not in medical evidence but in the imperative to compare well with competitors.
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