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Hospital management—patient-centered care, CEO appointments and their impact
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This dissertation is composed of three essays on key healthcare management problems using Portuguese public hospitals as the object of analysis. The first essay addresses healthcare management resistance to providing patient-centered care (PCC) and the priority given to it by senior managers in their practice. In doing so, the essay provides both a conceptual contribution and new empirical knowledge. Organizational and leadership theories offer a novel PCC path dependent theoretical framework for identifying specific requirements to enable PCC. The
proposed framework is complemented by the “care configuration grid,” which encompasses the concern for transaction- and patient-centeredness positions of providers in relation to PCC implementation. To test the main research question, essay one uses board minutes and a specifically designed CEO questionnaire; the findings reveal that PCC is not a management priority in decision-making, and specific implementation barriers exist. Essay two assesses NHS hospitals CEOs’ appointments through the lens of institutional logics. Analyzing an 11-
year period, using purpose build database of all NHS hospitals’ appointments, this study shows how the power dynamics between bureaucracy, medical professionalism, and managerial logic influence public appointments. Institutional actors show opportunistic and strategic behavior to gain advantages without achieving clear dominance. Essay three aims to determine the role and relevant characteristics of CEOs in hospital performance while minimizing reverse causality issues. By assessing CEOs’ performance over time, the study shows that CEOs impact hospital performance. The research identifies five CEO characteristics that influence clinical and financial performance within the financial constraints of Portuguese hospitals.
Moreover, under such circumstances, clinical and financial performances compete with each other, alerting managers to the potential negative effects of cost containment measures.
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Patient-centered care Hospital management CEO appointments Institutional logics CEO performance