From philanthropic to corporate : the hospital board within Australia - structure and functions within a changing economic environment
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(Published version)
Date
2004
Authors
Cocks, Susan Leila
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thesis
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Abstract
This study is an exploration of contemporary governing boards of hospitals within Australia, focusing on their current structures and functions within the context of a changing economic and political environment. Over the past two decades, hospitals within Australia have introduced principles associated with managed competition (such as those related to prospective payment for services) into their management systems. These principles have been introduced to expand the hospitals’ level of accountability for the provision of services to the community, and to control costs and the quality of outcomes. This has caused non-competitive-based organisations, such as government and non-profit hospitals, to function within the constraints of competition.
The study design was based on the collection of two sets of data. Phase one of the data collection focused on gathering data through a survey to investigate the structural characteristics under which hospital boards were undertaking their functions. The outcomes from this survey provided the environmental context in which to couch the outcomes from the second aspect of the study, which was to provide an interpretation of hospital board members’ perceptions about the phenomenon of the hospital board. The survey outcomes provided a description of the hospital boards’ structures as they related to: personal and professional characteristics of the membership; policies relating to the membership’s performance appraisal, role development activities and compensation; meetings and committee structures used to support the board.
These findings, in concert with the interpretation of the board members’ perceptions of their role, revealed four constructs, including supportive sub-constructs, about the functions associated with the hospital boards’ role. These were: board members’ expectations of their role on the board; conflicting organisational cultures in which the members provided their services; interfacing with hospital management; the ability to establish rational sources of information on which to base functional outcomes.
The survey findings indicated that the structures of hospital boards within Australia were consistent with what was revealed in the literature- an ambivalence, if not confusion, about their structure and that they appeared to contain a combination of characteristics associated with both philanthropic and corporate business models. This was replicated in the members’ views about their role on the hospital board. They perceived a dichotomy between the structure of the board, based on principles of philanthropy and their volunteer status, and being required to take on high levels of responsibility on the part of the hospital, roles they associated with corporate boards.
Members’ perceptions about the issues of board membership, its composition and how a board undertakes its functions expanded this insight, particularly in relation to the membership selection criteria. This was established either on having members representing the community’s needs or selecting them for their ability to provide the hospital with personal and professional expertise. Additional insight was gained into the practice of including board members who were internal to the organisation and the need to consider the professional status of the workforce in determining the nature of their contribution to the board. The study has also identified the concern for information, and the need for structures that provide board members with the ability to expand and verify information outside their reliance on the manager.
Issues for policy change were also identified. These included the need to realign board structures to befit the economic and political environment in which the hospital is based, in particular considering models associated with the corporate business world. Further, in redesigning the board’s structure, hospitals need to incorporate the growing community demand for a greater level of participation in the decisions that are being made about the services that the organisation is to provide.
School/Discipline
International Graduate School of Management
Dissertation Note
Thesis (PhD)--University of South Australia, 2004.
Provenance
Copyright 2004 Susan Leila Cocks
Description
xii, 267 leaves : ill
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506 0#$fstar $2Unrestricted online access