This empirical, multicase research into developing governance structures highlights the strategies of four Dutch hospitals to strengthen their governability. The hospitals studied choose to commit themselves to duality as their starting point for structuring governance arrangements. All of them create positions of doctors and managers that are based on consensual decision making and common responsibility, in this way structuring governance at hospital level and unit level. Interestingly, they consciously choose to create ambiguous positions keeping formalization by rules and job descriptions low. Efficacy of dual hospital governance depends heavily on personal strength, mutual understanding, and trust of the incumbents, which offers new chances for governability but also harbors vulnerability to hospital governance.

Additional Metadata
Keywords decision-making arrangements, dual governance, Dutch hospitals, hospital governance, structuring
Persistent URL dx.doi.org/10.1002/hpm.2693, hdl.handle.net/1765/111532
Journal International Journal of Health Planning and Management
Citation
Scholten, G.R.M, Muijsers-Creemers, L. (Linda), Moen, J. (Jan), & Bal, R. (Roland). (2018). Structuring ambiguity in hospital governance. International Journal of Health Planning and Management. doi:10.1002/hpm.2693