Understanding the role of physicians within the managerial structure of Russian hospitals

Ellen Kuhlmann, Sergey Shishkin, Erica Richardson, Igor Ivanov, Oleg Shvabskii, Ildar Minulin, Aleksandra Shcheblykina, Anna Kontsevaya, Katie Bates and Martin McKee

Health Policy, 2019, vol. 123, issue 8, 773-781

Abstract: This article examines the role of physicians within the managerial structure of Russian hospitals. A comparative qualitative methodology with a structured assessment framework is used to conduct case studies that allow for international comparison. The research is exploratory in nature and comprises 63 individual interviews and 49 focus groups with key informants in 15 hospitals, complemented by document analysis. The material was collected between February and April 2017 in five different regions of the Russian Federation. The results reveal three major problems of hospital management in the Russian Federation. First, hospitals exhibit a leaky system of coordination with a lack of structures for horizontal exchange of information within the hospitals (meso-level). Second, at the macro-level, the governance system includes implementation gaps, lacking mechanisms for coordination between hospitals that may reinforce existing inequalities in service provision. Third, there is little evidence of a learning culture, and consequently, a risk that the same mistakes could be made repeatedly. We argue for a new approach to governing hospitals that can guide implementation of structures and processes that allow systematic and coherent coordination within and among Russian hospitals, based on modern approaches to accountability and organisational learning.

Keywords: Hospital governance; Clinical management; Medical leadership; Coordination of accountability mechanisms; Comparison; Russia (search for similar items in EconPapers)
Date: 2019
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Citations: View citations in EconPapers (1)

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Persistent link: https://EconPapers.repec.org/RePEc:eee:hepoli:v:123:y:2019:i:8:p:773-781

DOI: 10.1016/j.healthpol.2019.05.020

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