Management Control Systems and Clinical Experience of Managers in Public Hospitals.

Healthcare authorities are encouraging managers in hospitals to acquire clinical experience and knowledge in order to better carry out and coordinate healthcare service delivery. The main objective of this paper is to analyse how the clinical experience of hospital managers is related to public health institutions’ performance. It is proposed that the effect of the clinical experience on operative and financial organizational performance is indirect through the mediating variables of perceived utility of management information and horizontal management control system. This paper analyses how these variables impact hospital performance through the data from a survey sent to 364 hospital managers in Brazil. The results show that managers’ clinical experience is related to higher perceived utility of historical, financial, short-term, and internal information, but not with horizontal control adoption in hospitals. Furthermore, our results show that, in hospitals, perceived utility of forecasted, non-financial, long-term, and external managerial information positively affects hospitals’ financial performance, while adoption of horizontal control management positively affects operational performance. Through showing evidence that clinical background could explain the differences not only in hospital service management but also in information capabilities and management control processes, this study offer meaningful implications for healthcare authorities and hospital managers involved in the development and implementation of strategies in the health sector.

Cómo los equipos de dirección usan los sistemas de información y control en la gestión hospitalaria / How management teams use information and control systems to manage hospitals

Objetivo: Analizar la relación entre las características de los equipos de dirección y el uso diferenciado de los sistemas de información y control de la gestión (SICG), así como el efecto de tales sistemas en la cooperación y la coordinación de actividades en los hospitales públicos. Métodos: Los datos se recogieron mediante un cuestionario enviado individualmente a los miembros del equipo de dirección de 231 hospitales públicos españoles (director/a gerente, director/a médico, director/a de enfermería y director/a de asuntos sociales y económicos). Se recibieron 457 respuestas válidas, con las cuales se formaron 86 equipos de dirección completos (37,23%). Resultados: Un equipo de dirección con diversidad de características está relacionado positivamente con un uso interactivo de los SICG. Los equipos directivos más jóvenes y de mayor antigüedad usaron interactivamente los SICG. Los equipos de dirección con formación y experiencia clínica también usaron los SICG interactivamente; sin embargo, los equipos con formación y experiencia predominantemente administrativas usaron los SICG de forma diagnóstica. Los resultados también muestran que la cooperación y la coordinación en los hospitales se relacionan positivamente con un uso interactivo de los SICG y negativamente con un uso diagnóstico de los SICG. Conclusión: El uso interactivo de los SICG es un mediador importante de la relación entre la diversidad del equipo de dirección y el fomento de políticas de cooperación y coordinación en los hospitales. Los equipos con diversidad de características (p. ej., edad, antigüedad, educación y experiencia) tienden a usar los sistemas de información de la gestión de forma interactiva para mejorar la coordinación de actividades y la asignación de recursos en los hospitales (AU)

Objective: To analyze the relationship between the characteristics of top management teams and the different use of management information and control systems (MICS) to implement policies that encourage cooperation and activity coordination in public hospitals. Methods: Data were collected through a questionnaire sent to each member of the top management teams of 231 Spanish public hospitals (chief executive director, medical director, nursing director and director for financial and social issues). A total of 457 valid questionnaires were returned, composing 86 full top management teams (37.23%). Results: Top management team diversity was positively related to the interactive use of MICS. Management teams composed of younger members and members with longer service used MICS interactively. Top management teams with a predominantly clinical education and experience used MICS interactively, while top teams with a predominantly administrative education and experience used MICS diagnostically. The results also showed that cooperation and coordination in hospitals were positively related to the interactive use of MICS and were negatively related to the diagnostic use of MICS. Conclusions: The interactive use of MICS is an important mediator in the relationship between top team diversity and policies focused on hospital decentralization. Top management teams with diverse characteristics (e.g. age, length of service, education and experience) use management information interactively to enhance activity coordination and resource allocation in hospitals (AU)

Traditional vs. Contemporary Management Control Practices for Developing Public Health Policies.

Public health policies must address multiple goals and complex community health needs. Recently, management control practices have emerged to provide a broader type of information for evaluating the effectiveness of healthcare policies, and relate activities and processes to multiple strategic outcomes. This study compares the effect of traditional and contemporary management control practices on the achievement of public health policies. It is also analyzed how two different uses of such practices (enabling vs. coercive) facilitate the achievement of public health policies. Relationships are explored using data collected from managers from public health agencies and public hospitals in Spain. The findings show that contemporary management control practices are more suitable than traditional practices to achieve public health policies. Furthermore, results show that public health policies are better achieved when managers use management control practices in an enabling way rather than in a coercive way.

[How management teams use information and control systems to manage hospitals]. / Cómo los equipos de dirección usan los sistemas de información y control en la gestión hospitalaria.

OBJECTIVE: To analyze the relationship between the characteristics of top management teams and the different use of management information and control systems (MICS) to implement policies that encourage cooperation and activity coordination in public hospitals. METHODS: Data were collected through a questionnaire sent to each member of the top management teams of 231 Spanish public hospitals (chief executive director, medical director, nursing director and director for financial and social issues). A total of 457 valid questionnaires were returned, composing 86 full top management teams (37.23%). RESULTS: Top management team diversity was positively related to the interactive use of MICS. Management teams composed of younger members and members with longer service used MICS interactively. Top management teams with a predominantly clinical education and experience used MICS interactively, while top teams with a predominantly administrative education and experience used MICS diagnostically. The results also showed that cooperation and coordination in hospitals were positively related to the interactive use of MICS and were negatively related to the diagnostic use of MICS. CONCLUSIONS: The interactive use of MICS is an important mediator in the relationship between top team diversity and policies focused on hospital decentralization. Top management teams with diverse characteristics (e.g. age, length of service, education and experience) use management information interactively to enhance activity coordination and resource allocation in hospitals.

Aplicación del benchmarking en la gestión de la cadena de aprovisionamiento sanitaria: efectos sobre el coste y la calidad de las compras / The use of benchmarking to manage the healthcare supply chain: effects on purchasing cost and quality

Objetivo: El gasto en aprovisionamiento sanitario consume una gran parte de los recursos financieros asignados a la sanidad pública. El objetivo de este trabajo es analizar la aplicación de un proceso de benchmarking en la gestión de las compras hospitalarias, así como examinar su efecto en la reducción del precio y la mejora de la calidad de los productos adquiridos. Métodos: Los datos fueron recogidos mediante una encuesta realizada en 29 distritos de atención primaria en el periodo 2010-11. También se usó una base de datos sanitaria relativa a precios, calidades, plazos de entregas y características de proveedores de 5373 productos. Resultados: La aplicación de procesos de benchmarking consiguió la reducción o la eliminación de compras de productos con baja calidad y alto precio. Tras aplicar el benchmarking se produjo un incremento medio del 10,57% en la calidad de los productos adquiridos, con una disminución media del 28,97% en el precio de compra. Conclusiones: Con un proceso de benchmarking, los centros sanitarios pueden ahorrar gastos y realizar una gestión más eficiente de la cadena de aprovisionamiento. El benchmarking facilita que los centros sanitarios adquieran productos a precios más reducidos y de mayor calidad (AU)

Objective: Healthcare supply expenses consume a large part of the financial resources allocated to public health. The aim of this study was to analyze the use of a benchmarking process in the management of hospital purchases, as well as its effect on product cost reduction and quality improvement. Methods: Data were collected through a survey conducted in 29 primary healthcare districts from 2010 to 2011, and through a healthcare database on the prices, quality, delivery time and supplier characteristics of 5373 products. Results: The use of benchmarking processes reduced or eliminated products with a low quality and high price. These processes increased the quality of products by 10.57% and reduced their purchase price by 28.97%. Conclusions: The use of benchmarking by healthcare centers can reduce expenditure and allow more efficient management of the healthcare supply chain. It also facilitated the acquisition of products at lower prices and higher quality (AU)

[The use of benchmarking to manage the healthcare supply chain: effects on purchasing cost and quality]. / Aplicación del benchmarking en la gestión de la cadena de aprovisionamiento sanitaria: efectos sobre el coste y la calidad de las compras.

OBJECTIVE: Healthcare supply expenses consume a large part of the financial resources allocated to public health. The aim of this study was to analyze the use of a benchmarking process in the management of hospital purchases, as well as its effect on product cost reduction and quality improvement. METHODS: Data were collected through a survey conducted in 29 primary healthcare districts from 2010 to 2011, and through a healthcare database on the prices, quality, delivery time and supplier characteristics of 5373 products. RESULTS: The use of benchmarking processes reduced or eliminated products with a low quality and high price. These processes increased the quality of products by 10.57% and reduced their purchase price by 28.97%. CONCLUSIONS: The use of benchmarking by healthcare centers can reduce expenditure and allow more efficient management of the healthcare supply chain. It also facilitated the acquisition of products at lower prices and higher quality.

El uso del cuadro de mando integral y del presupuesto en la gestión estratégica de los hospitales públicos / The use of the balanced scorecard and the budget in the strategic management of public hospitals

ObjetivoExaminar la relación entre el perfil de los directivos y el uso del cuadro de mando integral y del presupuesto en la consecución de objetivos estratégicos centrados en la reducción del coste y en la mejora de la flexibilidad en la prestación de servicios sanitarios.MétodosLos datos se recogieron mediante una encuesta enviada a 884 directivos miembros de equipos de dirección de 218 hospitales públicos en España. El índice de respuesta fue del 53,51%, con 473 cuestionarios útiles. Se realizó una validación métrica de las escalas usadas y un análisis del modelo con técnicas de ecuaciones estructurales.ResultadosLos directores más jóvenes y con menos antigüedad suelen hacer un mayor uso del cuadro de mando integral que del presupuesto. La diversidad en el equipo de dirección está relacionada con el empleo de diferentes técnicas de control de gestión. El uso del cuadro de mando integral se relaciona positivamente con la implantación de estrategias sanitarias centradas tanto en la mejora de la flexibilidad como en el control y la reducción del coste sanitario.ConclusionesLa adopción de sistemas de control de gestión no sólo es resultado de un proceso racional y de presiones institucionales, sino que también depende de las características de los individuos responsables de la toma de decisiones. El uso del cuadro de mando integral facilitará que los hospitales puedan implantar planes estratégicos con múltiples objetivos(AU)

ObjectiveTo analyze the relationship between hospital managers' characteristics and the use of the balanced scorecard and the budget. A further aim was to analyze how these two techniques influence strategic goals aimed at cost reduction and enhancing service flexibility.MethodsData were collected through a questionnaire sent to 884 members of top management teams in 218 public hospitals in Spain. The response rate was 53.51% with 473 useful questionnaires. Structural equation techniques were used to validate the metric scales and the model used.ResultsYounger managers and less tenured managers were more likely to use the balanced scorecard than the budget. Diversity in the top management team was related to the use of distinct management control techniques. The use of the balanced scorecard was positively associated with the implementation of healthcare strategies focused on enhancing service flexibility and reducing healthcare cost.ConclusionsThe adoption of management control systems is not only a function of the outcome of a rational decision-making process and institutional pressures but also crucially depends on the characteristics of the individuals ultimately responsible for such decisions. The use of the balanced scorecard facilitates hospitals’ implementation of plans with multiple strategic goals (AU)

[The use of the balanced scorecard and the budget in the strategic management of public hospitals]. / El uso del cuadro de mando integral y del presupuesto en la gestión estratégica de los hospitales públicos.

OBJECTIVE: To analyze the relationship between hospital managers' characteristics and the use of the balanced scorecard and the budget. A further aim was to analyze how these two techniques influence strategic goals aimed at cost reduction and enhancing service flexibility. METHODS: Data were collected through a questionnaire sent to 884 members of top management teams in 218 public hospitals in Spain. The response rate was 53.51% with 473 useful questionnaires. Structural equation techniques were used to validate the metric scales and the model used. RESULTS: Younger managers and less tenured managers were more likely to use the balanced scorecard than the budget. Diversity in the top management team was related to the use of distinct management control techniques. The use of the balanced scorecard was positively associated with the implementation of healthcare strategies focused on enhancing service flexibility and reducing healthcare cost. CONCLUSIONS: The adoption of management control systems is not only a function of the outcome of a rational decision-making process and institutional pressures but also crucially depends on the characteristics of the individuals ultimately responsible for such decisions. The use of the balanced scorecard facilitates hospitals' implementation of plans with multiple strategic goals.

Strategic performance in hospitals: the use of the balanced scorecard by nurse managers.

BACKGROUND: The competitive and dynamic health care sector has spurred hospitals into delivering greater flexibility and quality of services while cutting the hospital cost at the same time. However, hospitals differ in the extent to which they achieve these strategic goals. PURPOSES: This article explores the use of a new management tool-the balanced scorecard-which facilitates managers to meet multiple strategic goals. It also analyzes how nurse managers use the balanced scorecard in an interactive or diagnostic way and its subsequent effect on strategic goal achievement (cost reduction and flexibility). It also examines how "balanced" is the balanced scorecard in terms of financial versus nonfinancial measures. METHODOLOGY: Data were collected from a mail survey sent to 218 nurse managers in Spanish public hospitals. A satisfactory response rate was achieved, with 114 (52.29%) useful answered questionnaires. FINDINGS: The results show that younger, more tenured, and clinically trained nurse managers would be more likely to use the balanced scorecard in an interactive way. Conversely, older, less tenured, and administratively trained managers would use it diagnostically. The results also indicate that the balanced scorecard facilitates the cost reduction and flexibility in hospitals only when it is used interactively. PRACTICE IMPLICATIONS: This article provides evidence that not only the technical design of the balanced scorecard matters, but also an appropriate use of the balanced scorecard is paramount for achievement of multiple strategic goals. An effective use of the balanced scorecard requires managers to actively stimulate dialogue and agreement among hospital's staff about desirable financial and nonfinancial performance measures in alignment with multiple strategic goals.

How CEOs use management information systems for strategy implementation in hospitals.

Institutional and market changes seem to force hospitals across the Western world to revitalize their corporate strategies towards more cost efficiency on the one hand, and more flexibility towards customer demands on the other hand. Hospitals, however, apparently differ in the extent to which they are able to implement such strategies effectively. This paper explores whether these different levels of effectiveness depend on how hospitals' top managers' use of the available management information systems (MIS). Based on data obtained from the 218 CEOs of public hospitals in Spain, we analyze how CEOs' professional and educational backgrounds affect their use of MIS, and how the use of the MIS subsequently supports or inhibits the implementation of these strategic goals. The results indicate that CEOs with a predominant clinical background focus more on non-financial information for decision-making and prefer an interactive style of using MIS, which together support flexibility strategies. CEOs with a predominant administrative background seem more effective in establishing cost-reduction strategies, through their larger inclination to emphasize financial information in combination with a diagnostic use of the MIS. Implications for the strategic management of hospitals are outlined.