Rita Schepers

Hospital governance and the medical practitioner in Belgium

PURPOSEnThis paper aims to attempt to explore current transformations in hospital governance by tracing the evolution of medical autonomy in the Belgian hospital sector in the second half of the twentieth century.nnnDESIGN/METHODOLOGY/APPROACHnUsing published secondary sources and archive data the paper developed a historical approach to the relationship between profession and organisation, asking qualitative questions of the characteristics of professional power and knowledge.nnnFINDINGSnSince World War II, two important evolutions have occurred: first, the hospital evolved into an organisational entity that is described as a professional bureaucracy; second, at the sectoral level the hospital adopted a position that is characterised as a divisional structure. Both evolutions are linked by the processes of rationalisation and bureaucratisation. The findings do not support the thesis of an overall loss of autonomy but bring into focus the transformation of medical autonomy. New forms of professional power and knowledge are emerging with the processing (bureaucracy) and pre-processing (rationalisation) of information on medical work as key elements.nnnORIGINALITY/VALUEnThe paper explores the evolution of the medical professions autonomy in the second half of the twentieth century. It highlights reflexivity in the changing relationship between professions and organisations and how physicians are becoming managers of expertise who are important for both the hospital organisation and the state.

Regulation and Trust in Action The Subtle Balance between Doctors and Management in Two Belgian Hospitals

This article addresses the question of how problem doctors are defined and dealt with at the hospital level, where the possibility to observe practice is at its highest. Some general problems of the Belgian hospital scene impeding regulation of doctors in hospitals are discussed. Further, two large, prominent Flemish hospitals are studied in more detail. Although there are many similarities between the hospitals, they also differ in crucial aspects. In the first hospital, the relationship between the main representative body of hospital doctors and the hospital management was discordant and a culture of collaboration was absent. This meant that doctors could not be relied on to report problems about colleagues. The hospital management seemed therefore more inclined to develop objective indicators, which could be used independently of the doctors collaboration. In the second hospital, on the contrary, structural and cultural factors contributed to good working relationships between doctors and management. With respect to regulation, there was a long-standing culture of openness with respect to reporting problems among doctors as well as nurses. For doctors, there was a certain guarantee that the problems would be dealt with by other doctors. Nurses, however, were critical about the feedback they received although they admitted that the situation was improving.

The Medical Council in Belgian hospitals: A political perspective

Abstract Archetype-theory gained prominence in the literature dealing with the ‘‘managerialization’’ of professional organizations. However, this theory has been criticized. Due to its functionalist legacy it underplays the role of agency in the organizational structure or in its change. Following this critique we develop a political perspective on the relation profession – management. Such a view stresses the interlocking of organization and domination. However, control does not just apply to workers and work, a ‘rule by rules’ implies rulers are also object of regulation. Agency will be directed at having an impact on rule creation. In the end organizational structure is designed to control the agency of both profession and management. The elaboration of structure is not to be seen as a function of the qualities of work, or of organizational performance. Rather our analysis of the genesis of the medical council in Belgian hospitals suggest that it results out of agency within a specific policy process.