Hospital managers afraid of losing their jobs

Department managers in Norwegian hospitals nowadays have to take care of both the financial aspect of running a hospital and the treatment of patients. NHH researcher Katarina Østergren is concerned with the strong emphasis on financial results.

13.04.2007 - Maria M. Tveten (Text) Helge Skodvin (Photo)

Associate Professor, Katarina Østergren.

The Associate Professor Katarina Østergren has conducted a study focused on how department managers in the Norwegian healthcare regions Helse Øst (health east) and Helse Vest (health west) have adapted to the financial information demands placed on them by the restructured Norwegian health system.

Concern in the west
The research results are based on a comparison of the two regions that went through the same reforms and employ doctors with the same medical education.

"We have asked whether the department managers are afraid of losing their job if the department has financial difficulties. This is the case in Helse Vest, but not to the same extent as in Helse Øst", says Østergren.

Is this healthy?

"It is a sign that some take this seriously, so in this way it is healthy. It would be very interesting to make a study on how people see the pressure at work after the introduction of the health reform", she says.

Less prestige in the east
Amongst those questioned in Helse Øst, almost 60% showed no personal prestige in having budget constraints, and as much as 40% think that it is not unpleasant to present negative financial results.

A third also disagreed that the budget should be used as a guideline when department's activities are planned.

On the other hand, in Helse Vest, 71% think that following the budget is a matter of personal prestige. Many find it unpleasant to present deficits and nobody agreed that the budget should not determine the department's activities.

Østergren believes that one explanation is that managers of departments that have deficits are busy with budget planning, whereas managers in Helse Øst that meet their budget do not see the budget as a restriction for the desired activities.

A second explanation can be that the department managers in Helse Øst and Helse Vest have such close contact with the financial department that the financial situation is no longer a surprise for anybody, and so nothing to be ashamed of.

Hybrid managers
The "new" department manager who combines administrative, financial and medical responsibilities and has received the name hybrid manager from researchers. A study from Finland shows a very big number of hybrid managers.

The researcher behind the studies believes that this is due to the medical profession being weaker in Finland than in other countries and because finance has become a natural part of the Finish medical education following reforms.

Other countries with weak professions, like Italy and Germany, are experiencing a polarization where some are hybrid managers and some are not.

"You have to ask yourself if this is due to how department managers interpret the new weekdays, if it is felt to be controlled by authorities, or a struggle with other professions", explains Østergren.

Future scenarios
Østergren and her colleague's research is far from finished, but she believes that reactions will arise from physicians when the final results become available.

"I can see two scenarios. It only comes to the question: 'why should doctors know so much about finance?' Let them practice medicine and get the help of other professions when the operating costs have to be discussed."

In the other scenario, the reaction will be more in line with what doctors in Helse Vest currently do. The same person will be required to have all the competencies, so that he or she can make judgments based on both a medical and a financial basis.

But there is some time to go until the medical profession will choose one of these scenarios. "The initiative is with them", concludes Østergren.