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Background. Some Polish hospitals are in a good financial position but others are not, even though they are of a similar size according to their budgets, the number and structure of specialists and type of society they serve. Furthermore, it is difficult to find the factors responsible for their different financial standing. To investigate deeper the dissimilarities that might exist, the author hypothesizes that one of the most important factors that possibly influences a hospitals financial performance is its control system. Research aims. In these circumstances the research is aimed at identifying different control areas and mechanisms which have been used by hospital managers to ensure delivery of high-quality cost-effective patient care and that concurrently balance the hospital budget. Method. During the study the author investigated the operating core of hospitals in order to develop a deeper understanding of its internal control processes. This qualitative study is based on several in-depth interviews with general directors of two similar hospitals. Key findings. The research indicates that hospitals ought to concentrate on four generic areas of control: input control, legitimacy of medical procedures control, revenue control and overheads control. Thus comparing the studied hospitals according to their activities in the four control areas it is visible that the hospital which has a good financial situation, takes control measures in all four areas, and the top managers are directly involved in supervising most of these activities. While the hospital which is facing financial difficulties, is much less active in the described areas of control and the director does not participate actively in control of the lower levels of his organization nor does he build such extended control mechanisms as the director from the better-off hospital. [ABSTRACT FROM AUTHOR]

Background: Hospital governance increasingly combines management and professional self-governance. This article maps the new emergent modes of control in a comparative perspective and aims to better understand the relationship between medicine and management as hybrid and context-dependent. Theoretically, we critically review approaches into the managerialism-professionalism relationship; methodologically, we expand cross-country comparison towards the meso-level of organisations; and empirically, the focus is on processes and actors in a range of European hospitals. Methods: The research is explorative and was carried out as part of the FP7 COST action IS0903 Medicine and Management, Working Group 2. Comprising seven European countries, the focus is on doctors and public hospitals. We use a comparative case study design that primarily draws on expert information and document analysis as well as other secondary sources. Results: The findings reveal that managerial control is not simply an external force but increasingly integrated in medical professionalism. These processes of change are relevant in all countries but shaped by organisational settings, and therefore create different patterns of control: (1) ‘integrated’ control with high levels of coordination and coherent patterns for cost and quality controls; (2) ‘partly integrated’ control with diversity of coordination on hospital and department level and between cost and quality controls; and (3) ‘fragmented’ control with limited coordination and gaps between quality control more strongly dominated by medicine, and cost control by management. Conclusions: Our comparison highlights how organisations matter and brings the crucial relevance of ‘coordination’ of medicine and management across the levels (hospital/department) and the substance (cost/quality-safety) of control into perspective. Consequently, coordination may serve as a taxonomy of emergent modes of control, thus bringing new directions for cost-efficient and quality-effective hospital governance into perspective. [ABSTRACT FROM AUTHOR]