Improving hospital performance through policies to increase hospital autonomy : methodological guidelines

Following an introduction, section II reviews various definitions of autonomy and proposes a framework for understanding hospital autonomy. This framework is based on a differentiation of decision making in two domains: (1) decisions in the health domain, which are made by the government or government in concert with the hospital; and (2) decisions in the hospital domain, which concern strategic management, procurement, and financial and personnel management. Section III presents guidelines for assessing the benefits and costs of hospital autonomy. Five issues are deemed central: (1) the nature and extent of autonomy; (2) the process by which autonomy is extended to the hospital: (3) the effect of autonomy on the internal organization of the hospital; (4) the impact of autonomy on hospital operations, quality of care, personnel, accountability, etc; and (5) lessons learned during implementation. An appendix contains case studies of autonomy in public hospitals in Denmark, France, Holland, Italy, New Zealand, Singapore, the United Kingdom, and California. Includes bibliography.