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The objective of this research was to identify types of hospital governance in Latin America and to examine whether and how these governance types are associated with hospital performance. The authors also sought to explore hospital governance conceptually and contextually within national and international experience.
The research was based on survey of nearly 400 hospitals in Argentina, Brazil, Colombia and Mexico. The authors conducted a cluster analysis of the results identifying four governance types based on organizational elements theorized to affect hospital behavior: (1) budgetary unit of government; (2) autonomous unit of government; (3) corporate unit of a private conglomerate or broader, private hospital system; or lastly (4) a private and autonomous unit. These types were compared in five analyses: (a) administrators' ratings of their own hospital’s performance; (b) hospital performance indicators, such as occupancy and costs per bed; (c) performance tracking vis-à-vis standards; (d) ratings of criteria for selecting leadership; and (e) hospital administrators' qualifications.
The corporate and private governance types were generally associated with better performance. Performance differences were noted for facility and equipment upkeep, availability of medicines and auxiliary services, administrative and labor efficiency, and clinical quality, including the level of nursing training. Hospitals governed under private and corporate models tended to have more non-clinical, business-oriented leadership, while the budgetary governance type seems to be obligated to pursue a more broadly defined set of accountabilities.
Freeing hospitals from institutional and governmental control, referred to as facility-based management, seems to be associated with better hospital performance. The values underlying facility independence, however, must exist simultaneously with other socially or politically defined priorities and accountabilities. Commitment to pursue higher-performing governance models will be possible only through thoughtful examination of the internal and external contexts that shape hospital behaviors, including market strategies, regulations, local definitions of autonomy, and the scope and distribution of stakeholder incentives.