Leadership and governance in seven developed health systems

Peter C. Smith; Anders Anell; Reinhard Busse; Luca Crivelli; Judith Healy; Anne Karin Lindahl; Gert Westert; Tobechukwu Kene

doi:10.1016/j.healthpol.2011.12.009

Leadership and governance in seven developed health systems

Peter C. Smith^*, Anders Anell, Reinhard Busse, Luca Crivelli, Judith Healy, Anne Karin Lindahl, Gert Westert, Tobechukwu Kene

^*Corresponding author for this work

Centre for Health Economics

Research output: Contribution to journal › Review article › peer-review

Abstract

This paper explores leadership and governance arrangements in seven developed health systems: Australia, England, Germany, the Netherlands, Norway, Sweden and Switzerland. It presents a cybernetic model of leadership and governance comprising three fundamental functions: priority setting, performance monitoring and accountability arrangements. The paper uses a structured survey to examine critically current arrangements in the seven countries. Approaches to leadership and governance vary substantially, and have to date been developed piecemeal and somewhat arbitrarily. Although there seems to be reasonable consensus on broad goals of the health system there is variation in approaches to setting priorities. Cost-effectiveness analysis is in widespread use as a basis for operational priority setting, but rarely plays a central role. Performance monitoring may be the domain where there is most convergence of thinking, although countries are at different stages of development. The third domain of accountability is where the greatest variation occurs, and where there is greatest uncertainty about the optimal approach. We conclude that a judicious mix of accountability mechanisms is likely to be appropriate in most settings, including market mechanisms, electoral processes, direct financial incentives, and professional oversight and control. The mechanisms should be aligned with the priority setting and monitoring processes.

Original language	English
Pages (from-to)	37-49
Number of pages	13
Journal	Health Policy
Volume	106
Issue number	1
DOIs	https://doi.org/10.1016/j.healthpol.2011.12.009
Publication status	Published - 1 Jun 2012

Keywords

Accountability
Governance
Health systems
Leadership

Access to Document

10.1016/j.healthpol.2011.12.009

Cite this

@article{0ea0a441096640a6962300587d5b8f80,

title = "Leadership and governance in seven developed health systems",

abstract = "This paper explores leadership and governance arrangements in seven developed health systems: Australia, England, Germany, the Netherlands, Norway, Sweden and Switzerland. It presents a cybernetic model of leadership and governance comprising three fundamental functions: priority setting, performance monitoring and accountability arrangements. The paper uses a structured survey to examine critically current arrangements in the seven countries. Approaches to leadership and governance vary substantially, and have to date been developed piecemeal and somewhat arbitrarily. Although there seems to be reasonable consensus on broad goals of the health system there is variation in approaches to setting priorities. Cost-effectiveness analysis is in widespread use as a basis for operational priority setting, but rarely plays a central role. Performance monitoring may be the domain where there is most convergence of thinking, although countries are at different stages of development. The third domain of accountability is where the greatest variation occurs, and where there is greatest uncertainty about the optimal approach. We conclude that a judicious mix of accountability mechanisms is likely to be appropriate in most settings, including market mechanisms, electoral processes, direct financial incentives, and professional oversight and control. The mechanisms should be aligned with the priority setting and monitoring processes.",

keywords = "Accountability, Governance, Health systems, Leadership",

author = "Smith, {Peter C.} and Anders Anell and Reinhard Busse and Luca Crivelli and Judith Healy and Lindahl, {Anne Karin} and Gert Westert and Tobechukwu Kene",

year = "2012",

month = jun,

day = "1",

doi = "10.1016/j.healthpol.2011.12.009",

language = "English",

volume = "106",

pages = "37--49",

journal = "Health Policy",

issn = "0168-8510",

publisher = "Elsevier",

number = "1",

}

TY - JOUR

T1 - Leadership and governance in seven developed health systems

AU - Smith, Peter C.

AU - Anell, Anders

AU - Busse, Reinhard

AU - Crivelli, Luca

AU - Healy, Judith

AU - Lindahl, Anne Karin

AU - Westert, Gert

AU - Kene, Tobechukwu

PY - 2012/6/1

Y1 - 2012/6/1

N2 - This paper explores leadership and governance arrangements in seven developed health systems: Australia, England, Germany, the Netherlands, Norway, Sweden and Switzerland. It presents a cybernetic model of leadership and governance comprising three fundamental functions: priority setting, performance monitoring and accountability arrangements. The paper uses a structured survey to examine critically current arrangements in the seven countries. Approaches to leadership and governance vary substantially, and have to date been developed piecemeal and somewhat arbitrarily. Although there seems to be reasonable consensus on broad goals of the health system there is variation in approaches to setting priorities. Cost-effectiveness analysis is in widespread use as a basis for operational priority setting, but rarely plays a central role. Performance monitoring may be the domain where there is most convergence of thinking, although countries are at different stages of development. The third domain of accountability is where the greatest variation occurs, and where there is greatest uncertainty about the optimal approach. We conclude that a judicious mix of accountability mechanisms is likely to be appropriate in most settings, including market mechanisms, electoral processes, direct financial incentives, and professional oversight and control. The mechanisms should be aligned with the priority setting and monitoring processes.

AB - This paper explores leadership and governance arrangements in seven developed health systems: Australia, England, Germany, the Netherlands, Norway, Sweden and Switzerland. It presents a cybernetic model of leadership and governance comprising three fundamental functions: priority setting, performance monitoring and accountability arrangements. The paper uses a structured survey to examine critically current arrangements in the seven countries. Approaches to leadership and governance vary substantially, and have to date been developed piecemeal and somewhat arbitrarily. Although there seems to be reasonable consensus on broad goals of the health system there is variation in approaches to setting priorities. Cost-effectiveness analysis is in widespread use as a basis for operational priority setting, but rarely plays a central role. Performance monitoring may be the domain where there is most convergence of thinking, although countries are at different stages of development. The third domain of accountability is where the greatest variation occurs, and where there is greatest uncertainty about the optimal approach. We conclude that a judicious mix of accountability mechanisms is likely to be appropriate in most settings, including market mechanisms, electoral processes, direct financial incentives, and professional oversight and control. The mechanisms should be aligned with the priority setting and monitoring processes.

KW - Accountability

KW - Governance

KW - Health systems

KW - Leadership

UR - http://www.scopus.com/inward/record.url?scp=84863392982&partnerID=8YFLogxK

U2 - 10.1016/j.healthpol.2011.12.009

DO - 10.1016/j.healthpol.2011.12.009

M3 - Review article

C2 - 22265340

AN - SCOPUS:84863392982

SN - 0168-8510

VL - 106

SP - 37

EP - 49

JO - Health Policy

JF - Health Policy

IS - 1

ER -

Leadership and governance in seven developed health systems

Abstract

Keywords

Access to Document

Other files and links

Cite this