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Physician-hospital alignment : economic, administrative and professional aspects

Jeroen Trybou (UGent)
(2014)
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Abstract
Hospitals face challenging times. Currently many Western countries are seeking ways to increase the efficiency of care delivery and improve the quality care. Physicians have a major impact on hospital performance. This doctoral dissertation focuses on alignment of self-employed physicians. Economic, administrative and professional aspects are considered. The first chapter discusses the context and main characteristics of hospital-physician relationships in Belgium. The following chapters present five academic studies. We conclude with the general discussion of our findings. In a first study we developed an integrative conceptual framework of physician-hospital alignment including economic and noneconomic exchange. Building on the available literature and the theoretical insights of agency theory and social exchange theory, risk and trust were identified as two key antecedents. Since the payment framework cannot be neglected when studying physician-hospital alignment we continued with a second study focusing on the relationship between provider financial risk bearing and physician-hospital integration. These first two studies were followed by three empirical studies. In the third study two comparative case-studies were performed to investigate the contractual mechanisms in physician-hospital exchanges. Besides the contract, the relationship established on the basis of the transactions taking place was studied. The fourth study comprises a qualitative study of administrative and professional aspects of the noneconomic relationship between physician and hospital. Drawing on the concepts of the psychological contract we developed a rich understanding how mutual obligations and areas of ambiguity are perceived. In the fifth study we quantitatively investigated the impact of noneconomic exchange (administrative and professional psychological contract breach) and economic exchange (distributive and procedural organizational justice) on physicians’ organizational attitudes and organizational citizenship behaviours. In addition we focus on the moderating role of the Chief Medical Officer and organizational trust in these relationships. The final chapter summarises the theoretical, methodological and practical implications of this dissertation.

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Chicago
Trybou, Jeroen. 2014. “Physician-hospital Alignment : Economic, Administrative and Professional Aspects”. Ghent, Belgium: Ghent University. Faculty of Economics and Business Administration.
APA
Trybou, J. (2014). Physician-hospital alignment : economic, administrative and professional aspects. Ghent University. Faculty of Economics and Business Administration, Ghent, Belgium.
Vancouver
1.
Trybou J. Physician-hospital alignment : economic, administrative and professional aspects. [Ghent, Belgium]: Ghent University. Faculty of Economics and Business Administration; 2014.
MLA
Trybou, Jeroen. “Physician-hospital Alignment : Economic, Administrative and Professional Aspects.” 2014 : n. pag. Print.
@phdthesis{4263038,
  abstract     = {Hospitals face challenging times. Currently many Western countries are seeking ways to increase the efficiency of care delivery and improve the quality care. Physicians have a major impact on hospital performance. This doctoral dissertation focuses on alignment of self-employed physicians. Economic, administrative and professional aspects are considered. The first chapter discusses the context and main characteristics of hospital-physician relationships in Belgium. The following chapters present five academic studies. We conclude with the general discussion of our findings. In a first study we developed an integrative conceptual framework of physician-hospital alignment including economic and noneconomic exchange. Building on the available literature and the theoretical insights of agency theory and social exchange theory, risk and trust were identified as two key antecedents. Since the payment framework cannot be neglected when studying physician-hospital alignment we continued with a second study focusing on the relationship between provider financial risk bearing and physician-hospital integration. These first two studies were followed by three empirical studies. In the third study two comparative case-studies were performed to investigate the contractual mechanisms in physician-hospital exchanges. Besides the contract, the relationship established on the basis of the transactions taking place was studied. The fourth study comprises a qualitative study of administrative and professional aspects of the noneconomic relationship between physician and hospital. Drawing on the concepts of the psychological contract we developed a rich understanding how mutual obligations and areas of ambiguity are perceived. In the fifth study we quantitatively investigated the impact of noneconomic exchange (administrative and professional psychological contract breach) and economic exchange (distributive and procedural organizational justice) on physicians{\textquoteright} organizational attitudes and organizational citizenship behaviours. In addition we focus on the moderating role of the Chief Medical Officer and organizational trust in these relationships. The final chapter summarises the theoretical, methodological and practical implications of this dissertation.},
  author       = {Trybou, Jeroen},
  language     = {eng},
  pages        = {198},
  publisher    = {Ghent University. Faculty of Economics and Business Administration},
  school       = {Ghent University},
  title        = {Physician-hospital alignment : economic, administrative and professional aspects},
  year         = {2014},
}