Structuring ambiguity in hospital governance

G. Scholten*, L. Muijsers-Creemers, J. Moen, R. Bal

*Corresponding author for this work

Research output: Contribution to journalArticleScientificpeer-review

4 Citations (Scopus)
125 Downloads (Pure)


This empirical, multicase research into developing governance structures highlights the strategies of four Dutch hospitals to strengthen their governability. The hospitals studied choose to commit themselves to duality as their starting point for structuring governance arrangements. All of them create positions of doctors and managers that are based on consensual decision making and common responsibility, in this way structuring governance at hospital level and unit level. Interestingly, they consciously choose to create ambiguous positions keeping formalization by rules and job descriptions low. Efficacy of dual hospital governance depends heavily on personal strength, mutual understanding, and trust of the incumbents, which offers new chances for governability but also harbors vulnerability to hospital governance.
Original languageEnglish
Pages (from-to)443-457
JournalInternational Journal of Health Planning and Management
Issue number1
Publication statusPublished - 2019


  • Dutch hospitals
  • decision-making arrangements
  • dual governance
  • hospital governance
  • structuring


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