Wie beeinflussen dezentrale Machtstrukturen die strategische Entwicklung eines Schweizer Universitätsspitals?

Strategic decisions of the management of a university hospital have a high entrepreneurial impact to guarantee the security of patient care as well as to carry out research at the highest level.
This dissertation aims to investigate the research gap with regard to how, where and by whom strategic decisions are actually made in the expert organization of the university hospital - with consideration of the resulting interactions, which are developed in a causal model.
The aim is to find out which human behavior as well as which economic and ethical influences underlie strategic decisions. It can be assumed that strategic decisions are not developed and made entirely by the central departments (management, board of directors). Possible influences of the decentralized departments (professors, clinics) are to be examined, and of essential importance is the investigation of the causes of the underlying drivers (e.g. power, economy, ethics) of the respective decisions.
After careful literature research and analysis, the necessary topics were determined and discussed. They form the basis for the structuring of an interview guide. The methodological procedure is based on anonymous interviews with experts at the strategic level within the framework of a qualitative content analysis, so that the theoretical principles could be linked to the practical statements of the experts.
The structure of the paradox of multidisciplinary management, which was examined theoretically, was confirmed in the research process. Based on the results, centralized management in the University Hospital does not appear to be conducive. The decentralized forces (ordinaries), which were described by the experts' statements, unfold an excessive effect of their influence in the overall system of the University Hospital. Thus, the decentralized influence in strategic decision-making on the part of the ordinaries was identified as a striking feature. This influence is exercised through individual and group-specific behavior, with the goal of expanding, maintaining or defending the power of the respective professorial positions.
The possible consequences of a strong decentralized strategic influence include the emergence of wrong decisions that influence the development potential of the University Hospital. The structure of the University Hospital requires a gradual decoupling of hospital and university decisions.
The central units are responsible for the formulation of comprehensible goals (strategy). For this purpose, targeted communication, transparency and trust between the units are essential in order to channel the decentralized power impulses in an entrepreneurial and potential-promoting manner and to develop the cooperative behavior under study.