Regulation and Trust in Action

Abstract

This article addresses the question of how problem doctors are defined and dealt with at the hospital level, where the possibility to observe practice is at its highest. Some general problems of the Belgian hospital scene impeding regulation of doctors in hospitals are discussed. Further, two large, prominent Flemish hospitals are studied in more detail. Although there are many similarities between the hospitals, they also differ in crucial aspects. In the first hospital, the relationship between the main representative body of hospital doctors and the hospital management was discordant and a culture of collaboration was absent. This meant that doctors could not be relied on to report problems about colleagues. The hospital management seemed therefore more inclined to develop objective indicators, which could be used independently of the doctors' collaboration. In the second hospital, on the contrary, structural and cultural factors contributed to good working relationships between doctors and management. With respect to regulation, there was a long-standing culture of openness with respect to reporting problems among doctors as well as nurses. For doctors, there was a certain guarantee that the problems would be dealt with by other doctors. Nurses, however, were critical about the feedback they received although they admitted that the situation was improving.