While reading a recent op-ed on hospitals in a National Health System, suddenly I asked myself: but who is the owner?. The article was reflecting a new view on hierarchy and management of public organizations and was advocating for new cooperative models, horizontal schemes where professionals fit better than a pure civil servant. It may sound good, although it raises a certain fuzzy landscape. Who has the decision rights in a cooperative scheme? Who is the residual claimant?. Just check The Economist for a recent case and remember the potential implications if we translate such model in health care.
There are two sides of the coin: management and governance. Managers and owners have their specific roles. When somebody wants to play both, conflicts of interest arise. It's obvious. Unfortunately in public organizations, such considerations are too often forgotten. Public organizations require better governance designs, stronger and clearer, representing the preferences of the final owner: the citizen.
