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An exploration of governance in teaching hospitals in the Netherlands focused on educational objectives

BMC Medical Education volume 25, Article number: 88 (2025) Cite this article

Abstract

Background

Many countries are improving medical education in teaching hospitals through more focus on internal quality assurance, for example by creating new stakeholders like hospital-wide education committees. Adequate oversight is thought essential to ensure the quality of medical education. How teaching hospitals distribute roles and responsibilities for quality control across educational stakeholders to organize this oversight is rarely investigated. This study aims to answer the following exploratory question: Who are the primary stakeholders involved in educational governance, and what are their roles in safeguarding educational quality in teaching hospitals?

Methods

We conducted an exploratory qualitative study of educational governance structures in all teaching hospitals in the Netherlands with at least three training programs. We carried out document analysis of recent governance codes, documents drafted by Dutch teaching hospitals to describe their methods of internal governance for the national accreditor, and analyzed the data using a thematic analysis approach through the lens of organizational theories of Mintzberg and Freidson.

Results

The study identified key stakeholders in quality management of medical education in all teaching hospitals of the Netherlands. An overview of their roles and responsibilities is given and a stakeholder map is drafted. Teaching hospitals gave the hospital-wide education committee three different roles: an advisory role, a quality controller role and a conflict mediation role.

Discussion

Hospitals have set up the assignment of decision-making power in different ways, creating different variants of hospital-wide education committees and potentially causing them to be less effective at quality management. Whether these different roles affect the quality management of medical education in practice requires practice-oriented research. The study reveals remarkable ambiguity regarding the assignment and exercise of decision-making power between actors. This study contributes to the literature by identifying key actors and their roles in the quality management of postgraduate medical education, providing a foundation for follow-up research.

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Background

In past decades, there has been a call for modernization of postgraduate medical education (PGME) worldwide [1, 2]. This has led to a variety of implementations and changes in medical education, such as the widespread transition to competency-based medical education [3, 4]. Many countries are improving medical education by improving oversight of the quality of education [5]. In particular, methods of managing the quality of residency training have received considerable attention worldwide, especially internal quality assurance systems whereby the hospital itself aims to monitor and improve the quality of training programs, as a supplement to external accreditation [6,7,8]. One way to implement internal quality assurance is by creating a hospital-wide educational committee, a governance structure that is responsible for setting up and maintaining internal continuous quality improvement in collaboration with the other stakeholders in teaching hospitals [9]. This format has been used in the Netherlands and the United States [9, 10]. Since 2011, teaching hospitals in the Netherlands have been required by law to implement an operational hospital-wide education committee responsible for an internal quality system [11]. While internal quality assurance was complementary to external accreditation at first, the Dutch accreditation body for PGME changed their methods in 2020. Internal quality assurance is now to have a larger role in quality assessment and will be the main method the accreditation body uses to monitor the quality of education in the hospital. However, this poses a problem, as we cannot determine whether the internal quality control measures implemented through hospital-wide education committees are adequate for the complexities of teaching hospitals. Studies on how to organize similar governance structures with a focus on education in hospitals are scarce, leaving a gap in our understanding of how to manage educational stakeholders in teaching hospitals and the potential effects for the organization.

The goal of governance in an organization is to create a system of checks and balances whereby separate governance entities limit each other’s power to deviate from the goals of the organization [11]. Governance can provide balancing mechanisms as one of its goals is the alignment of human resources to pursue the intended strategic direction [12, 13]. Mintzberg’s framework for power in organizations highlights that power dynamics significantly influence decision-making processes, resource allocation, and overall governance [14]. In order to examine an organization’s power dynamics Mintzberg described several steps that we use in our present study, including identification of power coalitions, internal and external to the organization and the conflicts generated by their fight for influence in the organization. Analysis of conflict and how they are resolved can help to show how power is distributed in the organization and whether the recently designed quality management scheme can work with this distribution [14].

The concept of governance can be applied to different entities, such as a state and its government, a community, or all types of formal or informal organizations, including healthcare organizations. The application of governance theory in healthcare often splits governance into two distinctive concepts: clinical and hospital governance. Clinical governance aims to integrate fragmented quality improvement efforts into an (institutional) centralized quality management system [9, 15]. Hospital governance provides the overall framework for effective organizational management, including the support and implementation of clinical governance practices. However, governance in teaching hospitals extends to education as well, leading to the implementation of mechanisms aimed at ensuring the quality of medical training and education, called educational governance. Continuous quality improvement and internal quality assessment are used increasingly in educational governance as well [16, 17].

While internal quality mechanisms such as hospital-wide education committees have the potential to improve educational quality, governance in hospitals by means of these committees is likely to be complex, as teaching hospitals have been characterized as complex organizations [18–21]. Complex organizations have various objectives that are not always aligned, leading to tensions, for example between education and clinical productivity [20]. These tensions were also described in Freidsons theory of professionalism, mainly arising between the authority of professionals and the search for efficiency by managers. This professionalism culture is something to account for, especially in the management of healthcare organizations [22]. Another complicating factor is the large number of different stakeholders, who act in multiple interacting systems with unclear boundaries [21]. There is already a lack of clarity about the roles and responsibilities of the various players in the postgraduate training system internationally [5]. Additionally, how teaching hospitals distribute roles and responsibilities between actors in the organizational structure has not yet been researched. The addition of hospital-wide education committees might increase complexity and intra-organizational tensions [19]. This study will therefore address the following exploratory question: “Who are the primary stakeholders involved in educational governance, and what are their roles in safeguarding educational quality in teaching hospitals?” In order to respond to a national call for evaluation of PGME quality management, it is important to know which stakeholders influence the process in order to include them in further in depth research. The role of various stakeholders regarding safeguarding educational quality is currently under-investigated. The influence of these stakeholders on the performance of hospital-wide education committees is also unknown. Using our lens of organizational theories we describe the fields of tension between training quality, care quality, and financial benefits in the context of a teaching hospital. Findings from this context can be useful internationally for programs that want to implement internal quality assessment mechanisms to increase institutional accountability in medical education [17, 23]. Our findings can help to avoid pitfalls we discovered in the present study, such as symbolic implementation. In addition, this study adds to the academic body of literature on hospital governance and medical education by assessing this newly implemented governance structure [14, 24].

Methods

Overall approach

This exploratory qualitative study investigates educational governance structures in postgraduate medical education in all teaching hospitals in the Netherlands. We made use of secondary data, namely governance codes that are drafted by all teaching hospitals in the Netherlands with three or more PGME programs. This present study focuses on how teaching hospitals plan to organize the roles and responsibilities of educational stakeholders, rather than how these plans are implemented in practice.

Governance codes are formal documents that outline recommendations to improve governance and increase the accountability of organizations to shareholders [25]. Hospital governance codes provide accountability to the government or regulatory bodies, or society as a whole [13]. The accreditation body for PGME in the Netherlands requests governance codes from all teaching hospitals in which the hospital states the norms for educational governance. We used document analysis to identify relevant stakeholders mentioned in the governance codes and their respective roles. Document analysis is a systematic procedure for reviewing documents, which can be either paper or electronic material [26]. A qualitative document analysis begins with the selection and sampling of documents that are relevant to the research question. This process also involves assessing the documents for authenticity, credibility, representativeness, and meaning [27]. We chose the governance codes as they were easily accessible documents which described often quite extensive the intended organization of governance. The next step is to become familiar with the chosen documents and prepare them for analysis. For data synthesis, we employed thematic analysis, a widely validated and frequently used method in document analysis [26]. The study has an inductive approach, with the goal of generating meaning from the data drawn form in the field [28]. Document analysis offers a method for doing studies that are otherwise not possible, due to a lack of resources or time constraints [27].

Selection

In order to prevent selection bias and to properly assess educational governance structures and processes all teaching hospitals in the Netherlands with three or more PGME programs are included in this study (N = 46). We did not include teaching hospitals with less than three training programs as these constitute primarily specialized clinics (rehabilitation medicine, psychiatry). Based on the clinical experience of authors MS, IH, JB and RB, these clinics often have different dynamics and different governance interactions than the complex teaching hospital organizations. 7 out of the 46 hospitals are academic hospitals connected to a university. The number of different specialty training programs varies greatly, from 5 to 39 programs. All 46 hospitals provided a governance code.

Data collection

We made a request to the research department of the accreditation body for PGME. They accepted and we received access to all governance code documents of the included teaching hospitals from the accreditation body for PGME in the Netherlands. These were complete full text digital files. All accredited teaching hospitals deliver this file to the accreditation body as part of the accreditation process. Data was extracted from the separate governance codes by means of a data extraction form, illustrated in Table 1. The extracted data included: general characteristics (i.e. size, number of specialties), organizational structure, defined stakeholders and their roles and responsibilities per stakeholder, processes of relationship management, processes of conflict management and general strategy when mentioned. Data were stored completely anonymized in this extraction file, and each teaching hospital was given a separate number. Data were stored on a secured university database and will be kept for 10 years.

Table 1 Simplified example of the data extraction form
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Data analysis

We used thematic analysis to analyze the data. Thematic analysis is a data analysis method for qualitative data that seeks to identify, analyze and report repeated patterns [29, 30]. These constructed patterns derived from a data set are called themes and answer the research question [31]. The coding process was assisted using the qualitative data analysis software ATLAS.ti (version 9). The first author used three coding iterations—initial coding, axial coding, and selective coding—to systematically analyze and categorize the qualitative data [32]. In the initial coding iteration, each stakeholder was given a separate code. Ultimately, this was coupled with several themes, roles, hierarchical positioning, conflicts and connections with other actors. The first researcher then used stakeholder mapping to provide an overview on relevant stakeholder identification and positioning in the organization. In the selective coding stage, the first author engaged in discussions with all research group members in which the preliminary results were examined, leading to the formulation of overarching themes.

Results

Stakeholders

Table 2 Presents an overview of the stakeholders mentioned in the governance codes, along with their corresponding frequency of mentions, showing how many hospitals included each actor in their governance code. When looking at these numbers it is clear that the following stakeholders make up the core of education in these hospitals: residents, program directors, medical specialists from each program, the educational department, the hospital-wide education committee and the board of directors. The section below will explain and outline the roles and responsibilities of the stakeholders who were frequently mentioned in the governance codes; a complete overview of stakeholder roles and responsibilities within medical education as stated in the governance codes is provided in Table 3.

Table 2 Stakeholders mentioned by hospitals (n = 46)
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Table 3 Stakeholders and their tasks and responsibilities mentioned in the governance codes
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Roles and responsibilities of prominent stakeholders

Residents

Residents in training are doctors who are enrolled in a postgraduate training program to become a medical specialist, residents not in training are doctors not enrolled in a training program. While all governance codes acknowledge the residents as a group/stakeholder, the specific description of their role tended to vary. At a large number of hospitals, they were not mentioned as an actor with responsibilities or tasks (29 of 46 governance codes). In the remaining codes they were given a variety of responsibilities that included at least one of the following: active participation in education, providing adequate feedback and/or individually contributing to the educational climate.

Program director and teaching team

According to Dutch legislation, clinical teachers are required to operate within a structured team, commonly referred to as a ‘teaching team.’ This collaborative approach ensures shared responsibility for the education being provided and for its quality [11]. All teaching teams are steered by a program director. The teaching team was often mentioned in the governance codes together with the program director, who has an individual responsibility to deliver high-quality education and training and contribute to a safe educational climate. The deputy program director’s main task is to support the program director directly and take over that function in times of absence. Across hospitals the description of the role and responsibilities of a program director was very diverse. For 22 of the 46 hospitals there was a clear description, stated as follows:

“The program director is primarily responsible for their own program and its quality management, together with the medical specialists in its teaching team”.

However, in the other governance codes there was no explicit description. For 15 of the 46 hospitals there was no description of the role of the program director in general or as it relates to specific situations; for example, dysfunctional residents or responsibilities for the content of the training program. At a limited number of hospitals (2/46) the program director was named as the stakeholder who is in the lead of education in that program. However, what that means, was not made clear in the documents.

Hospital-wide education committee

The hospital-wide education committees are a core part of all governance codes. The committees consists of all program directors and is chaired by a daily board. This daily board executes the regular tasks provided to the committee. The hospital-wide education committee is mentioned in current national policy documents as a required committee having the aim of monitoring and promoting an adequate and safe training climate in the training institution [33]. This corresponds with most governance codes (34 out of 46) as they gave their hospital-wide education committee a similar responsibility. The hospital wide education committee is often given mandated tasks from the board of directors to monitor and improve quality of both educational quality and the educational climate in the whole institution. The governance code at these hospitals stated:

“The hospital-wide education committee is primarily responsible for the quality of the medical education in the institution”.

Two other common responsibilities mentioned were: giving advice on education to other stakeholders (7 out of 46) and guarding the interests of residents and program directors in the organization (10 out of 46 hospitals). However, the data showed that hospitals dealt with the role of the committee in different ways; at some hospitals committees had the power to enforce action and improvement while at others this was limited. In the latter, committees had a more advisory and signaling function to other stakeholders. While they were seen as very important in signaling educational complications and giving advice to program directors on how to improve, they were not in the position to enforce this improvement. That decision-making power was primarily reserved for the board of directors, and sometimes for divisional or medical staff boards.

Educational department

An educational department was mentioned in almost all governance codes (44 out of 46). In all cases this department had a supportive function. Their responsibilities included supporting and advising other stakeholders, such as the board of directors and the hospital-wide education committee, on all matters related to education. They also help operationally, for example by performing and analyzing questionnaires the hospital-wide educational committee uses to assess the educational climate. Policy documents spoke of educational departments as a central coordination point that exists within a training institution to support and facilitate training activities. This matches well with the descriptions found in the governance codes. Educational departments play a crucial role in implementing the continuous quality system and collaborate closely with the hospital-wide education committee to effectively monitor and ensure quality standards. The main difference from the hospital- wide education committee is that the educational department does not have the authority or decision-making power to address other actors on their shortcomings.

Medical staff board

Medical specialists are represented in the organization by a medical staff board. This was reflected in the governance codes, as 33 hospitals mentioned such a structure. However, their description in most documents was limited. The medical staff was most commonly mentioned in relation to structured consultation with the board of directors and the hospital-wide education committee. At 20 out of 46 hospitals the medical staff board had the responsibility to have regular meetings with other stakeholders on education. Specific tasks were mediation of conflicts between medical specialists and, for example, the hospital-wide education committee. Another task was that they could be part of the reporting structure regarding educational problems:

The medical staff board has yearly meetings with the board of directors regarding education, with the power to terminate an education program when quality is inadequate.

If the hospital-wide education committee signaled problems in a training program that were not resolved by advice or action that the committee gave to this training program, the medical staff board was to be notified of this and would be involved in the improvement process.

Board of directors

The board of directors, being the leading actor of the hospital, bears ultimate responsibility for the hospital’s educational objectives. This was stated in all governance codes analyzed and corresponds with the role stated in policy documents. Policy guidelines allowed for delegation of roles and educational responsibilities to other stakeholders, which we saw frequently with the hospital-wide education committee.

Stakeholder mapping

The stakeholder map presented in Fig. 1 was created by analyzing roles, responsibilities, and reporting structures within the hospital. This approach allowed us to establish a hierarchy of influence within the organization and correlate it with stakeholders’ interest in resident education, represented on the x-axis. However, it is important to note that this map carries certain uncertainties and may show some overlap between stakeholders, as indicated by the lighter yellow circles.

Fig. 1
figure 1

Stakeholder map based on governance codes

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Educational problems

To answer the latter part of our research question, namely how governance structures safeguard education in the organization, our study looked specifically into who solves educational problems and who has decision-making power in this process. Several types of problems were outlined frequently in the different governance codes. These were inadequate educational quality of a program, conflicts between stakeholders, a dysfunctional program director or medical specialist on the teaching team, and a dysfunctional resident. Table 4 provides an overview of the stakeholders involved in each problem and who makes the decisions in situations where advice and instruction have not sufficed to resolve the problem.

Table 4 Educational problems and involved stakeholders mentioned in the governance codes
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Discussion

By analyzing the governance codes of 46 teaching hospitals in the Netherlands, the present study provides an overview of how roles and responsibilities are distributed across stakeholders with regard to the quality management of medical education. The analysis showed variety in the way roles and responsibilities are distributed across these stakeholders. The study demonstrates that the hospital-wide education committees have an important position at each hospital but that their role differs greatly across organizations. These findings support two key contributions to the literature. Firstly, they highlight the importance of considering a broader range of stakeholders and their roles, beyond those earlier mentioned in hospital governance literature in the same context [6]. Secondly, the study seems to point at significant variations in the translation of national policy to practice across a wide range of teaching hospitals.

Roles of educational stakeholders

The present study shows a large diversity in how teaching hospitals distribute the roles of educational stakeholders. Several commonly researched actors were found to be involved in managing the quality management of education, such as the program directors and the board of directors [34, 35], but there were also some notable, unexpected actors who are actively involved at a majority of the hospitals. One actor with an important role in most governance codes was the educational department, largely consisting of policy staff members and educationalists. Their supporting role might be essential for the success of internal quality assessment, as Silkens et al. (2017) described that they reduced administrative and executive loads [9]. Another unexpected actor was the medical staff board, who were indicated to have an important say in decision-making regarding education-related dysfunction of medical specialists and conflict management between actors in the hospital. This role and authority of the medical staff board was larger than expected, as policy documents on PGME have rarely mention them as stakeholders [11, 33]. In academic hospitals, it seems that the responsibilities of the medical staff board are moved to a divisional board. Although other studies have discussed the potential benefit of involving medical staff more in quality management, they have not mentioned the specific function of the medical staff board function [15, 36]. It is interesting to note that the medical staff board actually has a voice in important educational decisions, despite having no formal role in PGME. If we consider Mintzberg’s internal coalitions [14], we could cluster the medical staff board with the board of directors, as their primary goal is to keep the hospital financially healthy. If this coalition of stakeholders gains too much influential power, education may become underrepresented in the organization.

Hospital-wide education committees were found as stakeholders in all governance codes. As Silkens et al. (2017) mentioned in their qualitative study on hospital-wide education committees, authority is necessary for the committees to properly function [9]. However, our analysis indicated that the authority and enforcement powers of these committees varies across hospitals. The study by Silkens et al. [9] found that three different roles that are given to hospital-wide education committees in the Netherlands can be distinguished. These three roles are: an advisory role, a quality controller role, and a conflict mediation role. This is largely consistent with the findings of the present study. These roles differ significantly in terms of the power and authority bestowed upon the committees. This brings us to Mintzberg’s classification of power and authority within managerial positions, which consists of three distinct roles: interpersonal, informational, and decisional [14, 37]. These roles correspond loosely to the roles we found in the present study, as is illustrated in Table 5.

Table 5 Corresponding roles based on power and authority
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Committees that have an advisory role have a primary goal to give solicited and unsolicited advice to other stakeholders. This contrasts with the intervention role, in which committees can enforce action in programs or even apply sanctions to non-improving teaching teams. The goal of the conflict mediation role is to manage interpersonal relationships in the organization. Some hospital-wide education committees might be given one role while others receive a combination of these three. These roles differ significantly in terms of the power and authority bestowed upon the committees.This variation also comes back to the amount of authority the hospital want to give to the committees, so also on their degree of professionalization and the tensions between clinical and educational productivity [20, 22].

Policy translation

The second key contribution from the findings is demonstrating how national policy around educational governance gets translated into practice at individual hospitals. The present study demonstrates that teaching hospitals implement the same national policy decision in various ways, thereby designing their internal governance structures differently. One possible explanation is that organizational factors, for example, leadership styles or available resources, influence how hospitals organize their hospital-wide education committees. An alternative explanation for this is decoupling, which refers to the process of separating the implementation of policies from their intended outcomes [38].

Earlier research has indicated that there tends to be a gap between formal policy and practice [38, 39]. Organizations sometimes respond to external pressures regarding legislation and regulation by implementing formal policies, yet maintain their actual practices without substantial change [40]. In this way, organizations can avoid legal sanctions while keeping internal practices unchanged [39, 41]. Sanctions in the case of teaching hospitals would result in not receiving accreditation for PGME programs, with important financial consequences. Withdrawal of accreditation also has a large impact on teaching hospitals’ status and clinical production, as residents provide both [42, 43]. This would elucidate the reasoning behind the widespread adoption of hospital-wide education committees, even though it seems that at the same time, the governance codes of certain hospitals designate them as stakeholders with a less authoritative role compared to others. A consequence of symbolic implementation could be a decrease in the effectiveness of the internal quality assessment system. Healthcare organizations have demonstrated a lack of responsiveness to educational policy when education is not prioritized over patient care and research [44].

Implications for future research

The present study provides a starting point for more in-depth research on PGME quality management, as this study shows which actors have a relevant role in educational governance. We found a great deal of variety and ambiguity with regard to the decision-making power of hospital-wide education committees. Follow-up research could also inform us whether hospital-wide education committees are able to steer the internal quality system of PGME in teaching hospitals in practice. An important distinction can be made based on the three roles that are given to the hospital-wide education committees and whether one role leads to better functioning quality management than others. Realistic evaluation offers an intriguing approach for follow-up research as it recognizes that healthcare organizations operate within complex and dynamic contexts [45]. This could identify the underlying mechanisms and contextual factors that influence this variability in policy implementation [45]. Furthermore, it is important to investigate further whether well-functioning hospital-wide education committees contribute to the quality of PGME.

Limitations

The study on PGME was performed as a nationwide study in the Netherlands, which leads to better generalizability of the results. However, the results are inherently tied to the specific circumstances of the country’s context, and therefore results may not directly be generalizable to other countries. Although the governance structures studied are country-specific, the study provides unique insights into the organization of educational quality management in teaching hospitals and the relevant governance structures connected with it. Further, the study used document analysis as the main method. However, documents might not always contain the necessary information required for analysis and can limit the accuracy of the study’s conclusions. This study, a document analysis, cannot fully assess how effectively governance structures function in monitoring and ensuring quality. While we examine these structures on paper, they may not operate as intended in practice due to various factors. The documents provided sometimes lacked contextual information and depth. Triangulation of results in future studies should be considered, with additional data such as focus groups, interviews or audit documents, as document analysis alone often does not lead to optimal comprehensive understanding [46, 47].

Conclusions

This study identified the variety of governance structures focused on educational quality, revealing the diversity in governance structures. In particular, hospital-wide education committees are crucial actors to achieve good educational quality; however, they implement different roles in practice and are assigned an unclear amount of authority. This undermines the potential positive effects their work can have on postgraduate medical education. Further research is necessary to answer how the important educational stakeholders work together in practice and whether internal quality assessment leads to better postgraduate medical education.

Data availability

The datasets generated and/or analyzed during the current study are not publicly available due to lack of written consent from the included hospitals to make them public. Anonymized datasets are available from the corresponding author on reasonable request.

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Acknowledgements

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Author information

Authors and Affiliations

  1. Health Services Research, School CAPHRI, Fac. Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands

    L. M. van der Baaren & R. E. Gifford

  2. SHE School of Health Professions Education, Fac. Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands

    L. M. van der Baaren, N. A. van der Baan & I. C. Heyligers

  3. Department of Surgery, Zuyderland MC, The Netherlands

    M. N. Sosef

  4. Royal Dutch Medical Association (KNMG), Utrecht, The Netherlands

    J. H. Blaauw

  5. Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, Amsterdam, The Netherlands

    R. J. Bennink

Authors
  1. L. M. van der Baaren
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  2. R. E. Gifford
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  3. N. A. van der Baan
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  4. M. N. Sosef
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  5. J. H. Blaauw
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  7. I. C. Heyligers
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Contributions

All authors participated in conception and design. van der Baaren collected data, performed majority of analysis and wrote the manuscript together with Giffords. All other authors revised it critically for important intellectual content and final approval of the version to be published.

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Ethics approval and consent to participate

METC approved research, by an ethics commission of Maastricht University called “Faculty Niet-WMO Verplicht Research Ethics Committee’. This is connected to Maastricht University. The case number is FHML-REC Number FHML/HPIM/2023.404. This research complied to the Declaration of Helsinki. Individual hospitals did not give written consent to include them in this study, however data was freely available, most often on the website of the hospitals itself. We made use of a collection of these forms sent to the national accreditation body.

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Appendix 1: key terms and their definitions

Appendix 1: key terms and their definitions

Key terms

Definition used

Governance

The system of checks and balances within an organization that ensures separate governance entities hold each other accountable and limit each other’s power to stray from the organization’s goals.

Quality assurance

Quality assurance refers to the methods for checking the quality of processes or outcomes.

Quality management

Quality management involves an organization’s activities and processes to ensure that its products or services meet established standards. Quality assurance is part of this.

Stakeholder

A stakeholder of an organization is any individual or group that has an interest in or is affected by the organization’s activities, decisions, and outcomes.

Oversight

systems or actions to control an activity and make sure that it is done correctly and legally.

Governance structure

Individuals or groups who hold specific roles and responsibilities related to decision-making, oversight, and accountability.

Governance code

Formal documents that outline recommendations to improve governance and increase the accountability of organizations to shareholders or the outside world in general.

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van der Baaren, L.M., Gifford, R.E., van der Baan, N.A. et al. An exploration of governance in teaching hospitals in the Netherlands focused on educational objectives. BMC Med Educ 25, 88 (2025). https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12909-025-06680-3

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Keywords

BMC Medical Education

ISSN: 1472-6920

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