Who Makes Decisions in Hospital? A Scoping Review and Meta-Synthesis

Context: The aim of this study was to identify decision-making issues and key decision-makers within the hospital. Methods: This scoping review was conducted by searching the databases of Web of Science, Scopus, and PubMed in January 2024. Additionally, articles related to Newhouse s main article were searched on Google Scholar to identify decision-makers in the hospital and their areas of decision-making. The 37 articles were analyzed using the framework analysis technique with Atlas-ti software. Results: Decision-makers addressed 160 issues, which were identified and categorized into 7 areas: Strategic management, human resource management, financial management, physical resource management, employee compensation payment, service delivery management, and hospital reputation. Additionally, 21 decision-makers were identified and classified into 6 categories: Group of managers, group of physicians, group of nurses, board of directors, government, and political groups. Hospital managers were identified as the primary decision-makers, responsible for making decisions independently in three areas and jointly with the board of directors in one area. Conclusions: It can be concluded that no single decision-maker holds a dominant role in the decision-making process. Several decision-makers exert varying degrees of influence depending on the issue. Among these decision-makers, managers play a more significant role in decision-making than others.