Study Defines Dependent Autonomy in Healthcare Management

Researchers have developed and refined a theoretical construct known as dependent autonomy to better understand how managerial authority functions within healthcare systems. The study, published in BMC Health Services Research, aims to clarify the practical exercise of delegated authority in the context of value-based healthcare and High-Value Health System frameworks. These frameworks identify components intended to support healthcare transformation, but their practical use may depend partly on organisational conditions affecting managerial authority. The proposed framework distinguishes managers’ practical scope for action from improved organisational performance.

The research employed a sequential two-stage design. Stage 1 involved the secondary qualitative coding of published findings from four empirical programme studies. This phase used directed content analysis informed by Decision Space Theory and organisational theory, with an earlier scoping review serving as a sensitising source.

Stage 2 of the study combined an external scoping review across three databases with a hybrid deductive and inductive framework synthesis. This phase included 78 articles, from which the researchers derived 482 analytical evidence statements. Study selection and analytical interpretations underwent independent review to ensure rigor, although no formal critical appraisal was undertaken. The external findings from this extensive review informed refinements to the initial themes generated in Stage 1.

The results from Stage 1 generated three primary themes: enabled yet contingent autonomy, organisational capacity as a conditioning force, and coordination as integrative yet complexity-generating. The synthesis in Stage 2 proposed dependent autonomy as the organisationally conditioned actionability of formally delegated managerial authority.

The final synthesis produced four propositions concerning formal authority, organisational conditions, conditional consequences, and feedback and reconfiguration. The framework suggests that managerial legitimacy and deployable capacity are critical factors that vary across different functions, contexts, and time periods. By mapping these relationships, the study provides a structured way to examine how organisational arrangements enable or constrain managerial action.

Limitations of the study include the fact that its explanatory value and proposed relationships require further empirical examination. The researchers noted that effects on patient value were not established in this theoretical development phase. The lack of formal critical appraisal in Stage 2 is also noted as a methodological boundary.

The publication is part of an open-access initiative to provide faster access to peer-reviewed research. The article is citable and carries a permanent DOI, though it is subject to further edits before the final Version of Record is published.

Subject of Research: Theoretical construct of managerial autonomy in healthcare

Article Title: Dependent autonomy: developing and refining a theoretical construct of managerial autonomy in healthcare

Article References: Ohrling, M. (2026). Dependent autonomy: developing and refining a theoretical construct of managerial autonomy in healthcare. BMC Health Services Research, 26(1), Article 1561. https://doi.org/10.1186/s12913-026-16096-4

Image Credits: AI Generated

DOI: 10.1186/s12913-026-16096-4

Keywords: healthcare management, managerial autonomy, value-based healthcare, theoretical framework, organisational theory, health services research, delegated authority, clinical governance, Dependent, autonomy, developing, refining