Organizational design and hospital performance
(2002)
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- Abstract
- This paper is only one part of a larger research that aims at modeling the relationship between organizational design and hospital performance. This research is related to the changing context of hospital payment systems. We observe the generalization of either prospective payment systems or more controlled retrospective payment systems. We want to analyze whether or not the traditional structure of hospitals is still appropriate by analyzing the existing literature in a single global model. Before modeling their relationship, we have to define hospital performance and to determine which organizational design hospital could choose. By this paper, we want to achieve it. What does hospital performance mean? Numerous authors are interested in this difficult question and a large literature exists (Donabedian, 1966; Shulz et al., 1983; Quinn et Rorhbaugh, 1983; Cameron et Whetten, 1983; Durant, 1986; Fottler, 1987; Fetter, 1991; Kazadjian et al., 1993; Shortell et al., 1994; Flood et al.; 1994; Berkowitz, 1995; Leggat et al., 1998; Guisset, 1998; Sicotte et al., 1998). From a rational point of view, we have synthesized the major performance criteria in a rational model (CrĂȘteur et al., 2000) in which we have retained five criteria: quality of care, satisfaction of patients, human resources, efficiency and financial results. Arbitration between some of those seems to be unavoidable and will be provided the global performance model. What does organizational design mean? To define this concept, we refer to the contingency authors (Galbraith, 1973; Duncan, 1979; Mintzberg, 1979; Nadler et Tushman, 1988; Daft, 1991; Obel & Burton, 1998). According to these authors, organization is considered as an information process and design as an answer for information requirement. In this paper, we develop a typology of organizational design and explain how each design could be applied to health care organizations. We retain three grouping strategies for activities: functional organization group activities around resources, divisional organization around output (or pathology) and matrix organization around both (input and output). The first two designs raise coordination problems and therefore, three linking mechanisms are defined: linking roles, linking groups and integrators. The matrix structure implies the most complex integration mechanisms. In total, seven designs are determined: functional and divisional groupings associated to each of the three linking strategies and the matrix form. We conclude with future researches that will allow us to model the relationship between organizational design and performance. The literature analyzing the relationship between performance and design often considers only one dimension of performance and design. For instance, authors use only profit for performance or only information system for describing design. In future research, we would like to integrate this existing literature and its partial contribution in a single global model. We could validate this model thanks to simulation of the organizational behaviors in alternative designs and thanks to a contextual analysis. Thanks to simulation, we will determine more precisely and illustrate how design could explain hospital performance. Contextual analysis will permit to see how design influence performance in comparison with rival explanations.
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Citations
Creteur, M., & Pochet, Y. (2002). Organizational design and hospital performance (IAG Working Papers 2002/51). https://hdl.handle.net/2078.5/129980