The design of performance monitoring systems in healthcare organizations : a stakeholder perspective

Monitoring the hospital’s performance is evolving over time in search of more efficiency by integrating
additional levels of care, reducing costs and keeping stuff up-to-date. To fulfill these three potentially divergent
aspects and to monitor performance, healthcare administrators are using dissimilar management control tools.
To explain why, we suggest to go beyond traditional contingent factors to assess the role of the different
stakeholders (governments, patients, authorities, personnel and administrators) that are at the heart of any
healthcare organization.
So, the main interest of our empirical study is to appraise how healthcare managers can foster strategic
“alignment” in chaotic environments. To investigate this subject, we rely first on seminal studies to appraise the
role of the main healthcare players and their influence on some organizational attributes (essentially size, lifecycle,
structure, climate and technology in use). We then consider the managerial awareness and the perception
of a suitable management control system (MCS) to promote a strategy-focused organization.
Our methodology is based on a qualitative approach of twenty-two case studies, lead in two heterogeneous
environments (Belgium and Lebanon). This method allows to illustrate, for each healthcare player, its
positioning within the healthcare systems. Thus, we define how its role, its perception and its responsiveness
manipulate the organization’s internal climate and shape the design of the performance monitoring systems. Our
findings are expected to add knowledge on the reasons of the choice of adequate management systems, within
three different healthcare organizational structures: university, general/university and general hospitals.