Performance Monitoring Systems in Healthcare Organizations The Managerial Perception of Uncertainty in Volatile Environments

Monitoring performance in healthcare organizations appears evolving drastically over time, due to a
continuous search for better quality, efficiency and timeliness. As a result, the usefulness of traditional
management/performance control systems in such organizations is questioned and a focus is then made on the
context in which each organization is operating.
In a contingent-based perspective, a limited number of qualitative and quantitative empirical studies
examine how some major contingent variables (nature of the organization, size, structure…) influence both the
managerial decision-making process and the management control process in healthcare organizations. But,
while largely integrated in other managerial contexts (Kabwigiri and Van Caillie, 2000), most of them ignore
the variable “uncertainty” and how uncertainty is perceived by managers in healthcare organizations.
So, the prime interest of our empirical study is to appraise how uncertainty is appraised by managers in
volatile environments. To investigate this subject further, we rely on seminal studies that link between the
influence of the organizational attributes (structure, size, level of technology), and their effect on the managerial
decisions-making (personal profile and perception) of a suitable management control system (MCS).
Our methodology rests on a “qualitative comparative approach” of thirty case studies, lead in two
heterogeneous environments (Belgium and Lebanon). Such method allows us to validate our theoretical
framework with qualitative case studies collected via semi-structured questionnaire. Our findings provide us
with a dialogue between a single (in-depth) case study exploring the phenomenon and a qualitative comparative
approach. Thus, we gain understanding of the causal mechanisms and processes, as well as of the core
determinants of the healthcare managerial adoption of performance monitoring systems (PMS).