Abstract :
[en] Our research applies to the healthcare sector which is operating in a period of significant and rapid evolutions since the last thirty years. It investigates the design of the performance monitoring systems in healthcare organizations, in a contingent and comparative perspectives.
This contribution summarizes the results of four chapters and uses respectively three methodologies, applied to answer the following “what” and “how” general questions:
- What influences the design of the performance monitoring systems adopted in the healthcare organizations?
- How does it evolve with the hospital’s attributes evolution?
- What are the major internal and external motivations and/or the major barriers that have emphasized and/or limited its evolution?
- What is the role of the healthcare players on the hospital’s management?
In a contingent perspective, the first chapter, based on macro-economic analysis of the healthcare sector, identifies the increasing need to monitor performance at the hospital entity level. It points out to some social, political, technological and competitive contingent factors that have emerged from the environmental mutations. These contingent factors are then integrated in an original unifying model that is validated via three empirical chapters.
- The first chapter is dedicated to the contingent model’s validation in the Belgian healthcare sector. It investigates the link between these variables and the management tools, via an online questionnaire, a test of information and a test of independence.
- The second chapter appraises the manager’s perception of uncertainty in volatile environments and analyzes the impact of some contingent factors affecting his decision-making style. It relies on the contingency theory of leadership that is applied to assess the external environmental mutations that are manipulating the organizational attributes (structure, size, level of technology and ownership). Hence, they are emerging certain situations of uncertainty that shape the managerial choices (“decision style”, autonomy and personal profile) on the adoption of a suitable management system. The methodology is based on a “qualitative comparative approach” of thirty case studies, lead in two heterogeneous environments (Belgium and Lebanon).
- The last empirical chapter goes beyond the organizational attributes to investigate the role and impact of the various players who are involved in healthcare organizations. Based on a qualitative approach, we illustrate, for every player, his position within the system. Consequently, we define his culture, intentions, and responsiveness that manipulate the organization’s internal climate and shape the design of the performance monitoring systems. Out of twenty-two case studies, the qualitative findings are expected to add knowledge on the adequate choice of a management system, within three healthcare organizational structures: university, general/university and general hospitals.
