Le design des systèmes de pilotage de la performance dans les organisations hospitalières : une approche par les parties prenantes

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