The institutional and technical antecedents of organisational design: a case study in the Victorian metropolitan hospital system

© 2002 Dr. Jennifer GraftonThis dissertation examines organisational structures and management control systems in the health care sector. The influence of two antecedent variables, the institutional environment and the technical environment, on organisational design choice is examined through the use of institutional theory and transaction cost economics. These theories are used to interpret the structural and management control system responses of hospitals under pressure to form inter-organisational networks. The implications of these design responses for organisational outcomes are examined in order to assess the relative importance of efficiency and/or effectiveness versus legitimacy as the principle logic of organisational action. A case-based investigation into three large public hospital networks in Victoria Australia is undertaken. Semi-structured interviews are the primary source of empirical evidence used to address the research questions of interest. Systematic data collection and analysis protocols are employed to ensure the reliability and validity of the qualitative research method employed. The results of this study indicate that both the technical and institutional environments in which an organisation operates jointly influence organisational design. Hospital networks are found to exhibit a range of structures, which are described according to the extent of horizontal integration observed. Both the type and use of control systems employed in these networks differs according to the extent of integration. Significant integration of core services across constituent hospitals of a network is found to be associated with an increase in the prevalence of integrative liaison devices. Such networks also realign other management control systems, such as the performance measurement system and standard operating procedures, to reflect the network-wide nature of activities. It is found that where a 'fit' is achieved between the antecedent environment variables and organisational design, organisational outcomes are enhanced