Control modes in care delivery organisations

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11th International Symposium on Human Factors in Organisational Design and Management (ODAM 2014) CPH Conference

Control modes in care delivery organisations
Author:Robert L WEARS (Department of Emergency Medicine, University of Florida, United States)
Carol Leah BARSKY (Division of Performance Management, Yale-New Haven Hospital, United States)
Shawna J PERRY (Department of Emergency Medicine, Virginia Commonwealth University Richmond, United States)
Date: 2014-08-20     Track: A -Special sessions     Session: A8 - Health care symposium part III: A systems approach to health care

Three different, overlapping management and control systems co-exist in healthcare delivery organisations: in order of their legibility, they are a Weberian bureaucracy (the formal hospital organization); a feudal system (the medical staff); and an informal, peer-based network of senior nurses roughly analogous to networks of noncommissioned officers in the military. The co-existence of these three modes of control leads to areas of conflict, confusion, and cooperation. The paper discusses the benefits and problems associated with this complexity and draws on insights from the engineering of polycentric control architectures involving heterogeneous agents to suggest ways to beneficially influence such organisations.