Re-thinking barriers to organizational change in public hospitals

摘要: Public hospitals are well known to be difficult reform. This paper provides a comprehensive six-part analytic framework that can help policymakers and managers better shape their organizational institutional behavior. The first describes three separate structural characteristics which, together, inhibit effective problem description policy design for public hospitals. These constraints i) the dysfunctional found in most organizations, ii) particular dysfunctions of professional health sector iii) additional dimensions politically managed organizations. While problems each these hospital organization well-known, two clearly affect private as publicly run hospitals, insufficient attention has been paid combined impact all factors making particularly manage steer. Further, interact an environment defined by restrictive context limitations, again which also but compound management dilemmas contextual limitation is inherent complexity delivering high quality, safe, affordable modern inpatient care setting. second set specific market failures limit scope standard financial incentives reform measures. third last unique generalized localized anxiety, accompanies delivery medical services, suffuses decision-making on part patients, staff, management, political actors alike. combination six – explain why different character from other parts sector, scale challenge they present decision-makers.