Daniel Lozeau

Explaining diffusion patterns for complex health care innovations.

Why are some less solidly supported health care innovations widely adopted while others with apparently stronger scientific support remain underused? Drawing on four case studies, the authors argue that the way in which the distribution of benefits and risks map onto the interests, values, and power distribution of the adopting system is critical to understanding how innovations diffuse.

The Corruption of Managerial Techniques by Organizations

Public sector organizations are under pressure to adopt private sector tools to sustain legitimacy despite uncertainty about the compatibility of the techniques with this context. We explore the consequences of the misfit between the theories underlying two widely adopted managerial techniques (strategic planning and quality management) and the pluralistic power structure and values of public hospitals. We identify four scenarios of adaptation and use qualitative data to examine their empirical prevalence. We suggest that when the compatibility gap is large, there is greater likelihood that formalized techniques will be captured by and integrated into existing organizational dynamics (corruption of the technique) than that the technique will change these dynamics in a way consistent with its objectives (transformation of the organization). We examine the implications of our observations for understanding the role of managerial techniques in organizational change.

Formal strategy in public hospitals

This paper suggests that the difficulties associated with the application of formal strategic planning in public professional service organizations may have been underestimated in much of the literature. A survey of written strategic plans produced by Canadian hospitals showed that these plans were often heavily oriented towards expansion, ambiguous and rather loosely integrated, leading to questions concerning their realism and utility as a basis for strategic decisions. This phenomenon seems symptomatic of the complex (and often highly political) decision making environment faced by hospital administrators (and by managers of other professional service organizations such as universities and social service agencies). It is concluded that the benefits of formal planning may be different and less tangible for these organizations than for private business.

The role and impact of formal strategic planning in public hospitals.

In recent years, formal strategic planning methods originally developed for private business have been increasingly adopted by health care institutions, including publicly funded hospitals. Yet, as a technocratic management process, formal planning may seem at first sight to run counter to the natural mode of strategy formation in these organizations where negotiation and mutual adjustment between powerful groups of professionals, managers and government agencies traditionally control decision-making. This article describes an exploratory study aimed at understanding how formal strategic planning has become integrated and adapted into the management practices of a group of 23 Canadian hospitals. The context, processes and impact of planning are first examined over the entire sample of hospitals (descriptive analysis), and an attempt is then made to explain different planning outcomes in terms of a variety of contextual and process design characteristics (comparative analysis). The descriptive analysis shows that in practice formal strategic planning is easily absorbed into the political process: political and symbolic motives often drive the initiation of planning, the processes themselves are highly participative and the resulting plans often reflect the difficulties of obtaining consensus on goals in these complex organizations. The comparative analysis suggests that in general, contextual factors (eg, stimuli behind planning) appear to be more significant than process design factors (eg, extent of participation) in determining outcomes. In conclusion, it is noted that the confrontation between technocratic rationality and professional bureaucracy gives rise to a number of paradoxes that make both the use and the subsequent evaluation of formal strategic planning a difficult task in these organizations.