The Dilemma of Health Reform

Poor performance is pressuring hospitals worldwide to reform, but the process of reform is contested, uneven and slow. Reform often fails to address the core business of hospitals: managing clinical work, and stakeholders can limit opportunities for collaborative problem solving as they seek to impose their own frame of reference in the struggle for control. This book is based on research into performance in 12 public hospitals in Australia and its relation to organisational culture. Hospitals with inclusive strategies for change, principally strategies of agreement, joint education and skills development, team-based incentives to direct and reward effort and a method to manage clinical work performed better than those without. Cost containment and patient safety dominated as policy objectives but these alone did not engage clinician interest or address service quality. Service systems necessary to support reform were not present in the majority of hospitals studied. Research results are used to develop an organisational model of clinical work management to improve health service cost-effectiveness.