Under what conditions can medical activity clusters reduce organized anarchy in public hospitals?

Abstract

Clusters of medical activities were established in French public hospitals in May 2, 2005, based on two principles, the search for medico-economic efficiency and subsidiarity. The purpose of this article is to analyze the impact of this change in organizational structure on the decisionmaking process. To address the relation between structure and decision, we mobilize organized anarchy (Cohen, March and Olsen, 1972) to demonstrate the effect of clusters on organizational efficiency. Our analysis is based on the case study of a large French university hospital, in two phases, with 3 clusters of medical activity. The results highlight the difficulties encountered by the clusters in achieving their efficiency objective: the influence of the economic context, the absence of cluster contracts, the problem of training of staff, the constant opposition between managers and medical staff. However, the analysis of the development of 2 cluster projects clearly highlights the cluster’s ability to reduce the organized anarchy in the hospital. We rely on this specific case to propose some conditions for the success of the cluster.