The iMpleMenTATion of MedicAl BUSineSS UniTS wiThin fRench hoSpiTAlS: An AnAlYSiS dRAwing fRoM MAnAgeMenT conTRol liTTeRATURe

Abstract

French New Public Management states that all public hospitals shall reorganize themselves on the basis of medical business units, managed on a contractual basis. Yet, available studies indicate that these medical business units result difficult to implement, mainly because of cultural and political difficulties. This article draws on the case study of an average French public hospital. Medical business units are studied from a management control point of view. More precisely, Malmi and Brown’s framework of management control systems as a package is used as an analytical framework to interpret the case study. From an empirical point of view, it appears that the three control systems within the organization are not in line one with each other. The administrative, cultural and cybernetic systems are poorly convergent. Doctors heads of the medical business units have a poor decision and financial authority. And they find themselves in a situation of role conflict which is partly explained by the differences existing between the medical and managerial responsibility. Finally, it appears that the cybernetic system presents endogeneous and exogeneous weaknesses. They cast doubt on its real capacity to effectively exert control on the organization. From a theoretical point of view, this article illustrates the interest of Malmi and Brown’s frame for analysis. Two propositions are also suggested, for the studies of medical business units. From a managerial point of view, this article invites managers to focus on the technical features of cybernetic models, and their practical uses. It seems important to consider both the environment and the dairy practices of these systems.