WHAT TOOLS SHOULD BE USED TO PROMOTE COORDINATION BETWEEN COMMUNITIES WITHIN HEALTH CARE INSTITUTIONS? AN ANALYSIS IN TERMS OF BOUNDARY OBJECTS

Abstract

The involvement of healthcare professionals in managerial decision-making has been considered for some time as essential to the transformation and performance improvement of healthcare organizations. Several reforms have aimed at fostering this engagement, but the empirical work analyzing the effects of these reforms has paid little attention to the role of management tools. However, literature on tools, in particular dashboards, indicates that their characteristics and the way in which they are used are likely to encourage the involvement of professionals in the management of their hospitals. We therefore seek to understand the conditions under which a dashboard could promote coordination between medical and managerial communities in a healthcare organization. To do this, we analyze the characteristics of the tool, the context of its implementation and the way by which it is used. We rely on a case study conducted from an interpretive perspective in a private healthcare organization belonging to a mutualist group. After our analysis, we conclude that it is because the dashboard has the characteristics of a boundary object – stable identity and interpretative flexibility – that it effectively fosters coordination between the medical and managerial communities. Our results may lead us to reconsider how dashboards are designed and implemented in practice, particularly in healthcare organizations where the involvement of the medical and paramedical professions in the management of the organization is not yet established and constitutes a major managerial challenge.