Competing Forces: A Mixed Methods Approach to Investigating the Link Between Organisational Control Mechanisms and Organisational Culture in the Acute Sector of a Public Healthcare Organisation

Abstract

This research investigates the operationalisation of activity-based funding (ABF) and its impact on the organisational control system and prevailing culture in the acute sector of a public healthcare organisation in South East Queensland. In doing so, it addresses the overarching research question: How do control mechanisms shape the organisational culture in public hospitals? Over the past 30 years, there have been two fundamental shifts in the way public hospitals are funded, structured, and managed. The first was the shift from healthcare organisations being characterised as professional bureaucracies to being managed as quasi-market bureaucratic organisations. This shift was caused by the initial introduction of new public management (NPM) ideology and more recently, the introduction of ABF. These changes represent a decreed set of external managerial controls imposed onto a pre-existing deeply entrenched culture dominated by medical professionalism, which resulted in ongoing tension and conflict between managers and clinicians.