Abstract
The paper aims to advocate the incorporating of the sustainability perspective into the management control system of healthcare organizations. The study is based on two main premises: (1) the evolution of business models towards a wide perspective of the sustainability approach; (2) the evolution of control systems in healthcare organizations towards a control-based approach to monitor the effectiveness and efficiency of the service targeted primarily to cut costs and expenses. Our methodology is developed at theoretical and conceptual level starting from: (1) a literature review on the issue, highlighting main trends and gaps and (2) the adoption of the Viable Systems Approach (VSA) as a conceptual framework oriented to integrate a wide variety of stakeholder perspectives and interests into the business model. Our findings lead us to introduce the Systems Viability Monitoring Model for Sustainability as a potential reference framework to build healthcare management control systems in which the notion of ‘systems viability,’ as defined by VSA, becomes a bridging concept by means of which the sustainability perspective can be incorporated into the management control system of healthcare organizations.
Highlights
In recent decades, the management of healthcare organizations has been characterized by the progressive establishment of reductionist paradigms in which attention to the rationalization of resources and the maximization of performance has shifted, through the formalization of procedures, codes and protocols, towards an increasing focus on technical and economic performance
On the basis of the above, the aim of the paper is to re-examine the management control system in healthcare organizations in order to align its evolutionary trends to the current requirements of a sustainable and more inclusive approach
The paper is organized as follows: after this Introduction, Section 2 illustrates our methodological approach describing the tool used for the literature review and giving a detailed description of main elements of the interpretative perspective of the Viable Systems Approach (VSA); Section 3 presents the results of our study illustrating findings emerging from the literature review and introducing the Systems Viability Monitoring Model for Sustainability; Section 4 discusses how, from a VSA perspective, the notion of ‘systems viability’ becomes the bridging concept to incorporate the sustainability perspective within the management control system of healthcare organizations; Section 5 sets out our main conclusions and discusses future implications for research and the limits of the study
Summary
The management of healthcare organizations has been characterized by the progressive establishment of reductionist paradigms in which attention to the rationalization of resources and the maximization of performance has shifted, through the formalization of procedures, codes and protocols, towards an increasing focus on technical and economic performance. This pathway has had significant repercussions impacting, on the one hand, on the ethical-value dimension of the relationship with the healthcare user [1] and, on the other hand, on the overall healthcare management approach, ever more focused on finding conditions of economic equilibrium at local level. Attention to the relationship with other relevant stakeholders is fundamental whereby the conditions of equilibrium and long-term survival of the system depend
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