Matching structure and strategy:Towards a market orientation in health care
Matching structure and strategy:Towards a market orientation in health care
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匹配结构与策略：医疗保健市场化
DOI：
10.1002/nvsm.6090020203
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发表时间：
1997
影响因子：
--
通讯作者：
A. Galbraith
中科院分区：
文献类型：
--
作者：
A. Laing;A. Galbraith
在国民保健服务中引入“内部”或“管理”市场机制需要进行根本性的结构重组，包括购买者和提供者职能的分离。虽然在初步改革之后，新兴的采购组织发生了一定程度的结构变化，但缺乏相应的证据表明急性供应商单位正在进行结构变化。尽管组织结构和战略之间存在直接关系，但医院组织结构的变化程度值得怀疑。事实上，在宏观层面上，目前的急性医院结构，即NHS信托基金，与“改革前”的结构非常相似，尽管这些结构不适合内部市场所要求的市场导向。这种普遍性可以说反映了目前的管理结构对提供服务者的边际影响以及医疗等级制度的主导地位。具体而言，尽管引入了临床首长级结构，但在现有结构中负责医院服务营销的人员与提供服务的人员没有直接联系。急性NHS信托在苏格兰的市场行为的更广泛的研究的一部分，本文探讨了开放给医疗保健提供者克服这种分离的追求市场主导的服务提供和伴随的市场导向的组织途径。
The introduction of an ‘internal’ or ‘managed’ market mechanism into the National Health Service required fundamental structural reorganisation, involving the separation of purchaser and provider functions. While a degree of structural change has occurred among the emergent purchasing organisations subsequent to the initial reforms, there is a lack of corresponding evidence of ongoing structural change in acute provider units. Despite the existence of a direct relationship between organisational structure and strategy, the extent of change in the organisational structure of hospitals is questionable. Indeed at the macro level current acute hospital structures, that is NHS Trusts, are remarkably similar to ‘pre-reform’ structures, despite the unsuitability of these structures for the market orientation required by the internal market. Such prevalence arguably reflects the marginal effect that current managerial structures have had on those delivering services and the predominance of the medical hierarchies. Specifically, those responsible for the marketing of hospital services in current structures are not directly linked to those who deliver the service, in spite of the introduction of clinical directorate structures. Part of a broader study of the market behaviour of acute NHS Trusts in Scotland, this paper explores the organisational avenues open to health care providers to overcome this separation in the pursuit of market-led service delivery and concomitant market orientation.