The management of health care: a model of control

This paper is aimed primarily at those involved in managing and implementing management structures in health services. It is concerned with the replacement of historical management structures with 'proven' private sector structures. It is argued that a major problem with the private sector models introduced in New Zealand is that they fail to recognise the levels of uncertainty inherent in the diagnosis and treatment of illness. The Gibbs Report criticisms of existing management practices are discussed, criticisms that were based strongly on the Griffiths Report. A model of organisational control is outlined, based on Ouchi's concepts of market, bureaucracy and clan. This model is used to evaluate two major structural changes: the introduction of general management and the involvement of clinicians in clinical directorates. It is argued that success or failure of health service management reform depends on a greater recognition of the underlying uncertainties involved in medical practice.