title: Resource constraints and strategic change in a public hospital system.
abstract: It has been suggested that strategic management in public services tends to be oriented towards preserving and perpetuating current patterns of service provision, rather than changing priorities. However, faced with severe resource constraints combined with growing demand and rapidly developing technology, public hospitals in Canada have come under increasing pressure. Based on an empirical study of strategic management and change in 32 Montreal hospitals, this paper examines the relationship between financial adversity and the extent and nature of strategic change in these organizations. Strategic change indicators considered in the study include overall product mix, product diversity, product complexity, market demographics, efficiency, and revenue diversification. Results suggest that resource constraints have indeed stimulated changes within these organizations. In particular, hospitals suffering more severe financial difficulties have reduced their size and focused on a narrower range of services. Moreover, there is evidence that greater complementarity has been achieved among the entire sample of hospitals.
authors.affiliation: Université de Montréal, Canada.
authors.forename: F
authors.initials: F
authors.lastname: Champagne
authors.forename: A
authors.initials: A
authors.lastname: Langley
authors.forename: J L
authors.initials: JL
authors.lastname: Denis
authors.forename: A P
authors.initials: AP
authors.lastname: Contandriopoulos
authors.forename: L
authors.initials: L
authors.lastname: Cazale
authors.forename: M
authors.initials: M
authors.lastname: Rivard
mesh_terms: D003625:Data Collection; D017598:Efficiency, Organizational; D004651:Employment; D005377:Financial Management, Hospital; D015276:Health Care Rationing / Q000379:methods*; D006302:Health Services Research / Q000379:methods; D006752:Hospital Planning / Q000379:methods*; D006754:Hospital Restructuring / Q000639:trends; D006779:Hospitals, Public / Q000191:economics / Q000458:organization & administration*; D006786:Hospitals, Urban / Q000191:economics / Q000458:organization & administration; D009936:Organizational Innovation; D010934:Planning Techniques; D011357:Product Line Management; D011792:Quebec