Medical care and postmodern management.
Because of the persistent influences of modern philosophies of management, health care has suffered from a monomania for economic thinking in a world thought of as a simple, unchanging machine. This form of management fails in the Netherlands, even in its own economic terms. We argue that best management is postmodern management and is inspired by postmodern thinking. It assumes that there is a non-reducible plurality of forms of life in human society which mostly interact in a powerful and complex way. It, therefore, stresses simplicity and dynamics in structure making. It advocates the principle of freedom, within constraints, for the staff of the medical organization. As a paradigm of new management we suggest the deconstruction of the present piecework payment per activity of doctors: it is static, expensive and fails to control the quality of medical care. Instead, two dynamic structures are suggested consisting of a payment per treated patient, together with the creation of a limited number of teams of highly qualified medical controllers. Both of these measures should improve the quality of health care as well as its cost-effectiveness.
D003695:Delivery of Health Care / Q000458:organization & administration*; D004469:Economics, Hospital; D004526:Efficiency; D009426:Netherlands; D011787:Quality of Health Care / Q000592:standards*