Impact of environmental change on strategy and management control systems in public organizations : the case of healthcare reform in Thailand | |
| Author | Dararat Rutanarugsa |
| Call Number | AIT Diss. no.DBA-SOM-17-02 |
| Subject(s) | Organization Change--Thailand Management Control Systems--Thailand Public administration--Thailand |
| Note | A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Business Administration, School of Management (Title page = 2016) |
| Publisher | Asian Institute of Technology |
| Series Statement | Dissertation ;no. DBA-SOM-17-02 |
| Abstract | In research on organizations, environment changes are hypothesized to lead to adaptive changes in strategies (strategies to fit) which in turn are, hypothesized, lead to supportive changes in their Management Control Systems (MCS) (system to fit). Empirical evidence in support are stronger for the latter than the former hypothesis. Significantly, classifying environment changes and defining what constitutes appropriate strategies for given environmental changes in a way that facilitates studies of large samples has proved troublesome. Managers in professional public organizations, such as public hospitals, work under several unique constraints that restrict their choices in making strategic changes in response to environment changes such as sector reforms. Such constraints to managerial action include values of a dominant professional class which often reject attempts to adopt managerial principles in running these organizations. This thesis develops a model in which nature of reforms, publicness of an organization and dominance of professional values in professional public organizations are identified as sources of constraints which restrict strategic choices available to managers of public hospitals. The model predicts that, in the presence of such constraints, environment change induces changes in MCS with no mediation of a changed strategy. The model is tested in two public hospitals in Thailand using the country’s healthcare reforms as a backdrop. Research design which compares pre and a 12 year post reform period is employed. Using a combination of methods including a survey of 131 senior staff, interviews with 23 key staff and administrators and hospital boards of both hospitals and published reports, this thesis describes and explains the changes or lack thereof in strategy and MCS of these hospitals. Analysis of results shows that nature of reform in the form of limited decentralization and autonomy combined with resistance from among professional staff, is an important reason why both hospitals made no changes in their strategies. The nature of reform in the form of changes in resource allocation and budgeting process combined with publicness of the hospitals resulted in increased bureaucratization of MCS. The nature of reforms also manifested in the introduction of a system of networks of healthcare units which together were responsible to patients as Contracted Units of Primary care. Publicness of hospitals combined with network aspect of reforms raised the importance of resource sharing as a focus of MCS. Hospital size partly explains the difference in importance of professional controls between the two hospitals. Managers in smaller public hospitals are better able to reduce the impact of professional values in making changes in response to reforms. Overall, the study finds that managers in professional public organizations do not respond with radically altered strategies to radical environment changes. Instead, they adopt an approach that is reactive in responding to demands of government agencies driving such reforms. |
| Year | 2017 |
| Corresponding Series Added Entry | Asian Institute of Technology.Dissertation ;no. DBA-SOM-17-02 |
| Type | Dissertation |
| School | School of Management |
| Department | Other Field of Studies (No Department) |
| Academic Program/FoS | Doctor of Philosophy in Business Administration (Publication code = DBA-SM, SM) |
| Chairperson(s) | Sununta Siengthai (Co-Chairperson);Venkatesh, Sundar, (Co-Chairperson); |
| Examination Committee(s) | Zimmermann, Willi;Chotchai Charoenngam; |
| Degree | Thesis (Ph.D.) - Asian Institute of Technology, 2017 |