Determinants and Effects of Organizational Strategies of Control Directed at Quality of Care in Organized Ambulatory Care Settings

摘要

A frequently used method for evaluating the quality of medical care services is to ascertain whether certain representative or critical clinical tasks or procedures were performed. The principal purpose of this investigation was to determine to what extent performance of nonperformance of such clinical tasks in outpatient clinics is influenced by congruence between 'strategies of control' directed at assuring performance of the task and the characteristics of the tasks and the attitudes of the clinic's staff about the strategies. It was found that if a task is routine, and 'bureaucratic' strategies of control are directed at it, performance levels tend to be high. However, equally high performance levels were observed in some cases when the task was routine but no strategies were present, suggesting that bureaucratic strategies are only one type of mechanism that can lead to high performance for routine tasks. Consistent with those findings, clinic chiefs and those who perform the tasks perceived bureaucratic strategies of control to be appropriate only for routine tasks, and to be only one of the optional mechanisms available for achieving high performance of such tasks.