Beyond quality management methods: Meeting the challenges of health care reform

Over the last 20 years, the increasing complexity and technical intensiveness of health care in French hospitals have increased the level of uncertainty in the process of care. This paper argues that beyond quality management approaches, the most important issue in health care management is the need to implement new organizational methods in response to the dynamic changes that are transforming the care process. Uncertainty, complexity and speed can all be managed by standardizing operating procedures, but when quality management is applied to a complex system such as health care, a different approach is needed. One alternative to standardization can be found in new theories of organization that emphasize the flexibility of an organization, i.e. its capacity to adapt to uncertainty. Building on empirical work, this paper integrates these different theoretical perspectives and tries to provide insight into the kind of quality management methods that will allow hospitals to deal with the new constraints being placed on the process of care.