Technology in contingency based research – a literature review in
the context of healthcare
Master Thesis Groningen, July 2012 M. van Gelder Goeman Borgesiuslaan 365 9722 VG Groningen Student number 1767712 University of Groningen
Faculty of Economics and Business MSc Business Administration
Specialization in Organizational and Management Control
First supervisor: Dr. B. Crom
Summary
This literature review has the aim to enhance our understanding of how a management control system (MCS) in a hospital should be designed. The emphasis is especially on operationalizations and conceptualizations of technological concepts in general as well as in the context of healthcare. Furthermore attention is paid to the influence of the technological concepts on the design of a MCS. The research question of this paper is:
“How can the contingency factor technology be conceptualized and operationalized in a healthcare context and in which way does technology influence the design of a MCS in hospital nursing
departments?”
The contingency factor technology is about the transformation process of inputs into outputs. Several contingent technological factors influence the design of a MCS. Task uncertainty, task
interdependence and task complexity are identified. Furthermore, review of the literature resulted in a fourth factor of importance, measurability of outputs. In order to characterize the definitions of these concepts, the literature and measurement scales are closely examined. This resulted in the development of definitions that are linked to the transformation process of inputs into outputs. After studying the technological characteristics of nursing, definitions of technological concepts with respect to nursing are developed. In illustration of this, the application of technological concepts in general and intensive care nurse departments is discussed. This has leaded to the conclusion that work of nurses is task uncertain, task interdependent and the ability to measure outputs is low. This also applies to IC-nurses. However their work is more task uncertain than the work of general nurses.
Some important theoretical contributions are made by this research. It became clear that the conceptualization and operationalization of technological concepts often is not clear and consistent between researchers. Furthermore, there is no universal way of measuring these concepts.
Preface
In 2008 I started studying Business Economics at the University of Groningen. After finishing my BSc, I decided to start a MSc of Business Administration, with the specialization Organizational and Management Control. This thesis is written in the context of this master and the final part of my college days in Groningen. I had an interesting and instructive time at the University of Groningen.
When writing my thesis I found out that it not always went as expected. I would like to thank my thesis supervisor, dr. B. Crom, for his support and useful feedback during the months I wrote this thesis. He always challenged me to look further and research extensively. Furthermore, I would like to thank my second thesis supervisor, dr. M.P. van der Steen.
At the end of my college days, I seize the opportunity to thank my family for their indispensible support during the days of my study. It was valuable to me.
Index
CHAPTER 1 – INTRODUCTION... 6 §1.1INTRODUCTION... 6 §1.2MANAGEMENT PROBLEM... 6 §1.3RESEARCH OBJECTIVE... 6 §1.4RESEARCH METHODOLOGY... 7CHAPTER 2 – INFLUENCE OF TECHNOLOGY ON A MANAGEMENT CONTROL SYSTEM ... 8
§2.1–INTRODUCTION... 8
§2.2–CONTINGENCY THEORY... 8
§2.3–TECHNOLOGICAL CONCEPTS... 9
§ 2.3.1 – Task uncertainty ... 9
§ 2.3.2 – Influence of task uncertainty on a management control system ... 14
§ 2.3.3 – Task interdependence... 18
§ 2.3.4 – Influence of task interdependence on a management control system... 22
§ 2.3.5 – Task complexity ... 25
§ 2.3.6 – Influence of task complexity on a management control system ... 26
§2.4OTHER RESEARCH ON TASK CHARACTERISTICS AND CONTROL... 27
§2.5SUMMARY... 31
CHAPTER 3 – ELEMENTARY TECHNOLOGY CHARACTERISTICS INFLUENCING A MANAGEMENT CONTROL SYSTEM ... 32
§3.1INTRODUCTION... 32
§3.2DEFINING THE CONCEPTS... 32
§3.3TRANSFORMATION PROCESS... 34
§3.4SUMMARY... 37
CHAPTER 4 – TECHNOLOGY IN THE CONTEXT OF NURSING IN A HOSPITAL ... 38
§4.1INTRODUCTION... 38
§4.2THE TECHNOLOGICAL CHARACTERISTICS OF NURSING... 38
§4.3DETERMINING THE RIGHT DEFINITIONS OF THE TECHNOLOGICAL CONCEPTS IN THE CONTEXT OF NURSING... 39
§4.4TECHNOLOGICAL CONCEPTS APPLIED IN DIFFERENT CONTEXTS OF NURSING... 42
§4.5SUMMARY... 43
CHAPTER 5 – CONTRIBUTIONS AND RECOMMENDATIONS FOR FUTURE RESEARCH... 44
§5.1INTRODUCTION... 44
§5.2THEORETICAL CONTRIBUTIONS... 44
§5.3PRACTICAL CONTRIBUTIONS... 44
§5.4RECOMMENDATIONS FOR FUTURE RESEARCH... 46
REFERENCES... 48
APPENDICES... 56
APPENDIX 1–FRAMEWORK OF PERROW (1967) ... 57
APPENDIX 2–OVERVIEW OF TASK UNCERTAINTY... 58
APPENDIX 3–INDEX DEVELOPED BY V/D VEN AND DELBECQ (1974) TO MEASURE TASK UNCERTAINTY... 60
APPENDIX 4–INDEX DEVELOPED BY DAFT AND MACINTOSH (1981) TO MEASURE TASK UNCERTAINTY... 61
APPENDIX 6–OVERVIEW OF TASK INTERDEPENDENCE... 63
APPENDIX 7–INDEX DEVELOPED BY V/D VEN ET AL.(1976) TO MEASURE TASK INTERDEPENDENCE... 64
APPENDIX 8–INDEX DEVELOPED BY SHARMA AND YETTON (2007) TO MEASURE TASK INTERDEPENDENCE... 66
APPENDIX 9–OVERVIEW OF TASK COMPLEXITY... 67
APPENDIX 10–FRAMEWORK OF OUCHI (1979) ... 68
APPENDIX 11–TYPOLOGY OF HOFSTEDE (1981) ... 69
APPENDIX 12–FRAMEWORK OF THOMPSON AND TUDEN (1959)... 70
APPENDIX 13–FRAMEWORK OF BIRNBERG ET AL.(1983) ... 71
APPENDIX 14–OVERVIEW OF DEFINITIONS... 72
Chapter 1 – Introduction
§ 1.1 Introduction
This chapter starts with defining the motive of this research, the management problem (§ 1.2). Then the objective of this research is stated, as well as the research question (§ 1.3). Furthermore, the research methodology is described (§ 1.4).
§ 1.2 Management problem
During the 1980s there was a move to the New Public Management (NPM). This meant increasing “accountingization” of public management (Hood, 1995, p.93). This shift in thinking also emerged at the management of hospitals. The emphasis shifted from process to output, from hierarchy to competition, from policy making to management skills and from fixed to variable pay (Hood, 1995, p.95). However, it is asked whether this “accountingization” fits the nature of the activities and tasks (the technology) of healthcare organizations, and in particular different departments (specialisms) in hospitals. Every specialism has its own technological characteristics. According to contingency theory, this would lead to differentiation in management control systems (MCS). However, in practice it seems that these differences in technological characteristics do not play a mayor role. There are four types of responsibility centres: investment centres, profit centres, revenue centres and cost centres. Specialisms in hospitals are increasingly defined as profit centres. So, differences in technological characteristics seem not to influence the choice of the appropriate type of
responsibility centre. Management of hospitals should be aware of the importance of the influence of technological characteristics influencing the design of a MCS.
§ 1.3 Research objective
The aim of this paper is to enhance our understanding of how a MCS in a hospital should be designed. The emphasis is on developing an overview of the conceptualizations and
The answer to this question is sought by conducting a contingency study. In order to determine the design of a MCS, the technological concepts and their influence on the design of a MCS are examined (chapter two). Furthermore, the operationalization of technological concepts in general is determined (chapter three). In addition, the definitions of technological concepts in a hospital nursing department are developed, as well as the application of these concepts in a hospital nursing department (chapter four). The paper ends with an examination of the contributions of this research and some recommendations for future research (chapter five).
§ 1.4 Research methodology
Chapter 2 – Influence of technology on a management control system
§ 2.1 – Introduction
Technology is referring to the way in which inputs will transform into outputs. As such, technology will influence the way in which a management control system (MCS) is designed. This chapter will give an overview of the influence of technology on a MCS. Firstly, contingency theory will be examined (§ 2.2), which is followed by a description of the technological concepts that play a role (§ 2.3). Furthermore, these technological concepts will be described in depth (§ 2.3.1 - § 2.3.6). This will be followed by an examination of some other influential research on the influence of technology on a MCS (§ 2.4). The chapter will end with a short summary (§ 2.5).
§ 2.2 – Contingency theory
§ 2.3 – Technological concepts
Chenhall (2003, p.128) emphasizes the importance of technology for MCS. The factor technology is referring to the way in which the organizations processes operate, the relations between input and output (Chenhall, 2003, p.139). So, technology is about the way in which a task transforms input into output. There are three generic concepts of technology, task uncertainty, task complexity and task interdependence (Chenhall, 2003, p.139). All these types of technology will influence the design of a control system.
§ 2.3.1 – Task uncertainty
As stated before, when examining the management and control literature, there are several ways in which contingent variables are classified. Some researchers see uncertainty as a contingent variable, including task uncertainty and environmental uncertainty (Fisher, 1998, p.49). Task uncertainty measures the perceived completeness of the cause and effect knowledge of a task (Hirst, 1983, p.599). It is about the knowledge that is needed to complete a task and the knowledge that is present. There is no single way in the literature in which task uncertainty is conceptualized. Moreover, there is no single way of measuring the degree of task uncertainty.
Perrow (1967, p.196) identifies two aspects of technology that seems to influence organizational structure; number of exceptions and analyzability, leading to a degree of routineness of a task. A routine task has few exceptions and is analyzable, while a nonroutine task has many exceptions and is unanalyzable. The degree of routineness defines the degree of task uncertainty (Crom, 2005, p.47). The most prominent way of conceptualizing task uncertainty is by following the way in which Perrow (1967) conceptualizes task uncertainty, as depicted in appendix 1. The conceptualization of task uncertainty as the number of exceptions (task variability) and the degree of analyzability (task difficulty) is followed by most researchers (see Hirst, 1983; Victor and Blackburn, 1987; Brownell and Dunk, 1991; Abernethy and Stoelwinder, 1991; Chong, 1996; Dunk, 1995; Abernethy and Brownell, 1997; Kim and Burton, 2002; Williams and Seaman, 2002; Chang, Chang and Paper, 2003; Hartmann, 2005; Nuñez, Giachetti and Boria, 2009). There are several ways in which these terms are referenced in the literature (Williams and Seaman, 2002). In this paper the terms are referenced as task variability and task difficulty. Low task variability and low task difficulty yields low task uncertainty.
activities can not be predicted in advance (Daft and Macintosh, 1981, p.208). In the model, this is the exceptions dimension.
Task difficulty is the second term contributing to task uncertainty. It measures the amount of expertise needed to perform a task (v/d Ven and Delbecq, 1974, p.184). A task that is low in difficulty can be performed in an objective way, using standard procedures (Daft and Macintosh, 1981, p.208). High task difficulty implies tasks that are not analyzable and have a lack of objective, standard procedures that can be used while performing a task (Dunk, 1995, p.64). In the model, this is called the search dimension. Perrow (1967, p.196) calls this the search dimension because it tells something about the nature of the search process undertaken by the individual when an exception occurs. When exceptions occur, task difficulty measures the extent to which the search- or problem solving process is conducted in a logical and analytical matter (Scott, 1981, p.37). A search process is always because of an exception.
(Williams and Seaman, 2002). They indexed 120 work units using the measure showed in appendix 3. Secondly, the measure Daft and Macintosh developed seems appropriate (Withey et al., 1983). Daft and Macintosh (1981, p.214) used a questionnaire to measure the degree of task variability and task difficulty, based on Perrows theory. Appendix 4 shows the index Daft and Macintosh (1981) used. So these two measures seemed the most appropriate. However, based on their examination of the measures of technology, Withey et al. (1983) developed a new, improved index of technology. This also measures task variability and task difficulty, which can be seen in appendix 5. This scale is widely used (for example see Chong, 1996; Abernethy and Brownell, 1997; Chang et al. 2002; Hartmann, 2005; Hartmann and Slapničar, 2012). Some researchers do not explain how they measured the degree of task uncertainty (Victor and Blackburn, 1987; Hirst, 1983; Kim and Burton, 2002; Nuñez et al., 2009). Abernethy and Stoelwinder (1991, p.111) measured the degree of task uncertainty using a modified version of v/d Ven and Ferry (1980).
v/d Ven and Delbecq (1974), Daft and Macintosh (1981) and Withey et al. (1983) all use the concepts of task variability and task difficulty to measure the degree of task uncertainty. Daft and Macintosh (1981, p.214) based the variability questions on variety and dissimilarity of work activities, the difficulty questions were about the extent to which work activities were understood and the availability of standard practices. v/d Ven and Delbecq (1974, p.183) based the task variability questions on the number of exceptional cases encountered when performing the tasks. Task difficulty questions referred to the degree of complexity of the search process in performing the task, the amount of thinking time required and the body of knowledge that provides guidelines for performing the tasks (v/d Ven and Delbecq, 1974, p.183). Withey et al. (1983) evaluated these measures of task uncertainty. They concluded that these two measures of task uncertainty seemed most appropriate because both operationalize the two dimensions of Perrow (1967) and both have reasonable measurement properties. Because both scales also had reasonable weaknesses, Withey et al. (1983) developed a new index to measure the degree of task uncertainty. They also based the index on the work of Perrow (1967), but their index differentiates better among work units than the existing scales. Though, this scale also faces weaknesses. The task difficulty scale differentiated less well among work units than the task variability scale, although this is acceptable (Withey et al., 1983, p.60). According to Withey et al (1983, p.61) future research should use one of the three scales described here (v/d Ven and Delbecq (1974), Daft and Macintosh (1981) or Withey et al. (1983)). The refined scale of Withey et al. (1983) is widely used, although it seems to be that this scale was never evaluated.
uncertainty. Hirst (1983, p.599) extended the conceptualization of task uncertainty with environmental uncertainty, measured on a scale developed by Duncan (1972). He extended the conceptualization because of the similarity between the definition of task uncertainty and the concepts underlying the scales. Therefore Hirst (1983, p.599) found that measures of the scales were correlated. In a later research, Hirst (1987) conceptualized task uncertainty in terms of repetitiveness and openness. He based this on the work of Thompson (1967). Repetitiveness measures the same as task variability, whereas openness is a measure of the extent to which a task can be influenced by external events or by other tasks internal to the organization. The degree of environmental uncertainty and the complexity of task interdependencies are underlying factors for the degree of openness (Hirst, 1981, p.773). So, task openness seems to relate to the concept of task interdependence and environmental uncertainty instead of task uncertainty. It is obvious that Hirst (1981, 1987) did not made clear why exact these variables form the degree of task uncertainty. Non-repetitiveness and openness lead to high task uncertainty (Hirst, 1987, p.777). Furthermore, Hartmann and Slapničar (2012, p.25) in their research about performance evaluation and uncertainty, base the level of task uncertainty only on the level of task difficulty. They did this because they researched the relationship between effort and output, which is related to the level of task difficulty (Hartmann and Slapničar, 2012, p.25).
The health care literature yields different results. Sometimes the same conceptualizations are used, whether there are also several different conceptualizations within the healthcare literature. Broekhuis and van Donk (2011, p.260) conceptualize task uncertainty as the distinction between surgical and nonsurgical tasks. Surgeons execute highly complex technical tasks, applying highly technical knowledge and skills (Broekhuis and van Donk, 2011, p.253). Non-surgeons apply more analytical knowledge setting up a decision tree and deciding on diagnosis and treatment (Broekhuis and van Donk, 2011, p.253). Broekhuis and van Donk (2011) classified physicians work as surgical or non-surgical, but did not made clear how they measured this.
Holmberg (2006, p.459) used a more general definition of task uncertainty. Task uncertainty is according to him lack of reliable knowledge. Holmberg (2006) however, did not made clear how he measured the degree of task uncertainty.
Sicotte and Béland (2001, p.168) conceptualize task complexity as task difficulty and task variability. It is obvious that these concepts are mostly used as a conceptualization of task uncertainty. Task difficulty is referring to the ability to analyze the task and task variability is referring to the extent to which exceptional cases occur (Sicotte and Béland, 2001, p.168). According to them these two concepts suit healthcare practice. In healthcare practice, Sicotte and Béland (2001, p.168) define task difficulty as illness severity, influencing the consulting and prescription process. They however do not define how this will influence the consulting and prescription process. Task variability is defined as patient case mix; some types of patients appear a lot, while other types of patients appear less frequent (Sicotte and Béland, 2001, p.168). The infrequent type of patient entails more uncertainty, because of the relative rarity. The measurement of task difficulty is by indicators of age, secondary morbidities, co morbidity severity and patient type – medicine or surgery – and the measurement of task variability as the occurrence of the principal diagnosis (Sicotte and Béland, 2001, p.171).
In their research, Overton et al. (1977) had the purpose to describe the technology of nursing subunits. So they did not describe the influence of technology on a variable, they only described technology. Overton et al. (1977) are quite clear in their operationalization on task variability and task difficulty in a healthcare setting, specifically nursing. Task variability is defined as the variety of health problems and various age groups of patients (Overton et al., 1977, p.206). Task difficulty is the type of skills involved, as well as the extent to which activities were not programmed (Overton et al., 1977, p.206).
(1980). Van der Geer et al. (2009), in their healthcare research, measured task uncertainty using five dimensions of the task uncertainty framework. The measurement scale of Withey et al. (1983) is mostly used.
§ 2.3.2 – Influence of task uncertainty on a management control system
‘Performance is significantly higher when task uncertainty is low’ (Abernethy and Stoelwinder, 1991, p. 114).
Budgets
According to Abernethy and Stoelwinder (1991, p.114), under high task uncertainty it has proven to be problematic to use budgeting. They concluded that there has to be a fit between task uncertainty, system goal orientation and the effective use of budgeting. However, it remains unclear what exactly the fit is between these three variables.
Brownell and Dunk (1991, p.702) concluded that when task difficulty is high, the budget participation is an important information exchange role, even when this is not matched with budget emphasis. Some organizations build budgetary slack within their budgets, providing some flexibility of the budget. When task difficulty is combined with a low level of budgetary slack, performance will be low. Under high levels of budgetary slack, task difficulty will not affect performance (Dunk, 1995, p.69-70). Therefore the influence of task difficulty on performance is lower when slack is high in comparison with high levels of slack. So Dunk (1995, p.70) concluded that slack may be effective to manage the relationship between task uncertainty and performance.
low and the reliance on accounting performance measures decreased, tension to dysfunctional behavior also decreased. If performance criteria are more general and less precise, it becomes unclear what the work requirements are, leading to tension to dysfunctional behavior (Hirst, 1983, p.602). Otherwise, when performance measures are incomplete, there may be tension to dysfunctional behavior due to conflict between the superior and subordinate (Hirst, 1983, p.602). So, Hirst (1983) concluded that task uncertainty influences the relationship between reliance on accounting performance measures and dysfunctional behavior.
Performance measures
Hartmann and Slapničar (2012, p.28) researched justice perceptions of performance evaluation practices, concluding that having voice has a positive effect on justice perceptions, especially when task uncertainty is high. So, when task uncertainty is high, giving voice to the employees will positively influence the justice perceptions. They also found that when task uncertainty is high, diversity of performance measures will lead to justice perceptions of performance evaluation, while formality of performance measures will decrease the justice perceptions (Hartmann and Slapničar, 2012, p.28).
Task uncertainty will lead managers to disagree with the use of performance indicators they see as uncontrollable and incomplete (Hartmann, 2005, p.245). Therefore, task uncertainty negatively affects managers’ opinions about the appropriateness of performance measures. When a manager is not tolerant for ambiguity, this manager, facing high task uncertainty, will have an even more negative opinion about individual performance measures (Hartmann, 2005, p.258).
Controls
On the one hand, tasks low in uncertainty may take advantage of tight controls, because in this way it can be ensured that people will act in the organizations best way (Auzair and Langfield-Smith, 2005, p.406). On the other hand, task high in uncertainty need to have loose controls, because tight controls may prohibit creativity and cause dysfunctional behavior (Auzair and Langfield-Smith, 2005, p.406).
When task difficulty increases, an employee needs relatively more time doing coordination of the tasks (Nuñez et al., 2009, p.372), whether this relation can not be proven for task variability. So, it is important to standardize work, thereby making decisions more objective and improving the efficiency of the work (Nuñez et al., 2009, p.373).
Accounting information systems
There has to be a ‘fit’ between contextual variables and the accounting information system (Chong, 1996, p.415). When task uncertainty is high, there is more information that has to be processed during task execution in order to achieve high performance (Galbraith, 1974, p.28). So, under high task uncertainty managers will require more information. Tasks facing high uncertainty, interacting with broad scope information, can improve performance (Chang et al., 2003, p.701). This research was conducted in Taiwan only, so it remains unclear whether this result can be generalized to other countries. Chong (1996, p.416), reviewing prior studies, notes that when task uncertainty is high, managers perceive it useful to have broad scope information. Supporting this view Chong (1996, p.419) states that task uncertainty and the use of broad scope information together influence the performance of an organization.
Centralization
Moreover, when task uncertainty becomes extremely high, the decentralized team did not anymore perform better than the centralized team on time and cost. Furthermore, quality consistently was better within the centralized team. This could mean that there is a limit to the optimal level of decentralization with regard to task uncertainty (Kim and Burton, 2002, p.376). They therefore conclude that a decentralized structure may not lead to high performance, because it produces lower quality.
Findings on management control in a healthcare environment
There are also several researchers who conducted research on task uncertainty with respect to a healthcare environment. Coordination practices depend on contingency factors (Broekhuis and van Donk 2011, p.266). Broekhuis and van Donk (2011) found that, irrespective of the level of task uncertainty, written medical records are an important part of coordination practices. Non-surgical units, facing low levels of task uncertainty, focus on time-structured communicative coordination mechanisms (Broekhuis and van Donk, 2011, p.263).
et al., 2009, p.1528). The use of process checklists stimulating prescribed treatment programs was mostly used by teams with low levels of task uncertainty.
Holmberg (2006) identifies two types of rationality, action rationality and decision rationality. Action rationality refers to what is rational from an action point of view, whereas decision rationality refers to what is rational from a decision point of view (Holmberg, 2006, p.459). For example, from a decision point of view it is good to examine all the alternatives, benefits and costs before making a decision. However, from an action point of view this is not rational, because having many alternatives, benefits and costs to be evaluated will increase uncertainty. This uncertainty will lead to decreased commitment and motivation, because there is no certainty about the situation (Holmberg, 2006, p.459). When task uncertainty is low, action rationality seems to fit and processes that reduce uncertainty are encouraged. Furthermore, with high task uncertainty decision rationality seems to fit and processes that increase the capacity to handle uncertainty are encouraged (Holmberg 2006, p.461). A sequential dependence between activities is present when task uncertainty is low. Therefore technical skills and resources are grouped together, sometimes even through highly structured network planning (Holmberg, 2006, p.416). The tasks are considered as research related when task uncertainty is high. Therefore it is important to guard against premature routinization and ideas that are production centered (Holmberg, 2006, p.416). Holmberg (2006) therefore suggests building separate problem solving groups around each problem area. This will ensure the accumulation of knowledge. Routinization and streamlining in a healthcare environment only fits in environments facing low level of task uncertainty (Holmberg, 2006, p.416).
Sicotte and Béland (2001, p.177) conclude that when the severity of illness increases, the use of resources increases. So, the utilization of resources can be mainly explained by task complexity. They conclude that only task difficulty explains the use of resources.
§ 2.3.3 – Task interdependence
(departments), one employee (department) performing different tasks by himself is not showing task interdependence. As soon as this employee (department) is dependent on another employee (department), there can be some type of task interdependence. The greater the dependence on another employee (department), the greater the task interdependence. Task interdependence goes together with broad scope information (Chenhall and Morris, 1986, p.27). In this paper, task interdependence between departments is of importance. This type of task interdependence is used because one of the topics of this research is the influence of technology on MCS used to control a (nursery) department, not individuals or teams within the department.
al. (2009) tried to structure the teams as such that the team mirrored the interdependence as stated. Molleman (2009, p.252) however, measured the level of task interdependence using a single-item measure at the team level, measuring task interdependence within the team. The question ‘to what extent are team members interdependent when doing their jobs’ was asked (Molleman, 2009, p.252), therefore measuring perceived task interdependence. Sharma and Yetton (2007, p.226) measured the level of task interdependence using a scale developed by Pearce et al. (1992), as shown in appendix 8. Expert raters, as well as one of the authors rated the level of task interdependence. However, they did not make the distinction between the different types of task interdependence and it is not clear whether they measure task interdependence within or between departments. Chenhall and Morris (1986, p.24) used a different measure of task interdependence, following Pugh et al. (1969). They asked respondents to indicate which description best fits their sub-unit, where the descriptions correspond to pooled, sequential and reciprocal interdependence (Chenhall and Morris, 1986, p.24). It remains however unclear whether they measure the level of task interdependence within or between departments. Unfortunately, they do not show which descriptions were used. Macintosh and Daft (1987, p.53) used the instrument developed by v/d Ven et al. (1976). With this instrument four types of work flows are indicated. The manager should indicate the type of work flow and for each type indicated, six questions were asked to validate the supervisors’ response and to obtain a qualitative understanding. Furthermore, Mohr’s task interdependence index is used. Managers were asked for their perception of the level of task interdependence. It is obvious that Macintosh and Daft (1987) write about the level of task interdependence between departments while using the index of v/d Ven et al. (1976), which measures the level of task interdependence within a department. So, it remains unclear whether Macintosh and Daft (1987) measure the level of task interdependence within or between departments.
Mia and Goyal (1991) conducted research on the influence of task uncertainty in not-for-profit government organizations, such as public hospitals. Task interdependence was conceptualized using the work of Thompson (1967). They measured task interdependence using the instrument developed by v/d Ven et al. (1976) and Chenhall and Morris (1986) and adapted this to suit it to their study (Mia and Goyal, 1991, p.256). However, they did not made clear why the instruments had to be adapted. They write about task interdependence within and between departments, not choosing one type. Pizzini (2010) researches the relationship between group rewards and the level of task
influence a physician can exert and c) the extent to which a physician controls the timing and amount of work performed. As continuity becomes more important, as less influence can be exerted and as non controllability increases, task interdependence increases. The specialism of the physician influences the level of task interdependence. Task interdependence is here measured within a department. Pizzini (2010, p.356) measured task interdependence with an average of the physicians ratings of the three determinants of task interdependence. Overton et al. (1977, p.207)
operationalize task interdependence internal and external to the subunit. Within the subunit task interdependence is the degree to which nurses were relying on assistance from other nurses within the same subunit to complete the work (Overton et al., 1977, p.207). External to the subunit, task interdependence is the extent to which nursing tasks depend on feedback from patients, physicians, services from other departments and nursing subunits within the hospital (Overton et al., 1977, p.207). As mentioned before, they did not describe the influence of technology on a variable, they only described technology.
interchangeable and reflect different conceptual definitions of task interdependence (Wybo and Goodhue, 1995, p.326). Wybo and Goodhue (1995, p.326) therefore ask for explicit definitions and validation of the construct task interdependence. Furthermore, it seems that the different measures of task interdependence mostly are not evaluated. According to Sharma and Yetton (2007, p.226) the scale of Pearce et al. (1992) exhibits acceptable reliability.
§ 2.3.4 – Influence of task interdependence on a management control system Flexibility
Molleman (2009) researches task interdependence in relation with task autonomy. Task autonomy is defined as the freedom an employee has to make decisions about goals, work methods and planning issues (Molleman, 2009, p.245). When task interdependence is high, there is a need for employees to work together; task autonomy gives an employee the freedom to decide to help a colleague. When task interdependence is high, employees with task autonomy belief that being flexible will lead to social benefits (Molleman, 2009, p.260). With low levels of task interdependence this relationship is not established. With low task interdependence and flexibility, employees will not experience the negative effects of flexibility because they do not depend on their colleagues (Molleman, 2009, p.261). Although, with high task interdependence, team members will focus on their colleagues and will behave more socially (Molleman, 2009, p.261).
Information requirements
When task interdependence is high, managers need broad scope, aggregated and integrated information (Chenhall and Morris, 1986, p.30). Broad scope information means that the MCS provides information related to the external environment, economic as well as non-economic information (Chenhall and Morris, 1986, p.22). Integrative information means combining information about different departments of the organization.
Centralization
According to Thompson (1967, p.75) organizations with low task interdependence will centralize, in order to schedule the work of different independent tasks. Since these tasks are not interdependent centralization is needed in order to make a cohesive plan. Therefore, Chenhall and Morris (1986, p.23) conclude that organizations with high task interdependence would have decentralization. The before mentioned relationship between task interdependence and MCS information also works via the effect of decentralization (Chenhall and Morris, 1986, p.31).
Control
resources, targets, scheduling, monitoring and feedback. This can be accomplished by budgets and statistical reports, measuring performance of departments. For reciprocal interdependence it appears that statistical reports are used for planning, target setting and coordination, whereas SOPs and budgets are used less (Macintosh and Daft, 1987, p.56). This is because with reciprocal interdependence there is uncertainty and a need for rapid adaption, which needs expert knowledge.
Incentive system
Pooled interdependent organizations tend to use individual compensation schemes that are tailored to the individual (Fisher, 1994, p.502). Organizations with sequential interdependence tend to use a group incentive scheme, setting a group goal in order to motivate employees that are low performers (Fisher, 1994, p.501). An organization with maximum interdependence, according to Fisher (1994, p.502) tends to use individual incentive schemes. With maximum interdependence, the high performer is the key performer. A group incentive scheme in this situation will lead to the free-riding problem, because output of the whole organization is shared among all employees (Fisher, 1994, p.502). Furthermore, the same contract is used for all individuals and the goals are set high because only high performers have to be motivated.
Findings on management control in a healthcare environment
In their not-for-profit government organizations study in hospitals Mia and Goyal (1991) research the relations between span of control, task interdependence and the usefulness of MCS information. They found that an increase in the span of control leads to an increase of perceived task interdependence, probably due to an increase of the division of labor when span of control increases (Mia and Goyal, 1991, p.261). Span of control and perceived task interdependence also influence the perceived usefulness of MCS information for decision making. Therefore it is argued that when designing or implementing a MCS, care should be taken of the span of control and perceived task interdependence. The reason is that these factors influence the information needs of the manager.
§ 2.3.5 – Task complexity
Task complexity is the third contingent technology variable. Task complexity seems to have strong links with the two other constructs of technology. Although it is widely researched in a non-management environment, in relation with non-management and control there seems to be less research. Complex tasks consist of components, coordinative activities and dynamic complexities (Wood, 1986, p.74). According to Bailey and Fessler (2011, p.191) complex task have more components, require greater coordinative activities and are more dynamic than less complex tasks. Task complexity affects the financial control structure of an organization via the intervening variable of organizational structure (Piper, 1978).
There seems to be no single way of conceptualizing and measuring task complexity. Appendix 9 gives an overview of the task complexity studies. Task complexity is mostly not separated in different constructs. Collins and Hull (1986, p.152) measure task complexity by looking at personnel records and measuring the percentage of craftsmen in the production system. Bailey and Fessler (2011) use a more experimental design by letting participants solve an online jigsaw puzzle, varied in the degree of complexity. After solving the puzzle some questions were asked about the process of solving the puzzle.
Chinburapa, Larson, Brucks, Draugalis, Bootman and Puto (1993) examined, among others, the influence of task complexity on physician information acquisition and decision making in a healthcare environment. They do this by examining, via an experiment, the drug prescribing decision process. Task complexity is measured by varying the number of drug alternatives in the choice set in the experiment.
Sicotte and Béland (2001, p.168) conceptualize task complexity as task difficulty and task variability. It is obvious that these concepts are mostly used as a conceptualization of task uncertainty. So, in § 2.3.1 this conceptualization is described.
van Vijfeijken, Kleingeld, van Tuijl, Algera and Thierry (2002) conceptualize task complexity as the number of different elements of the task of an individual, as well as the relationship between these elements. However, they did not made clear how they measured this.
Task complexity is about the complexity of the task of an individual (van Vijfeijken et al., 2002, p.366). Task complexity has strong relations with the other task concepts. For example, Sicotte and Béland (2001, p.168) conceptualize task complexity as task difficulty and task variability.
performed when and hence task complexity influences task difficulty. Collins and Hull (1986, p.160) noticed that task variability and task complexity both reflect the broader construct of task
uncertainty. According to Hartmann (2005, p.244) task uncertainty is caused by the complexity and diversity of the tasks performed by the manager. So, there is a strong relationship between task uncertainty, especially task difficulty, and task complexity.
§ 2.3.6 – Influence of task complexity on a management control system Span of control
When task complexity increases, the span of control is narrowed (Collins and Hull, 1986, p.155). The level of task complexity and span of control correlates with production types as identified by Woodward (1965). Managers in mass production organizations have a wide span of control and low task complexity (Collins and Hull, 1986, p.155). Managers in process organizations however, have a low span of control and higher task complexity (Collins and Hull, 1986, p.155). Batch production organizations have a weak relationship with span of control and show high levels of task complexity (Collins and Hull, 1986, p.155).
Incentive system
As task complexity is low it is more effective to use incentive pay (Bailey and Fessler, 2011, p.205). This can be clarified by taking a look at the effort level. Incentive schemes in complex tasks will increase the effort level; performance however does not necessarily increase. The relationship between task complexity and the use of incentive pay only holds when the task is unattractive, because incentive pay will be less effective in increasing performance for an attractive task (Bailey and Fessler, 2011, p.193). Consequently, incentive compensation is less effective at improving performance when task complexity is high or when tasks are attractive (Bailey and Fessler, 2011, p.206).
Table 1 – Goals and rewards, based on van Vijfeijken et al. (2002) Combination Task complexity Task inter-dependence Goals Rewards
I Low Low Specific, difficult
individual outcome goal and specific difficult group outcome goal.
Independent, individual reward and positively interdependent group reward.
II Low High Specific, difficult group
outcome goal.
Positively interdependent group reward.
III Moderately
high
Low Specific, difficult individual learning goal and specific difficult group learning goal.
Independent, individual reward and positively interdependent group reward.
IV Moderately
high
High Specific difficult group learning goal.
Positively interdependent group reward.
An outcome goal specifies the performance level to be attained (van Vijfeijken et al., 2002, p.369). Learning goals, however, are aimed at discovering the effective task strategies (van Vijfeijken et al., 2002, p.370). The results in relation with rewards are inconclusive. In either combination (I-IV) the results concerning rewards are mixed. There is research in support of the propositions, but also research that does not support these propositions (van Vijfeijken et al., 2002, p.377, p.379).
Findings on management control in a healthcare environment
Chinburapa et al. (1993, p.1480) have found that task complexity had a main effect on the information acquisition and decision-making of physicians drug prescribing processes. When deciding on which drug to prescribe, physicians pay attention to certain kinds of information. Increasing task complexity leads to proportionately less time spent on cure rate information and less time spent on information about the duration of treatment (Chinburapa et al., 1993, p.1480). They however indicate that the results might not be generalized to the physician population as a whole.
§ 2.4 Other research on task characteristics and control
of reciprocity, agreement on legitimate authority and shared values and beliefs (Ouchi, 1979, p.838). Control relies on a level of common agreement on social behavior.
are measurable, effects of interventions are not known and the task is repetitive. After tasks are performed, a thorough analysis is needed of successes and failures in order for the organization to learn from their own failures (Hofstede, 1981, p.197). Fourthly, if the tasks become not repetitive, intuitive control is needed. Control can be seen as an art, where a person intuitively has to find the proper forms of control (Hofstede, 1981, p.197). Fifthly, judgmental control, where outputs are not measurable and objectives are unambiguous. When there also are no direct measures available, control has to be exerted via subjective judgment (Hofstede, 1981, p.197). It differs per organization who has to exert the control and in which way. Lastly, political control is distinguished, where objectives are ambiguous. With this way of control there are power structures, negotiation processes, the need for distribution of scarce resources, particular interests and conflicting values (Hofstede, 1981, p.198). However, according to Hofstede (198, p.198) political control is needed at the top of the organization and inside the organization other forms of control can be used.
Birnberg et al. (1983) researched the relationship between task characteristics and control. They made use of the work of Perrow and Thompson and Tuden (1959). Perrows framework focuses on the task, whereas the framework of Thompson and Tuden (1959) focuses on managements beliefs about goals, process and decision making approach (Birnberg et al., 1983, p.113). The framework is about whether the goals are clear. They analyze this along two dimensions: a) preferences about possible outcomes and b) beliefs about causation. When it is believed that management knows what the task is, the problem is seen as resolvable by computation (Birnberg et al., 1983, p.113). The complete framework is shown in Appendix 12.
related to the work of Thompson and Tuden (1959) about goals. However it can be doubted whether goals are directly related to the factor technology. Goals are here not about the task itself, but only about whether the team has a belief that they know what the task is (Birnberg et al., 1983, p.113).
In § 2.3 the influence of the various technological concepts on endogenous variables were described. These endogenous variables were variables like budgets, incentive systems and centralization. These variables were rather practical. The endogenous variable described in this paragraph is control type. It is about the type of control that fits a situation and not about how this control is practically exerted. There are some clues about the practical execution of control, but their main message is about the type of control exerted. Therefore, it can be said that the endogenous variable of this paragraph is on a higher level.
§ 2.4 dealt with other research on task characteristics and control. In some way this differs from the technological concepts in § 2.3. It appears that this research is mostly linked with Perrows task uncertainty concept. Birnberg et al. (1983) use the same dimensions as Perrow. Also the concept knowledge of the transformation process is used, which can be linked to the concept of task difficulty. The most important difference is that Ouchi (1979) as well as Hofstede (1981) uses the concept measurability of outputs. This does not correspond with the technological concepts of § 2.3. So the main contribution of this research is the concept measurability of outputs.
§ 2.5 Summary
Chapter 3 – Elementary technology characteristics influencing a management
control system
§ 3.1 Introduction
As stated in chapter two, three generic types of technology are of importance: task uncertainty, task interdependence and task complexity. Furthermore, the ability to measure outputs is a concept of importance. Chapter three deals with the elementary basics of these concepts. When it comes to tasks and the transformation of inputs into outputs, to which items does each technology concept exactly refer? By doing this, a closer look is given at the way researchers have operationalized these concepts. Firstly, the technological concepts are defined in general (§ 3.2). Secondly, the
technological transformation process is described in relation with the technological concepts (§ 3.3). The chapter ends with a short summary (§ 3.4).
§ 3.2 Defining the concepts Task uncertainty
Task uncertainty consists of two concepts, task variability and task difficulty. Firstly, task variability measures the number of exceptional cases encountered in the work (Perrow, 1967, p.195). However, this definition is quite abstract and broad. By analyzing the measurement scales of v/d Ven and Delbecq (1974), Daft and Macintosh (1981) and Withey et al. (1983) this definition can be made more tangible. Task variability is about variety in inputs that cause the work. v/d Ven and Delbecq (1974) call this the variety in cases, claims, clients or things that are encountered in a working day. However, it is more than that. Task variability also is about the tasks performed. How repetitious or how routine is the task? Perrow (1967) calls this the number of exceptions, which is the same as task variability. This part of the task variability concept is also measured in the scales by questions about repetitiveness, routineness and the work performed. For example: “People in this unit do about the same job in the same way most of the time” (v/d Ven and Delbecq, 1974; Withey et al., 1983). Task variability is the extent to which activities are repeated. Therefore, task variability is the variety in inputs as well as the repetitiveness of the activities performed.
Secondly, task difficulty measures the amount of expertise needed to perform a task (v/d Ven and Delbecq, 1974, p.184). Again, by analyzing the measurement scales of v/d Ven and Delbecq (1974), Daft and Macintosh (1981) and Withey et al. (1983) this definition can be made more
followed in doing your work” (v/d Ven and Delbecq, 1974; Withey et al., 1983). v/d Ven and Delbecq (1974) also measure whether there are problems encountered and the way of solving those
problems. The questions in the measurement scales are all about the knowledge underlying the tasks performed. So, task difficulty is about the extent to which there is knowledge about how to perform the tasks. This is also confirmed by Scott (1981, p.209-210). When there is no knowledge about how to perform the task, the worker has to look for ways of performing his task. Therefore, task difficulty is the extent to which the search- or problem solving process is conducted in a logical and analytical matter. The search- or problem solving process is the process looking for the right activities to perform in the right order. It is about expertise.
To summarize, task difficulty is about whether there is knowledge about which activities to perform, in which sequence. Task variability is about variety in inputs and activities of the work performed.
Task interdependence
The level of task interdependence is determined by the way in which people work together (van Vijfeijken et al., 2002, p.366). It is about the tasks and the work procedures that are used. Task interdependence deals with interdependence among persons, teams or departments (Jones, 1995, p.365). Task interdependence consists of three types of interdependence, pooled interdependence, sequential interdependence and reciprocal interdependence. Firstly, pooled interdependence, where each department of the organization is relatively autonomous, but the actions of a department have implications for the whole organization (Thompson, 1967, p.54). This definition of Thompson is rather vague, so it needs a more tangible definition. The measurement scale of task interdependence used by v/d Ven et al. (1976) can shed some light on the definition. This scale is used because this is the only available scale that considers each type of task interdependence separate. However, it measures the level of task interdependence within a department, so some adaptation is needed in order to define task interdependence between departments. v/d Ven et al. (1976) measure pooled interdependence using this statement: “(…) where work and activities are performed by your
immediate subordinates independently and do not flow between them”. So, pooled interdependence is a situation where each department of the organization performing the tasks, contributes
flows to Z. Therefore, sequential interdependence is a situation where actions of one department of the organization influence directly the subsequent departments of the organization. Thirdly,
reciprocal interdependence, where output of the first department of the organization becomes the input for the second department (Thompson, 1967, p.55). v/d Ven et al. (1976) measure this type of interdependence using the following statement: “(…) where work and activities flow between your immediate subordinates in a reciprocal “back and forth” manner over a period of time”. So, work flows between departments of the organization, in all directions. For example, work can flow from X to Y to Z and back to X. Therefore, reciprocal interdependence is a situation where all departments of the organization are entirely dependent on other departments of the organization. Moving from pooled to sequential to reciprocal increases interdependence.
Task complexity
Complex tasks consist of components, coordinative activities and are more dynamic than less complex tasks (Wood, 1986, p.74). As mentioned before, the concept of task complexity has strong links with task difficulty. Furthermore, there is no consensus with respect to the meaning of the concept task complexity. There are no clear and unambiguous definitions of this concept. Therefore, no single, unambiguous definition can be developed. Task complexity can be aligned with the concept of task difficulty.
Ability to measure outputs
The ability to measure outputs is the last concept of importance. Ability to measure outputs is a quite straightforward concept, defined as the ability to measure the outputs of the organizations activities.
§ 3.3 Transformation process
Technology is referring to the way in which tasks transform inputs into outputs (Chenhall, 2003, p.139). Organizations have some kind of ‘raw material’ (inputs) which has to be transformed into a marketable product (outputs) (Perrow, 1970, p.75). Machines and equipment are not the technology itself, but only tools (Perrow, 1970, p.76). The transformation of inputs into outputs includes
hardware (such as tools), software, materials, people and knowledge (Chenhall, 2003, p.139). Technology here is not only producing a product for sale, as in manufacturing firms. It is also the product of a service firm (Lowry, 1990, p.173). According to Perrow (1970, p.75), the transformation of inputs into outputs consists of three phases: a) inputs; b) transformation and c) outputs. According to Crom (2005, p.29, p.45), the transformation process of inputs into outputs also includes d)
increases when revenues and costs are influenced by the outcome of the process. The basic
transformation process is depicted in figure 1. Several factors contribute to this model of technology. The first factor contributing to the transformation process is inputs. Relying on operations management theory, inputs are transformed resources as well as transforming resources (Slack et al., 2007, p.8). Transformed resources are the resources that are treated, transformed or converted in the process (Slack et al., 2007, p.9). Transformed resources are a mixture of materials, information and customers. Transforming resources however, are the resources that act upon the transformed resources (Slack et al., 2007, p.9). Transforming resources are facilities and staff. Therefore, inputs are the transformed resources, consisting of materials, information and customers.
The second factor related to the transformation process is activities. Scott (1981, p.209-210) calls this the throughputs, the transformation process performed by the organization. According to Crom (2005, p.29) an activity is the execution of work. The distinction between activities and tasks is rather vague, however it can be stated that activities are the execution of a task. As stated before, task characteristics can be related to all parts of the transformation process, activities are just a part of it.
The third factor contributing to the transformation process is output. Relying on operations management theory, outputs are the products and services as a result of the activities (Slack et al., 2007, p.10).
The last factor, outcome is the effect of the outputs (Crom, 2005, p.29). An organization has more than one single technology, and therefore subunit measures of technology are best suited (Alexander and Randolph, 1985, p.845). Technology is more uniform within subunits than within a whole organization.
Figure 1 – Transformation process, derived from Crom (2005)
Task uncertainty is a characteristic of a job that relates to managerial work processes (Hartmann, 2005, p.244). So it is about the process instead of the outputs of the process.
As mentioned in § 3.2 task variability is the variety in inputs as well as the repetitiveness of the tasks performed. According to Crom (2005, p.47) task variability is about point (c) in figure 2. In line with this Withey et al. (1983, p.47) state that task variability is about activities performed.
However, this only deals with one aspect of task variability, the number of exceptions. Task variability however also deals with the variety of the inputs of the transformation process. By analyzing the measurement scales used to measure task variability, which is related to inputs, it can be concluded that inputs are here the transformed resources. So task variability is about point (a) and point (c) in figure 2.
Task difficulty is defined as the extent to which the search- or problem solving process is conducted in a logical and analytical matter. Task difficulty is described in terms of the relation between the inputs and the outputs (Brownell and Dunk, 1991, p.695). Task difficulty is about whether there are standard procedures. When there are no standard procedures there is expertise needed to perform the task. It is about doing the right activities in the right order. Therefore, task difficulty is about activities, this means point (c).
According to Daft and Macintosh (1987, p.49) task interdependence is reflecting workflow. According to Fisher (1994, p.494) the conversion process of inputs into outputs will impose a level of interdependence within the firm. This interdependence within the firm is about how inputs from organizational departments affect organizational or group outcome (Fisher, 1994,p.495).According to Scott (1981, p.210) task interdependence is about the activities performed, at the layer of operations. The three different forms of task interdependence between departments are all about the inputs the department receives from an other department. A department has some output, which is the input to the interrelated department. This is about point (a) in figure 2.
§ 3.4 Summary
This chapter has dealt with the elementary basics of the technology concepts. It has been shown that technology is about the relation between inputs, activities, output and outcome. The main message of this chapter is summarized in figure 2, showing the technological concepts and their relation with the transformation process of inputs into outputs and ultimately outcome.
Chapter 4 – Technology in the context of nursing in a hospital
§ 4.1 Introduction
This chapter deals with the technological characteristics in a hospital. The emphasis is on nursing. First of all, the technological characteristics of nursing are characterized (§ 4.2). Furthermore, the technological concepts within a nursing department are defined (§ 4.3). Lastly, the technological concepts are applied in different contexts of nursing (§ 4.4). This chapter ends with a summary (§ 4.5).
§ 4.2 The technological characteristics of nursing
As stated in chapter three, technology is defined as the way in which tasks transform inputs into outputs (Chenhall, 2003, p.139). This paragraph describes the transformation process in a healthcare setting. Within Dutch hospitals there are approximately 27 specialisms, which are divided into three clusters (v/d Bergs, 2009, p.21). These clusters are the surgical specialisms, non-surgical specialisms and the supportive specialisms. The emphasis in this chapter is on the core specialisms and not the supportive specialisms in the hospital, because the core specialisms are specific to a hospital. Furthermore, in order to clearly define the scope of this research the emphasis is on nursing, because in the literature much specific information about technology is on nursing and nursing is an important part of the organization of the hospital. Nursing has a great influence on the quality of care provided in a hospital. Furthermore, care within the hospital consists for a considerable part of nursing. And there are many employees within the hospital that work as a nurse. Therefore, nursing departments are of importance for management control.
In order to characterize the work of nurses in hospitals, a distinction is made between nursing care in general and nursing care on the intensive care (IC) department. This distinction is made in order to delimitate the subject. Furthermore, according to Wulff (1996, p.57) there is differentiation between departments based on the intensity of the care provided. When
characterizing the work of nurses, one has to keep in mind that the technological characteristics are a continuum. For example, a task is not simply certain of uncertain, but there is some degree of task uncertainty.
§ 4.3 Determining the right definitions of the technological concepts in the context of nursing Task uncertainty
Task uncertainty consists of task variability and task difficulty. In chapter three, task variability is defined as the variety in inputs as well as the repetitiveness of the tasks performed. In a hospital the input is a patient. So, the variety in inputs in a healthcare setting is the variety in illnesses patients have. The tasks performed consist of the activities or actions nurses perform. Repetitiveness of the tasks performed is therefore the repetitiveness of the nursing activities. To which extent performs the nurse the same activities every working day? So task variability in a nursing environment is the variety in patients’ illnesses and the repetitiveness of nursing activities.
Task difficulty is defined as the extent to which the search- or problem solving process is conducted in a logical and analytical matter. This is especially important when exceptions occur. So, when there is no standard way of handling a situation or patient, the nurse has to search for a way of reacting. This is closely related to expertise. So, task difficulty is the extent to which the nurse reacts in a logical and analytical manner to exceptional situations or patients.
the extent to which the activities are not programmed. The type of skills involved can give a good indicator of the expertise of the nurse. The extent to which activities are not programmed seems to state more about the cause of an exception than about the reaction of the nurse to this exception. The definition of Broekhuis and van Donk (2011), discriminating between surgical and non-surgical physicians work does not fit to nursing, but to physicians. In § 2.3.1 the usefulness of the task uncertainty concept in the service context is questioned by Modell (1998). The critique is that the measurement is lacking direct reference to customer activities. Although it is beyond the scope of this research to develop a measurement scale, it is recommended that, when developing a measurement scale for this concept, one should pay attention to customer activities.
Although some researchers in a healthcare environment use different conceptualizations, in this paper task variability is referred to the conceptualizations in the management literature, as defined in chapter three. As mentioned in chapter three, that are the appropriate definitions for measuring task uncertainty. However they have to be adjusted to nursing technology as described in § 4.2. Therefore, in a nursing environment task variability is the variety in patients’ illnesses and the repetitiveness of nursing activities. Task difficulty is the extent to which the nurse reacts in a logical and analytical manner to exceptional situations or patients.
Task interdependence
As stated before, task interdependence in this paper is interdependence between departments. Pooled interdependence is defined in chapter three as a situation where each department of the organization performing the tasks, contributes separately to the whole organization. In a nursing setting, this means that when the tasks are pooled interdependent, nurses are contributing separately from other care providers to the treatment of the patient. Examples of other care providers are physicians, surgeons, physiotherapists and social workers.
Sequential interdependence is defined as a situation where an action of one department of the organization influences directly the subsequent departments of the organization. In a nursing setting, this means that the activities the nurses perform influences only the activities performed by the subsequent care providers.
Reciprocal interdependence is defined as a situation where all departments of the
organization are entirely dependent on other departments of the organization. In a nursing setting, this means that activities the nurses perform influences activities of the subsequent care providers, as well as the previous care providers.
It is interesting to compare these results to the healthcare literature on task
the importance of care continuity in the physician-patient relationship; b) the amount of individual influence a physician can exert over his patient panel and c) the extent to which a physician controls the timing and amount of work performed. So, Pizzini (2010) did not use the classification of
Thompson (1967), but there is no clear link with the main transformation process. Furthermore, it is related to physicians instead of nursing, so does not fit for this paper. Overton et al. (1977) also conceptualize task interdependence between subunits. However, they do not make a difference between the three types of task interdependence. They do conceptualize task interdependence as the extent to which nursing tasks depend on feedback from patients, physicians, services from other departments and nursing subunits within the hospital (Overton et al., 1977, p.207).
Just like task uncertainty, in this paper task interdependence is referred to the
conceptualizations in the management literature, as developed in chapter three. As mentioned in chapter three, that are the appropriate definitions for measuring task uncertainty. This definitions have to be adjusted to nursing technology as described in § 4.2. Therefore, in a nursing environment pooled interdependence is a situation where nurses are contributing separately from other care providers to the treatment of the patient. Sequential interdependence is defined as a situation where the activities the nurses perform influences only the activities performed by the subsequent care providers. Reciprocal interdependence is defined as a situation where the activities the nurses perform influences activities of the subsequent care providers, as well as the previous care providers.
Task complexity
As stated in § 3.2, task complexity can be aligned with the concept of task difficulty.
Ability to measure outputs
The ability to measure outputs was simply defined as the ability to measure the outputs of the organization’s activities. In a healthcare setting, outputs are treated patients as they finally leave the hospital. As stated in § 3.3 ability to measure outputs in a healthcare setting is also related to the outcome. So ability to measure outputs is the ability to measure the state of health of the patient when it finally leaves the nursery department of the hospital as well as the effect of the treatment.
