Pulse: Quality Control at Xpert Clinic (Case B)

Abstract

This is part of a case series. The field of health care is changing due to a variety of factors, such as rising costs, demographic changes, technological innovation, the introduction of more business-like and market-based principles, and an increased involvement of the media and the general public. Within this context, quality control and quality reporting have become increasingly important to health care providers, governmental institutions and insurance companies, as well as patients. Although there is a general consensus that measuring and monitoring quality is important in health care, there are many different notions about the required characteristics of management control systems for quality and how and for what purposes they should be used. What is quality? How do you measure quality, and how can it be measured in a reliable and valid way? How do you build a system that satisfies the needs of all the stakeholders involved? Who should you involve in building such a system? What impact will the system have on other organizational elements? These are important questions that need to be answered before and during the course of building and implementing a management control system focused on quality. This case presents the challenges faced by the founders of Xpert Clinic in relation to - among other things - the questions posed above. It illustrates the following issues: 1) The challenge of building a management control system in a dynamic context, characterized by a great variety of stakeholders with different needs; 2) The need for re-aligning the organizational architecture when one of its determinants is changed; 3) The challenge of determining how a management control system should be designed, implemented and used and with what purpose, as well as how to deal with the dilemmas that are encountered during this process; and 4) The challenges of management control of quality in an environment dominated by 'professionals.'