Monitoring viability and sustainability in healthcare organizations

The starting point of the analysis is the observation that the studies on healthcare control referred mainly to monitoring the conditions of effectiveness and efficiency of the service, especially as a consequence of the adoption of a managerial approach to healthcare. Given the variety of stakeholders and interests in play, such control logics often reveal trade-offs hard to manage, making apparent the high complexity of healthcare to deal with. Considering the healthcare organizations as open systems that interact in a context of “supra-systems” that exert different expectations and pressures on them, and believing that an overall logic of sustainability should be adopted to reconcile the variety of interests in play, we propose to adopt the Viable Systems Approach (VSA) in order to rethink the management control system of healthcare organizations as a complex of solutions and interventions that can deeply change the culture of healthcare organizations contributing to the adoption of a sustainability perspective. In this view, useful to re-read the governance decision-making processes and, therefore, the concept of responsibility in healthcare organizations, the notion of ‘systems viability’, as defined by the VSA, becomes the bridging concept to reconcile the effectiveness and efficiency of service under an overall view of sustainability.