Walking a Tightrope: Managing Paradoxes and Tensions between Care Taking and Efficiency during IT-Enabled Organizational Transformation in a Hospital Group

The healthcare sector in general and hospitals in particular are often portrayed as lagging behind in terms of organizational efficiency. Management is facing the challenge to introduce economic principles to guide the care giving processes of their organization. Yet, the internal structures of hospitals seldom follow exclusively an economic rationale. Patient care and quality of treatments are core to the ethos of medical personnel. This paper aims for studying the role of management in accommodating stakeholders' concerns that result from different rationales. We use the introduction of a centralized pharmacy and electronic ordering system in a German hospital (group) as an illustrative case. In doing so this paper portrays the careful maneuvering of management in order to mitigate and overcome the tension between economic and medical logic. It shows how management translates regulatory constraints into accepted rules and mechanisms that facilitate quality of care and productivity at the same time.