Process orientation and management control in health care organizations

The public sector in Sweden has been an early adopter of public management reforms and the health care sector has been in the forefront of the development. In recent years, process orientation has been one key component in this endeavour. Studies in two health care organizations show that an increased focus on horizontal processes leads to changes in the management control system. However, it also shows that the vertical organization structure most often remains unchanged and that important management control devices like resource allocation in the budget process still are used in that structure. The management control devices that are focused on horizontal processes are mainly performance measurement systems. In addition to that, other types of informal devices like fora for dialogue, joint projects across organizational borders and leadership become more important in the management of horizontal processes. This is a challenge since these types of devices, which seem to be important for process orientation, have, so far, not been used a lot in public management in Sweden.