∗ Corresponding author.
E-mail address: dnargil@upo.es (D. Naranjo-Gil).
in health care demands by citizens, and the need to
repair supposed inefficiencies in the design and running
of national health care systems [3–6]. In several
countries, such as Spain, formal legislation requires
regional health care authorities to encourage hospitals
to become flexible organizations that are more
receptive to the demands from the public, and to offer
these higher quality services at lower cost [7,8,9].
Although these strategic goals and policies are not
mutually exclusive by definition, the strategic management
literature suggests that the organizational
requirements for the effective implementation of qual-
0168-8510/$ – see front matter © 2006 Elsevier Ireland Ltd. All rights reserved.
doi:10.1016/j.healthpol.2006.05.009
∗ Corresponding author.E-mail address: dnargil@upo.es (D. Naranjo-Gil).in health care demands by citizens, and the need torepair supposed inefficiencies in the design and runningof national health care systems [3–6]. In severalcountries, such as Spain, formal legislation requiresregional health care authorities to encourage hospitalsto become flexible organizations that are morereceptive to the demands from the public, and to offerthese higher quality services at lower cost [7,8,9].Although these strategic goals and policies are notmutually exclusive by definition, the strategic managementliterature suggests that the organizationalrequirements for the effective implementation of qual-0168-8510/$ – see front matter © 2006 Elsevier Ireland Ltd. All rights reserved.doi:10.1016/j.healthpol.2006.05.009
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