As a hospital increases in size, its organizational structure becomes more complex. Consequently, as
the number of employees increases, there is a tendency to formalize and standardize work processes as
well as increase the levels of management control (Mills, 1986). The larger hospital also tends to have
more specialized staff and units that develop their specialized managerial roles to make communication
and coordination between staff and units more effective and efficient (Munson & Zuckerman, 1983).
These effects can cause changes in the mechanism of communication, coordination, and integration, thus
affecting the hospital’s efficiency. When the increase in size can both support the unique nature of the
hospital’s production process and complement its operating environment, such increase can positively
contribute to hospital efficiency.