The influence of contingencies factors strategy and structure in the enterprise risk management in a hospital

Abstract

Founded on the premise that Enterprise Risk Management (ERM) as a Management Control System (MCS) and according to contingency theory, the design and the use of MCS tends to vary according to the organizational context. The aim of this paper is to describe how the contingency factor strategy and structure are interrelated with the control and presence and processes of ERM in a health organization. The methodology has a qualitative approach and, as a research procedure, the study of the case. Two theoretical propositions are presented to data analysis. Data were collected through interviews, observations, and documents. The theoretical propositions are: i) the kind of strategy adopted by the organization, typified according to Miles and Snow´s adaptive cycles interfering in the processes and in the controls of ERM; ii) the organization structure interfere in the processes and in the controls of ERM. The investigated hospital is a philanthropic entity distinguished as the general hospital of high complexity that is related to the Brazilian Sistema Único de Saúde (Unified Helth System). The main conclusions found in the study were: health area managers have bigger expertise regarding the use of controls and processes of ERM when compared to the administrative area managers; the strategy is the contingency factor that guides the way the organization is positioned against the risk management. The risk management supported in health certification systems revealed useful to minimize problem inherent to professional bureaucracy. In this case, the risk management helped to control inner characteristics related to the hospital professional structure, as well as, the organizational structure, defined by the formalization degree of tasks, contributing to the risk management.

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