Process orientation in hospitals has gained in importance dramatically because of a more challenging competitive environment and external pressures from government departments focusing on value-for-money criteria. There is a number of best practices available addressing clinical treatment as “critical pathways” (Dykes and Wheeler, 1998). In the heart of every hospital’s process orientation lies managing the flow of patients (Haraden and Resar, 2004).
Drucker (1990) shows throughout his book that organisations need a mission in order to perform well, and Porter (1996) makes a strong point by arguing that operational effectiveness is necessary, but not sufficient to superior performance. But hospitals operated on cost control do not find it easy to deal with strategic issues (Kaplan and Norton 2001, p. 133). An additional obstacle can be seen in a highly decentralised organisation of experts, where many actors have power and inclination to further their own interests (Mintzberg et al. 1998, p. 261).