Federally, Australia devotes nearly 10% of total Government expenditure to health services. The Queensland Public Hospital System a~counts for approximately 16% of total state government expenditure (ie $619.2M in a state budget of $4,211.9M in 1983-84) and is therefore deserving of close attention. The cost of health services in general and hospitals in particular has been subject to rapid escalation of the order of 12% per annum, indicating a need for more effective management of the delivery of health services.
The history of the development of the modern hospital and the Queensland system shows that the modern hospital is a comparatively recent institution that was and still is subject to intensive struggles for control by Governments and medical practitioners. Major issues in health services management are accessibility, quality, allocative efficiency and operational efficiency. The bulk of the hospital management literature is concerned with operational efficiency, and current issues are primarily in the areas of cost containment, organisational structure, and relationships between the major parties in the hospital structure - particularly with respect to conflict. The internal structure of Queensland hospitals is fixed by the Department of Health, and the Department exerts extremely powerful controls over the operations of the hospital. The major managerial developments in the hospital system at present are the Department's Strategic Plan for Computing, the Medicare Agreement, the Government's adoption of the Management Sciences America (MSA) government accounting package, and the introduction of a degree-level course in Health Administration at the Queensland Institute of Technology.
Domain Theory, as originally expounded by Kouzes & Mico (1979), posits that all Human Service Organisations (such as hospitals) consist of three distinct domains, or spheres of influence and control claimed by a social entity. These domains are the Policy Domain, the Management Domain, and the Service Domain - each of which functions by a separate set of governing principles, success measures, structural arrangements, and work modes. Each domain functions in a manner which is incongruent with the others, and thus gives rise to contrasting legitimating norms. The result of the interactions of these domains is an organisation that is internally disjunctive and discordant; it is therefore predominantly an explanation of organisational conflict. The essential question addressed in this project is whether this theory can be usefully applied to the Queensland Public Hospital System, but there are broader implications for theories of organisational psychology as it is suggested that the majority of these theories only apply in the management domain. Whilst the theory has a superficial appeal, it has a number of flaws and it is debatable as to whether or not the theory is simply a synthesis of previously existing ideas.
For Domain Theory to be useful when applied to Queensland Public Hospitals, it should (at least potentially) provide a better description of behaviour and/or a superior guide to the activities of the hospital (in some important aspect) than alternative theories. The particular aspect which is used to evaluate the potential utility of Domain Theory is conflict in hospitals, with particular reference to the top management group of the hospital. Other theories which are relevant to this particular aspect of hospital management are grouped into Management, Economic and Sociological perspectives. A number of theories from each of these perspectives are evaluated for potential utility according to "the criteria of comprehensibility, accuracy, empirical operationalisation, generalisability, contribution to science, and indepependence from control. Domain Theory does not compare favourably with many of these alternative theories.
To evaluate the actual utility of Domain Theory, its validity in the context of the Queensland Public Hospital System must first be established. The theory must therefore be operationalised and empirically tested. A number of hypotheses are derived in the areas the typology of governing principles, success measures, etc.; the groupings of system values and their correspondence with the domains; and the locus of organisational conflict. Due to logistical considerations, the only viable research strategy at this point is a questionnaire survey of a single hospital. Design considerations for such a questionnaire are specified as well as the means by which the results could be analysed to test the hypotheses.
The conclusion of this project is that Domain Theory cannot be usefully applied to Queensland Public Hospitals as:
1) its validity is suspect
2) its potential utility (compared to other explanations of organisational conflict) is low, and
3) it would be difficult to validate empirically.
There are, however, broader implications of Domain Theory in that it correctly identifies a deficiency in the epistemology of organisational psychology. A number of other conceptual problems are discussed and the characteristics of a more appropriate foundation for theories of organisational psychology are identified.