Chapter 2

lop, rather than a variable to be changed and constantly adapted to the strategies pursued
and concretely implemented.
One way in which these restrictions may be avoided, in our opinion, lies in the building of
enterprise bylaws limited to defining the institutional and strategic “framework” within
which each enterprise may go about its business, while delegating to other tools (such
as the organization Plan, application rules, internal organization documents) the task of
Figura 2 - Organization Plan Functions
ORGANIZATIONAL
RESOURCES
AND CONDITIONS
increase
ENTERPRISE MISSION
STRATEGIC PLAN
STRATEGIC OBJECTIVES
taking account of
ORGANIZATION
PLAN
defining and managing the processes of organizational change. Therefore, it would be
expedient if the Regional governments issued not too restrictive directives and guidelines,
with respect to the contents of the Bylaws; by limiting the organizational autonomy
of the health enterprises the opposite effect is obtained of deresponsibilising them with
regard to the exercise of a discretionary power of self-organization.
The organization Plan, unlike the enterprise Bylaws, should represent the process of
change consistently with the strategy (which could be defined in a Strategic Plan), long
term, with all the possibilities of changing in progress based on the emergence of new
needs or the assessment of the results achieved (see fig. 2).
2. A second limit to the prospects of organizational development of health enterprises is
the absolute predominance of interventions on the organizational structure. All too often
organizational change is identified with the formalisation of new structures (at both macro
and micro-organizational level): the establishment of departments, the modification of
simple or complex structures, the setting up of new coordination or specialist structures.
In short, organizational change seems to be reduced to structural solutions, through
which to take account of all the possible criteria of aggregation of the simple units. For
example, within the local services provided by a health enterprise a series of elements
may coexist, such as the geographical element (the district), the specialist-functional element
(the departments and offices) and the professional element (medical, psychologists
and sanitary professions). It is often the case that, in order to meet all three of the abo-
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ORGANIZATIONAL
CONSTRAINTS AND
CRITICALITIES
reduce
CEIS Health Report 2006