Organizational change: decentralization in hospitals.

Decentralization may be defined as the spread of power from higher to lower levels in a hierarchy. For hospitals, decentralization is an organizational change of special importance. Decentralization in hospitals may be accomplished through decentralization to departments; more general changes in organizational structure (reduction in the number of hierarchical levels and divisionalization); and, delegation of tasks. A framework for an analysis of decentralization status in hospitals is proposed in four main points; its starting point; the need for change in decentralization status; decentralization solutions; and, the need for review before a decentralization proposal is put into practice. Positive effects of decentralization may be obtained; but, to date, empirical investigations on the impact of decentralization in hospitals are few.