Myth #8: The Myth of Scale

Elephants have bigger brains than humans, but less interconnected and, consequently, less developed (adapted from Morgan 1986). The quest for measurement in health care paved the way for the myth of scale, which ultimately assumes that higher dimensions are associated with better organizational performance. Moreover, it pretends that organizational design is a simple issue, which could be dealt with through reductionism (Gharajedaghi 1999). Organizations are conceived as engines (Morgan 2016): human resources are easily replaceable and performance is predictable (Thiétart and Forgues 1995). This approach produces a veil of ignorance, which diminishes the meaningfulness of organizational science. Sticking to this, several scholars have found that organizational dimensions are able to affect organizational performance in terms of efficiency (Chadwick et al. 2004), effectiveness (Sahin and Ozcan 2000), and adoption of innovative technologies (Irwin et al. 1998). However, this reductionist reasoning does not capture the real nature of healthcare organizations.