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The complexity of providing health services presents different challenges in structuring healthcare organization due to their diversity of facilities, qualifications of staff, size, and variety of goals (e.g. inpatient, outpatient care, research, teaching, and prevention) (Duffield, Kearin, Johnston, & Leonard, 2007). Healthcare organizations are bureaucratic structures characterized by a hierarchical authority system, a highly developed horizontal division of labour, and an elaborate structure of rules and roles for controlling behaviours (Yang, Fang, & Lin, 2011). This structure is more often called functional departmentalization. In this structure, decisions are generally centralized with information flow following the hierarchy of a high degree of formalization (Creteur, Pochet, Pouplier, & Closon, 2002). Moreover, this structure ensures an optimal resource use, integration of knowledge and functional excellence, but lacks reactivity and flexibility (Yang et al., 2011).
A different healthcare structure is the divisional, where divisions are created around the services-customers-markets, with departments relatively autonomous contrary to the functional configuration. The divisional structure ensures flexibility, reactivity and a greater attention to the customer requirements. Despite, the creation of strong coordination between the groups (multidisciplinary views) the resource consumption is the weak point of this structure, as the resources (e.g. financial, skills etc.) are expanded for various divisions, without possible sharing between them (Creteur et al., 2002). Evermore, hybrid approaches, such as: (a) Clinical Directorate (CD) service structure, designed to induce collaboration and involve clinicians in financial and management decision-making (Braithwaite et al., 2005), (b) the doctor-manager approach in which doctors act as managers (Day, 2007) and the nurse-manager in which nurses are involved in managerial positions (Norrish & Rundall, 2001) are introduced in healthcare. These hybrid approaches reflect on a more decentralised decision-making and thus provide greater flexibility in the overall organisational structure.
In this respect, many healthcare strategies tried to strategically renew healthcare through large scale restructuring, yet there is uncertainty about whether there is the best way, or even a particular way, to structure a healthcare organization (Chryssanthou, Varlamis, Sarivougioukas, & Apostolakis, 2012; Duffield et al., 2007). This is evident as the constant restructuring of health services suggests that while it is fairly easy to determine a broad strategy, it is clearly more difficult to define the exact organisational structure necessary to support the overall strategy (Tjerbo, 2009).
Recently healthcare organisations turned to Service Oriented Architecture (SOA) to integrate their isolated systems and built a more reliable cost-effective Information Technology (IT) infrastructure (HL7/OMG, 2010). SOA is an architectural paradigm that supports reusability and emphasizes on breaking business processes into smaller blocks of functionality (e.g. services). These small blocks are well defined, self-contained modules that provide standard business functionality and are linked together to build an integrated business process (Papazoglou, 2003). In essence, SOA builds upon previous architecture methodologies to offer healthcare services available to the entire organization through a standard interface. Organizations that adopt SOA can: (a) reduce costs, (b) provide higher return on investment (c) reuse and integrate services and legacy systems, (d) reduce time to market and (e) better align business with IT (Koumaditis & Themistocleous, 2011; Marks, 2008; Mueller, Viering., Legner., & Riempp., 2010).