In this thesis, we examine the administrative responses by Ontario hospitals to fiscal restraint between 1977 and 1984. Using the conceptual 'model' of organizational change developed in James Thompson's Organizations in Action [1967], we predict that the most significant adaptations occurred in hospitals' administrative components, while "core" activities such as medical procedures remained relatively inflexible. More importantly, the observed changes in administrative tasks and activities can be accounted for by the role played by administrators in maintaining internal order and dealing with external contingencies. Accordingly, the greatest adaptations will be in how the administrative component assesses the performance cf "core" activities and communicates this to an external funding agency (i.e. Ministry of Health). We find that the empirical data collected is consistent with our predictions. As a result, we conclude that hospital adaptation during this time period was explicitly related to renewing the political conditions necessary for organizational growth. Moreover, we suggest that the organizational logic of fiscal restraint does not affect how hospitals perform medical activities, but rather, further entrenches this technology through the adoption of standardized funding formulae. / Thesis / Master of Arts (MA)

nÃo hà / Infraestrutura adequada à condiÃÃo essencial para o crescimento de qualquer paÃs, sobretudo em paÃses em desenvolvimento, como o Brasil, que alÃm de significativas restriÃÃes fiscais possui larga extensÃo territorial. PaÃses que enfrentaram este tipo de problema encontraram como alternativa para o seu desenvolvimento o parceiro privado, que ao longo do tempo participou atuando de diferentes formas neste processo. Muitas foram Ãs experiÃncias adotadas na busca por melhoria e viabilidade de investimentos para a oferta de serviÃos pÃblicos. O presente trabalho faz um rÃpido relato dessa evoluÃÃo e se detÃm de forma mais especÃfica na nova modalidade de contrataÃÃo por meio da Parceria PÃblico-Privada, em que o pÃblico busca um aumento da eficiÃncia e eficÃcia em seus serviÃos. Aborda os processos envolvidos para os estudos de modelagem, utilizando ou nÃo o Procedimento de ManifestaÃÃo de Interesse, bem como o enquadramento e anÃlise da conveniÃncia e oportunidade por meio do Value for Money. Apresenta e analisa a experiÃncia do Governo do Estado do Cearà na elaboraÃÃo, execuÃÃo e monitoramento do projeto da Arena CastelÃo implantado, identificando seus aspectos positivos e negativos. / Adequate infrastructure is essential for the growth of any country, especially in developing countries such as Brazil, which in addition to significant fiscal constraints has large territorial extension. Countries that have faced this type of problem found as an alternative for its development the private partner, which over time took acting in different ways in this process. Many experiments have been adopted in the search for improvement and investment feasibility for the provision of public services. The present study is a quick account of this evolution and hold more specifically in the new mode of contracting through the Public- Private Partnership, in which the public seeks to improve the efficiency and effectiveness of their services through this modality. Discusses the processes involved for modeling studies, using or not the Expression of Interest Procedure as well as the framework and analysis of convenience and opportunity through Value for Money. Presents and analyzes the experience of the State of Cearà in the preparation, implementation and monitoring of the project implanted Arena CastelÃo, identifying their strengths and weaknesses.