Outsourcing: Uncovering the Complexity of the Decision

Outsourcing is a phenomenon that, on the surface, is used to reduce costs and enable an organization to focus on its core competencies. In researching into outsourcing and whether this assumption holds true, this article focuses on public health organizations where outsourcing has been applied to both clinical and non-clinical services. In the cases observed, public sector managers assumed contracting would lower production costs for peripheral services whose outcomes could be easily measured and monitored. Clinical services were not usually outsourced because these core services were more difficult to measure. In implementing contracts for non-core services, decision makers' political and ideological objectives overshadowed management imperatives that are necessary for effective contract design and implementation, leading to poor service outcomes and little cost savings. Choosing the “right” services to contract does guarantee good outcomes such as lower costs and improved labor flexibility, but it is necessary to understand that optimum outcomes are only achievable if the service is clearly non-core, has measurable outcomes, and has low transaction frequency. It is also clear that outsourcing will not remove management problems; it simply adds another layer of complexity on top of managing staff who still provide the service.