As health care in general and pharmaceutical organizations in particular become more complex, the paradigm for making decisions within these organizations must also, from necessity, become more complex.   Traditional hierarchical decision making structures have the advantage of clarity but lack the ability to spread risk and to pull in ideas from throughout the organization.  Matrix decision structures – where each person might report to several stakeholders as in drug development teams – have become more the norm in pharmaceutical companies. Yet within matrix structures there exists the possibility that the decision making process has become confused – individuals are unsure of who has the final approval for a decision, who is ultimately responsible and who needs to be consulted.

The Center for Applied Research (CFAR), a Philadelphia based consulting firm, recently conducted a large-scale survey inside a major pharmaceutical company to determine the clarity and efficiency of its matrix decision making structure. The survey found that for major projects there was considerable confusion as to who had the power to approve certain decisions and, in some instances, no one could be identified as having the ultimate responsibility. It found that some executives’ understanding of their actual role was not clearly understood either by themselves or by other members of the organization. 

Because of the interdisciplinary and inter-cultural nature of the health care industry, especially as it is likely to evolve in the 21^st century, matrix structures will become more of a necessity. A variety of opinions and viewpoints will need to be heard, a variety of different cultural understandings will need to be taken into consideration, and collaboration will become the foundation for all decisions. However, without clear reporting and approval structures in place, matrix systems will not be able to capitalize on these dynamics. Effective implementation of matrix systems will affect the development of drugs, the actualization of health policy on both large and small scales, and the operation of hospitals.  In other words, the future of health care.