| Managed Care and Treatment Practices: A Model of Organizational Response to External Influence |
| | Lemak, Christy H. | U. of Florida | clemak@hp.ufl.edu | (352)-395-8042 |
| | I present a conceptual model of how managed care influences the treatment practices of one type of health services organization--outpatient substance abuse treatment providers. The model has three parts. First, using resource dependence theory, I suggest that treatment practices will vary as a function of the organization's dependence on managed care, as well as the scope and stringency of behavioral oversight mechanisms used by managed care firms. Next. I draw from institutional theory and argue that the expectations of professional staff and sources of legitimacy will also influence treatment practices. Finally, I use and extend integrating frameworks and suggest that institutional factors will influence tratment by moderating or constraining the negative effects of managed care oversight. |
| | Keywords: managed care; resource dependence theory; institutional theory |
| Organization Designs for Innovation in Academic Health Centers |
| | Livingston, Jean | Benedictine U. | jeanliving@aol.com | (630)-963-9677 |
| | Few academic health centers (AHCs) today are unaware of the case for change. Insistent pressures, driven by myriad environmental factors are affecting their ability to accommodate multiple stakeholders. Many AHCs are struggling with the scale and scope of their organizations'challenges, organizational complexity, internally competing agendas, and pressures from multiple external sources. This paper describes organization development and change interventions designed to introduce matrix configurations in an alliance of academic health centers in order to structure flexible, adaptable systems of innovation and efficiency to meet demands of a highly competitive and continually changing health care delivery environment.
An hypothesis relating to the degree of comphrehensiveness of organization matrix configurations in a health care delivery system and its implementation of innovation was evaluated. Preliminary findings support the hypothesis; statistically significant unexpected findings create the imperative for academic health centers to integrate an important innovation to improve health care delivery processes. |
| | Keywords: change; matrix; outcomes |
| Field-Level Change: Integrating Perspectives on the Evolutionary Dynamics of Health Care Governance Associations |
| | Galvin, Tiffany L. | U. of Texas, Dallas | tgalvin@utdallas.edu | (972)-883-4844 |
| | This study explains organizational level dynamics (e.g. population changes) as jointly shaped by efficiency considerations and institutional processes. Specifically, the ecological dynamics of a community organizations are examined within their embedded institutional context. The sample used is governance associations within the health care arena. This project tests claims that different resource and institutional pressures are evident in the founding rates of organizations in a field. The methodology of this work directs attention to field level concepts that integrate processes at different levels of analysis. These concepts are used to inform investigation of founding rates at the community level. Results support the importance of 1) resources and 2) institutional effects of contention and negotiation among interests and actors within the field. The examination of founding patterns among this community of health care associations provides a unique proxy of the interaction between interests and actors and the resultant institutional changes.
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| | Keywords: Institutional Processes; Organizational Fields; Health Care |
| The Influence of Organization and Industry on the Culture of Canadian Hospitals |
| | Sue-Chan, Christina | U. of Western Australia | csuechan@ecel.uwa.edu.au | (618) 9380 2781 |
| | Organization scholars have argued that ignoring dissimilarities in the cultures of merging or amalgamating organizations may impede effective amalgamation (e.g., Carlton, 1997; Schein, 1996). This field study sought to determine the ways in which the cultures of three Canadian hospitals that varied in size, medical specialty focus, and academic orientation prior to their operational amalgamation into one hospital differed. The hypothesis examined in this research was informed by Hofstede (1997a; 1997b) who claimed that cultural differences manifest primarily in practices at the level of organizations and in values at a higher level, that of nations. In this study, the higher level was operationally defined as the Canadian health care industry. It was expected that while the hospitals would be dissimilar to each other in practices, they would exhibit similar values. Data were gathered from semi-structured interviews of key informants, published sources, and a survey consisting of both closed and open-ended questions. The obtained results supported the research hypothesis. The results highlight the need for amalgamating hospitals to be aware of barriers to amalgamation that may be caused by practice dissimilarities and to capitalize on industry-wide value similarities that may facilitate amalgamation. |
| | Keywords: organizational culture; hospitals; industry culture |