| A Structure/Technology Contingency Analysis of Caregiving in Nursing Facilities |
| | Brannon, Susan Diane | Pennsylvania State U., U. Park | f8z@psu.edu | 814-863-5421 |
| | Zinn, Jacqueline S. | Temple U. | zinn@vm.temple.edu | 215-204-1684 |
| | Mor, Vincent | Brown U. | vincent_mor@brown.edu | 401-863-3490 |
| | Barry, Teresa | Pennsylvania State U., U. Park | txb13@psu.edu | 814-863-9970 |
| | Davis, Jullet | Pennsylvania State U., U. Park | jad155@psu.edu | 814-863-9970 |
| | While recent legislation has attempted to promote improved assessment and more individualized care in nursing facilities, it remains questionable, whether institutional long term care, as provided primarily through paraprofessional staff is, in any way, differentiated. Guided by structure/technology contingency theory ( Woodward, 1965; Thompson, 1967, Perrow, 1967), this paper addresses
the question of whether care processes, or task technologies, in contrasting domains--psychosocial and physical--are differentially structured in
in a way that fits the nature of the raw materials and the causal knowledge underlying the tasks. Data are from a survey of 739 charge nurses
in 308 facilities in 8 states. Consistent with structural/technology contingency theory, the extent to which task sequences are prescribed, the amount of autonomy afforded direct caregivers, and the
centralization of influence on care processes were rated for three physical care task technologies and three in the psychosocial domain. Psychosocial care, as hypothesized because of the nature of the
inputs and underlying knowledge was more loosely structured than physical care on the first two variables but not on centralization of influence. |
| | Keywords: technology; Contingency analysis; Nursing facilities |
| Does strategic orientation predict medical group performance? |
| | Fottler, Myron D. | U. of Alabama, Birmingham | mfottler@fms.uab.edu | 205-934-1649 |
| | Slovensky, Donna J. | U. of Alabama, Birmingham | donnaslo@uab.edu | (205)-934-1679 |
| | Blair, John D. | Texas Tech U. | odjdb@coba2.ttu.edu | 806-742-2134 |
| | Medical groups have been under-researched relative to hospitals in terms of their strategic orientations, strategies, and performance. We know very little about the strategic orientations of medical practice executives and the impact of these on their organizations' performance. The present study, conducted in 1995, examines a national sample of 686 medical practice executives. Using a strategic orientation scale originally developed by Venkatraman (1989) and validated by Tan and Litschert (1994), we factor analyzed the scale into two factors: an engineering orientation with a focus on efficiency and cost control, and an entrepreneurial orientation with a focus on market expansion. All medical groups were then classified (based on these orientations) into four categories: (a) the Strategic Navigator (high on both), (b) the Strategic Engineer (high engineering, low entrepreneurial), (c) the Strategic Entrepreneur (low engineering, high entrepreneur), and (d) the Strategic Ostrich (low on both). The performance dimensions studied here include market share, profitability, cost-effectiveness, satisfaction of key stakeholders, service orientation, clinical quality, organizational survival, and effectiveness of managing stakeholders. Results indicate that Strategic Navigator medical groups (combining engineering and entrepreneurial orientation) and non-academic medical groups exhibit the highest levels of performance along most performance dimensions. Implications for managerial practice in medical groups are discussed. |
| | Keywords: Academic Medical Practice; Organizational Performance; Strategic Orientation |
| Mind the Gap? Rethinking the Generation and Implementation of Health Care Research |
| | Wood, Martin | U. of Warwick | martin.wood@warwick.ac.uk | +44 1203 522 249 |
| | The generation and implementation of health care research is a
significant issue in health policy and clinical decision making.
Whilst commentators rightly point out that passive diffusion models
are doomed to failiure they retain a structural commitment to
understanding change as the vacuous movement between
discrete, substantial, and enduring entitites - research and
practice. Here the challenge is to stem the apparent
degredation of information suffered in moving from one to the other.
The explication of an ever more codified and communicable
information base for purposive action is, however, driven largely
by a conception of research generation as being separable from
research implementation. To illustrate this binarism the paper
will draw on 'process' thinking with its primary emphasis on
movement, relations, and emergence. It will agure that research
generation and implementation do not simply bridge the various
stages between two essentially independent entities - research and
practice - but relatively stabilise or fix these familiar terms in
a universal field of movement.
Instead of suggesting any real separation between research
generation and implementation, the paper will propose
that any distinction is only the product of an active and
temporary selection, which must be constantly renewed. That is to
say, meaning is not an inherent property of information, and
that research findings cannot be put into practice because they
were never external to it in the first place. The paper will
conclude that the generation and implementation of health care
research produces a necessary complementarity of relations that
constitute a whole. |
| | Keywords: process philosophy; poststructuralism; evidence based healthcare |