It is often difficult in complex organizational systems for managers to attribute accurately changes in organizational performance to changes in management strategy. In this case study of the Kaiser Permanente Northern California Health Care System, managers attributed improvement in patient enrollment to strategic action taken earlier to improve patient satisfaction. Empirical data demonstrate that changes in patient enrollment were actually due to changes in the market for medical care external to Kaiser and out of the control of Kaiser managers. Subsequent problems in the Kaiser system may have been worsened by this earlier misattribution. It is important for health care managers to appreciate the difficulty in linking strategic action to changes in organizational performance.
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