This article reviews the recent literature on organizational decline and identifies four key elements or events: the problem definition decision process, substantive cutback decisions, the implementation process, and the resulting outcomes. The conceptual and empirical literature to date is somewhat deficient and limited in linking these elements together. A more integrative approach is demonstrated by our longitudinal research study of six hospitals which faced underfunding over a period offive years. Using a mixture of qualitative and quantitative methods, the responses of these hospitals to moderate cutbacks is documented and explained in the context of the phases noted above. Our findings illustrate the importance of linking rather than isolating the four components of decline management. It is suggested that this framework provides both a diagnostic explanatory toolfor practitioners and a source of useful hypotheses for researchers.
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