Health care organizations are presently attempting to adapt to an increasingly turbulent environment that poses significant challenges to both managers and management scholars. As a result of the unique nature of health care organizations and their external environments, most research and empirical writing is available only in context-specific sources. This paper examines and evaluates research evidence concerning issues that are likely to be crucial in health care management research and practice over the next decade. Specifically, we examine structural and process determinants of the following measures of health care organizational performance: cost efficiency, clinical quality, patient satisfaction, and financial outcomes. Managerial implications of this research are discussed along with some guidelines forfuture research.
Get full access to this article
View all access options for this article.
References
1.
Alexander, J.A., Anderson, J.G. & Lewis, B.L. (1985). Toward an empirical classification of hospitals in multihospitals systems. Medical Care, 23 (7), 913-932.
2.
Alexander, J.A., Morrisey, M.A., & Shortell, S.M. (1986). The effects of competition, regulation and corporatization on hospital-physician relationships. Journal of Health and Social Behavior, 27 (3), 220-235.
3.
Alexander, J.W, & Randolph, WA. (1985). The fit between technology and structure as a predictor of performance in nursing subunits. Academy of Management Journal, 28 (4), 844-859.
4.
Alexander, J.A. & Rundall, T.G. (1985). Public hospitals are under contract management: An assessment of operating performance. Medical Care, 23 (3), 209-219.
5.
Argote, L. (1982). Input uncertainty and organizational coordination in hospital emergency units. Administrative Science Quarterly, 27, 420-434.
6.
Arthur Anderson and Company & the American College of Hospital Administrators (1984). Health care in the 1990s: Trends and strategies. Chicago: Author.
7.
Austin, C.J., & Carter, H.S. (1981). Hospital information systems and quality assurance. Hospital and Health Services Administration, 26 (5), 42-62.
8.
Barrett, D., & Windham, S.R. (1984). Hospital boards and adaptability to competitive environments. Health Care Management Review, 9 (4), 11-20.
9.
Ben-Sira, Z. (1983). The structure of a hospital's image. Medical Care, 21 (10), 943-954.
10.
Biggs, E.L., Kralewski, J E., & Brown, G.D. (1980). A comparison of contract-managed and traditionally managed nonprofit hospitals, Medical Care, 18 (6), 585-698.
11.
Birnbaum, H., Bishop, C., Lee, J. A., & Jensen, G. (1981). Why do nursing home costs vary? The determinants of nursing home costs. Medical Care, 14 (11), 1095-1109.
12.
Blair, J.D., Baliga, B.R., Whitehead, C.J., & Korukonda, A.R. (1986-August). Stakeholder management strategies for healthcare organizations. Paper presented at the 1986 meeting of the Academy of Management, Chicago.
13.
Blair, J.D. & Hunt, J.G. (1986). Getting inside the head of the management researcher one more time: Context-free and context-specific orientations in research. 1986 Yearly Review of Management of the Journal of Management, 12, 147-166.
14.
Boerma, H. (1983). The Organizational Impact of DRG's: DRG Evaluation. Princeton, NJ: Center For Health Affairs, Health Research and Educational Trust of New Jersey.
15.
Bracken, J., Calkin, J., Sanders, J. & Thesen, A. (1985). A strategy for adaptive staffing of hospitals under varying environmental conditions. Health Care Management Review, 10, 43-53.
16.
Choi, T., Allison, R.E, & Munson, F. (1985). Impact of environment on state university hospital performance. Medical Care, 23 (7) 855-871.
17.
Clemenhagen, C. & Champagne, F. (1984). Medical staff involvement in strategic planning. Hospital and Health Services Administration, 29 (4), 79-94.
18.
Cleverley, WO., & Felkner, J.G. (1984). The association of capital budgeting techniques with hospital financial performance. Health Care Management Review, 9 (3), 45-58.
19.
Cleverley, WO., & Mullen, R.P. (1982). Management incentive systems and economic performance in health care organizations. Health Care Management Review, 7 (1), 7-14.
20.
Cleverley, W O., & Nutt, P.C. (1984). The effectiveness of group-purchasing organizations. Health Services Review, 19 (1), 65-75.
21.
Cleverley, WO., & Stetson, R.L. (1985). In search of excellence: Fact or fiction?Hospital and Health Services Administration, 30 (6), 26-47.
22.
Cohen, D.I., Jones, P., Littenberg, B., & Neuhauser. D. (1982). Does cost information availability reduce physician test usage? A randomized clinical trial with unexpected findings. Medical Care, 20 (3), 286-292.
23.
Cook, K., Shortell, S.M., Conrad, D.A., & Morrisey, M.A. (1983). A theory of organizational response to regulation: The case of hospitals. Academy of Management Review, 8 (2), 193-205.
24.
Cornell, L. (1984). Quality circles: A new cure for hospital dysfunction?Hospital and Health Services Administration, 29 (5), 88-93.
25.
Coyne, J.S. (1985a). Assessing the financial characteristics of multi-institutional organizations. Health Services Research, 19 (6), 701-715.
26.
Coyne, J.S. (1985b). Measuring hospital performance in multi-institutional organizations using financial ratios. Health Care Management Review, 10 (4), 35-42.
27.
Coyne, J.S. (1986). A financial model for assessing hospital performance: An application to multiinstitutional organizations. Hospital and Health Services Administration, 31 (2), 28-40.
28.
Crawford, M., & Fottler, M.D. (1985). The impact of diagnosis related groups and prospective payment systems on health care management. Health Care Management Review, 10, 73-84.
29.
Cummings, K.M., Frisof, K.B., Long, M.J., and Hrynkiewich, G. (1982). The effects of price information on physician's test-ordering behavior. Medical Care, 20 (3), 293-301.
30.
Donabedian, A. (1966). Evaluating the quality of medical care. Milbank Memorial Fund Quarterly, 44 (2), 166-206.
31.
Donabedian, A. (1980). Explorations in quality assessment and monitoring. Volume 1: The definition of quality and approaches to its assessment. Ann Arbour, MI: Health Administration Press.
32.
Egdahl, R.H. (1984). Should we shrink the health care system?Harvard Business Review, 62, 125-132.
33.
Ellwood, P. & Paul, B.A. (1986). But what about quality?Health Affairs, 5 (1), 135-140.
34.
Ermann, D., & Gabel, J. (1984). Multihospital systems: Issues and empirical findings. Health Affairs, 3 (1), 50-64.
35.
Ermann, D., & Gabel, J. (1985). The changing face of American health care multihospital systems, emerging centers, and surgery centers. Medical Care, 23 (5), 401-420.
36.
Fetter, R.B., & Freeman, J.L. (1986). Diagnosis related groups: Product line management within hospitals. Academy of Management Review, 11, 41-54.
37.
Fleming, G.V. (1981). Hospital structure and consumer satisfaction. Health Services Research, 16 (1), 43-63.
38.
Flood, A.B., & Scott, W R. (1978). Professional power and professional effectiveness: The power of the surgical staff and the quality of surgical care in hospitals. Journal of Health and Social Behavior, 19, 240-254.
39.
Flood, A.B., Scott, WR., & Ewy, W (1984). Does practice make perfect? Part II: The relation between volume and outcomes and other hospital characteristics. Medical Care, 22 (2), 115-125.
40.
Flood, A.B., Scott, WR., Ewy, W, & Forrest, WH. (1982). Effectiveness in professional organizations: The impact of surgeons and surgical staff organizations on the quality of care in hospitals. Health Service Research, 17 (4), 341-366.
41.
Ford, J.D., & Slocum, J.W (1977). Size, technology, environment, and the structure of organizations. Academy of Management Review, 2, 561-575.
42.
Fottler, M.D. (1972). Manpower substitution in the hospital industry. A study of New York City voluntary and municipal hospital systems. New York: Praeger.
43.
Fottler, M.D. (1977). The union impact on hospital wages. Industrial and Labor Relations Review, 30 (3), 342-355.
44.
Fottler, M.D. (1979). Physician attitudes toward physician extenders. Medical Care, 17 (3), 101-114.
45.
Fottler, M.D. (1981). Is management really generic?Academy of Management Review, 6, 1-12.
46.
Fottler, M.D. (1982). Manpower utilization practices in physician offices: The role of physician extenders. Journal of Health and Human Resources Administration, 5 (2) 159-185.
47.
Fottler, M.D. (1984). Improving health care planning: Lessons from immunization. Long Range Planning. 17 (5), 88-95.
48.
Fottler, M.D. (1985). Invited commentary: Consultation in health care organizations. Consultation: An International Journal, 4, 346-352.
49.
Fottler, M.D., & Lanning, J.A. (1986). A comprehensive incentive approach to employee health care cost containment. California Management Review, 29 (1), 75-94.
50.
Fottler, M.D., & Maloney, WF. (1979). Guidelines to productivity bargaining in the health care industry. Health Care Management Review, 3, 59-70.
51.
Fottler, M.D., & Rock, WH. (1974). Some correlates of hospital costs in public and private hospital systems: The case of New York City. Quarterly Review of Economics and Business, 25 (4), 26-31.
52.
Fottler, M.D., Smith, H.L., and James, WL. (1981). Profits and patient care quality in nursing homes: Are they compatible?The Gerontologist, 21 (5), 532-538.
53.
Fottler, M.D., Smith, H.L., and Muller, H.J. (1986). Retrenchment in health care organizations: Theory and practice. Hospital and Health Services Administration, 31, 29-43.
54.
Fottler, M.D., & Vaughn, D.G. (in press). Multihospital systems. In WP. Wolper & J.J. Pena (Ed.), Health care administration. Rockville, MD: Aspen Systems.
55.
Fox, P D., Goldbeck, W B. & Spies, J.J. (1984). Health care cost management: Private sector initiatives. Ann Arbor, MI: Health Administration Press.
56.
Freeman, R.E. (1984). Strategic management: A stakeholder approach. Boston: Pittman.
57.
Friedman, E. (1986). What do consumers really want?Healthcare Forum, 1 (3), 19-24,
58.
Fuchs, V. R. (1982). The battle for control of health care. Health Affairs, 1, 5-13.
59.
Georgopoulas, B.S. (Ed.). (1972). Organization Research on Health Institutions. Ann Arbor, MI: University of Michigan Institute for Social Research.
Georgopoulas, B.S. (1986). Organization structure, problem-solving, and effectiveness: A comparative study of hospital emergency services. San Francisco: Jossey-Bass.
62.
Georgopoulos, B.S., & Mann, F.C. (1962). The community general hospital. New York: Macmillan.
63.
Goldsmith, M., & Leebov, W (1986). Strengthening the hospital's marketing position through training. Health Care Management Review, 1 (2), 83-93.
64.
Gray-Toft, PA., & Anderson, J.G. (1985). Organizational stress in the hospital: Development of a model for diagnosis and prediction. Health Services Research, 19 (6), 753-774.
65.
Greene, VL., & Monahan, D.J. (1981). Structural and operational factors affecting quality of patient care in nursing homes. Public Policy. 29, 399-415.
66.
Grossman, R.M. (1983). A review of physician cost-containment strategies for laboratory testing. Medical Care, 21 (8), 783-796.
67.
Hancock, WM., & Fuhs, PA. (1984). The relationship between nurse staffing policies and nursing budgets. Health Care Management Review, 9, 21-26.
68.
Heffring, M.P, Nielson, E.J., Szklarz, M.J., & Dobson, G.S. (1986). High tech, high touch: Common denominators of patient satisfaction. Hospital and health services administration, 31 (2), 81-93.
69.
Howell, J.P, & Wall, L.C. (1983). Executive leadership in an organized anarchy: The case of HSO's. Health Care Management Review, 8, 17-26.
70.
Kaluzny, A.D., Warner, D.M., Warren, D.G., & Zelman, WN. (1982). Management of health services. Englewood Cliffs, NJ: Prentice-Hall.
71.
Kimberly, J.R. (1978). Hospital adoption of innovation: The role of integration into external information environments. Journal of Health and Social Behavior, 19, 358-371.
72.
Kralewski, J.E., Dowd, B., Pitt, L., & Biggs, E.L. (1984). Effects of contract management on hospital performance. Health Services Research, 19 (4), 479-498.
73.
Leatt, P., Schneck, R.E. (1982). Technology, size, environment, and structure in nursing subunits. Organization Studies, 3 (3), 221-242.
74.
Lee, Y.S. (1984). Nursing homes and quality of health care: The first year result of an outcomeoriented survey. Journal of Health and Human Resources Administration. 7 (1), 32-60.
75.
Levitz, G.S., & Brooke, PP., Jr. (1985). Independent versus system-affiliated hospitals: A comparative analysis of financial performance, cost and productivity. Health Services Research20 (3), 315-339.
76.
Lewin and Associates. (1981). Studies in the comparative performance of investor-owned and notfor-profit hospitals (Vol. 1). Industry analysis. Washington, DC: Lewin and Associates.
77.
Linn, L.S., Brook, R.H., Clark, V.A., Davies, A.R., Fink, A., & Kosecoff, J. (1985). Physician and patient satisfaction as factors related to the organization of internal medicine group practices. Medical Care, 23 (10), 1171-1178.
78.
Linn, L. S., & DiMatteo, M.R. (1983). Humor and other communication preferences in physicianpatient encounters. Medical Care, 21 (12), 1223-1231.
79.
Linn, L.S., Brook, R.H., Clark, V.A., Daves, A.R., Fink, A., and Kosecoff. J. (1985). Physician and patient satisfaction as factors related to the organization of internal medicare group practices. Medical Care, 23 (10), 1171-1178.
80.
Longest, B.B. (1978). An empirical analysis of the quality/cost relationship. Hospital and Health Services Administration, 23, 20-35.
81.
Luft, H. (1981). Health maintenance organizations: Dimensions of performance. New York: John Wiley & Sons.
82.
Mangelsdorff, A.D. (1983). Flexitime in an army center. Journal of Health and Human Resources Administration, 6 (1), 92-99.
83.
Marks, S.D., Greenlick, M.R., Hurtado, A.V, Johnson, J.D., & Henderson, J. (1980). Ambulatory surgery in an HMO: A study of costs, quality of care and satisfaction. Medical Care, 18 (2), 127-138.
84.
Marquis, M.D., Davies, A.R., & Ware, J.E., Jr. (1983). Patient satisfaction and change in medical care provider: A longitudinal study. Medical Care, 21 (8), 821-831.
85.
Mendenhall, R.C., Repicky, PA., & Neville, R.E. (1980). Assessing the utilization and productivity of nurse practitioners and physician's assistants: methodology and findings on productivity. Medical Care, 18 (6), 609-620.
86.
Meyer, A.D. (1982). Adapting to environmental jolts. Administrative Science Quarterly, 27, 515-537.
87.
Morlock, L.L., Nathanson, C.A., Horn, S.D.,. & Schumacher, D.N. (1979, May). Organizational factors associated with quality of care in 17 general acute care hospitals. Paper presented at the Annual Meeting of the Association of University Programs in Health Administration, Toronto.
88.
Morone, J.A., & Dunham, A.B. (1984). The waning of professional dominance: DRGs and the hospitals. Health Affairs, 3, 73-84.
89.
Neuhouser, D. (1971). The relationship between administrative activities and hospital performance (Research Series No. 28). Chicago: Center for Health Administration Studies, University of Chicago.
90.
Nutting, PA., Burkhalter, B.R., Dietrick, D.L., & Helmick, E.F. (1982). Relationship of size and payment mechanism to system performance in 11 medical care systems. Medical care, 20 (7), 676-687.
91.
Pauly, M. (1978). Medical staff characteristics and hospital costs. Journal of Human Resources, 13, 78-111.
92.
Payne, B.C., Lyons, T.F., Neuhaus, E., Kolton, M., & Dwarshins, L. (1984). Method of evaluating and improving ambulatory medical care. Health Services Research, 19 (2), 219-232.
93.
Pfeffer, J. (1973). Size, composition, and function of hospital boards of directors: A study of organizational-environment linkage. Administrative Science Quarterly, 18, 349-364.
94.
Pointer, D.D. (1985). Responding to the challenges of the new healthcare marketplace: Organizing for creativity and innovation. Hospital and Health Services Adminstration, 30, 10-25.
95.
Quintana, J.B., Duncan, W.J., & Houser, H.W (1985). Hospital governance and the corporate revolution. Health Care Management Review, 10 (3), 63-71.
96.
Rakich, T.S., Longest, B.B., & Darr, K. (1985). Managing health services organizations. Philadelphia: WB. Saunders.
97.
Restuccia, J.D., & Holloway, D.C. (1982). Methods of control for hospital quality assurance systems. Health Services Research, 17 (3), 241-251.
98.
Rhee, S.O., Luke, R.D., Lyons, T.F., & Payne, B.C. (1981). Domain of practice and the quality of physician performance. Medical Care, 19 (1), 14-25.
99.
Ritvo, R.A. (1980). Adaptation to environmental change: The board's role. Hospital and Health Services Administration, 25 (1), 23-97.
100.
Robbins, S.A., & Rakich, J.S. (1986). Hospital personnel management in the late 1980s: A direction for the future. Hospital and Health Services Administration, 31, 18-33.
101.
Robinette, T.K. (1985). Adapting to the age of competition: A paradigm shift for voluntary hospitals. Hospital and Health Services Research, 30 (3), 8-19.
102.
Roos, L.L., Roos, N.P., Gilbert, P., & Nichol, J.P. (1980). Continuity of care: Does it contribute to quality of care?Medical Care, 18 (2), 174-187.
103.
Roos, N.P. (1980). Impact of the organization of practice on quality of care and physician productivity. Medical Care, 18 (4), 347-361.
104.
Rushing, W. (1974). Differences in profit and non-profit organizations: A study of effectiveness and efficiency in general short-stay hospitals. Administrative Science Quarterly, 19, 473-484.
105.
Sager, A. (1983). Why urban voluntary hospitals close. Health Services Research, 18 (3), 451-463.
106.
Salkever, D.S. (1984). Cost implications of hospital unionization: A behavioral analysis. Health Services Research, 19 (5), 639-664.
107.
Schulz, R., Greenley, J.R., & Peterson, R.W (1983). Management cost and quality in hospitals. Medical Care, 21, 911-926.
108.
Scott, WR., Flood, A.B., & Ewy, W. (1979). Organizational determinants of services, quality, and cost of care in hospitals. Milbank Memorial Fund Quarterly, 57, 234-264.
109.
Scott, W R., Forrest, W H., & Brown, B.W (1976). Hospital structure and postoperative mortality and morbidity. In S.M. Shortell & M. Brown (Eds.), Organizational research in hospitals (pp. 72-89). Chicago: Blue Cross Association.
110.
Selbst, P.L. (1985). A more total approach to productivity improvement. Hospital and Health Services Administration, 30 (4), 85-96.
111.
Sheridan, J.E., Vredenburgh, D.J., & Abelson, M.A. (1984). Contextual model of leadership influence in hospital units. Academy of Management Journal, 27 (1), 57-78.
112.
Shortell, S.M., (1985). High-performing healthcare organizations: Guidelines for the pursuit of excellence. Hospital and Health Services Administration, 30 (4), 7-35.
113.
Shortell, S.M., Becker, S.W, & Neuhouser, D. (1976). The effects of management practices on hospital efficiency and quality of care. In S.M. Shortell & M. Brown (Eds.), Organizational research in hospitals (pp. 90-107). Chicago: Blue Cross Association.
114.
Shortell, S.M. & Kaluzny, A.D. (1983). Organizational theory and health care management. In S.M. Shortell & A.D. Kaluzny (Eds.), Health Care Management: A text in organizational theory and behavior (pp. 5-37). New York: Wiley.
115.
Shortell, S.M., & LoGerfo, J.P. (1981). Hospital medical staff organization and quality of care: Results for myocardial infarction and appendectomy. Medical Care, 19 (10), 1041-1054.
116.
Smith, H.L., & Fottler, M.D. (1981). Costs and cost containment in nursing homes. Health Services Research, 16 (1), 17-41.
Smith, H.L., James, WL., & Fottler, M.D. (1982). Applications and implementation of a canonical analysis of managerial-environmental relationships: Implications for methodology and policy. Decision Sciences, 13 (3), 471-484.
119.
Smith, H.L., Ottensmeyer, D.J., & Pasternak, D.P (1984). Physician incentive compensation in group practice: A review with suggestions for improvement. Health Care Management Review, 9 (1), 41-49.
120.
Sommers, L.S., Sholtz, R., Shepherd, R.M., & Starkweather, D.B. (1984). Physician involvement in quality assurance. Medical Care, 22 (12), 1115-1127.
121.
Spencer, D.G. (1986). Employee voice and employee retention. Academy of Management Journal, 29 (3), 488-502.
122.
Starkweather, D., & Cook, K.S. (1983). Organization-environment relations. In S.M. Shortell & A.D. Kaluzny (Eds.), Health care management: A text in organization theory and behavior (pp. 333-377). New York: Wiley.
123.
Thakur, M., English, W, & Hoffman, W (1986). Cost containment in small hospitals: Targeting strategies beyond this decade. Hospital and Health Services Administration, 31 (3), 34-46.
124.
Tierney, WM., Hui, S.L., & McDonald, C.J. (1986). Delayed feedback of physician performance versus immediate reminders to perform preventive care effects on physician compliance. Medical Care, 24 (8), 651-666.
125.
Trent, WC. (1986). Some unique aspects of healthcare management. Hospital and Health Services Administration, 31, 122-132.
126.
Trivedi, VM., Lee, M.J., & Hess, J. (1985). Managing hospital census through physician/administrator teamwork. Hospital and Health Services Administration, 30, 58-71.
127.
Weick, K. (1976). Educational organizations as loosely coupled systems. Administrative Science Quarterly, 21, 1-15.
128.
Weisbord, M.R., Stoelwinder, J.U., & Pava, C.H.P. (1983). Involving physicians in hospital cost containment: Developing an action research strategy. Journal of Health and Human Resources Administration, 2, 23-45.
129.
Weisman, C.S., Alexander, C.S., & Chase, G.A. (1980). Job satisfaction among hospital nurses: A longitudinal study. Health Services Research, 15 (4), 341-354.
130.
Weisman, C.S., & Nathanson, C.A. (1985). Professional satisfaction and client outcomes: A comparative organizational analysis. Medical Care, 23 (10), 1179-1192.
131.
Weissert, W G., & Scanlon, WJ. (1985). Determinants of nursing home discharge status. Medical Care, 23 (4), 333-345.
132.
Wolinsky, ED., & Marder, W D. (1982). Spending time with patients: The impact of organizational structure on medical practice. Medical Care, 20 (10), 1051-1064.
133.
Zucker, L.G. (1977). The role of institutionalization in cultural persistence. American Sociological Review, 42, 726-743.
