Physician-organization integration (POI) has emerged as a key issue for hospitals and health systems seeking to improve the quality and cost-effectiveness of care. Although competition and managed care are often cited as primary market drivers of the adoption of POI strategies, prior research has shown only weak associations between these market attributes and POI. This article argues that the role of key organizational decision makers has not been adequately accounted for in explaining strategic change. The study examines the role of hospital CEO perceptions of competition in predicting the adoption of five different approaches to POI. CEO perceptions of general market competition are explained by a combination of market and organizational attributes. Furthermore, when controlling for objective characteristics of the environment and organization, CEO perceptions of competition have consistent, statistically significant associations with four of five measures of POI examined.
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References
1.
Alexander, J. A. , L. R. Burns, H. S. Zuckerman, T. Vaughn, R. Anderson, P. Torrens, and D. Hilberman. 1996. An exploratory analysis of market-based physician-organization arrangements. Hospital and Health Services Administration41 (3): 311-329.
2.
Alexander, J. A. , M. Morrisey, and S. Shortell. 1986. The effects of regulation, competition and corporatization on hospital-physician relationships. Journal of Health and Social Behavior27 (3): 220-235.
3.
Alexander, J. A. , and W. R. Scott. 1984. The impact of regulation on hospital administrative structure: Toward an analytic framework. Hospital and Health Services Administration29 (3): 71-85.
4.
Alexander, J. A. , T. E. Vaughn, L. R. Burns, H. S. Zuckerman, R. Anderson, P. Torrens, and D. Hilberman. 1996. Organizational approaches to integrated healthcare delivery. Medical Care Research and Review53 (1): 71-93.
5.
Bamezai, A. , J. Zwanziger, G. A. Melnick, and J. M. Mann. 1999. Price competition and hospital cost growth in the United States (1989-1994). Health Economics8:233-243.
6.
Blair, J. D. , and M. D. Fottler. 1998. Strategic leadership for medical groups. San Francisco: Jossey-Bass.
7.
Blair, J. D. , C. R. Slaton, and G. T. Savage. 1990. Hospital-physician joint venture: A strategic approach for both dimensions of success. Hospital and Health Services Administration35 (1): 326-339.
8.
Bluedorn, A. C. , R. A. Johnson, D. K. Cartwright, and B. R. Barringer. 1994. The interface and convergence of the strategic management and organizational environment domains. Journal of Management20 (2): 201-262.
9.
Bolinger, J. E.1999. Effective physician integration strategy. Health Care Strategic Management17 (7): 18-20.
10.
Bowman, C. , and K. Daniels. 1995. The influence of functional experience on perceptions of strategic priorities. British Journal of Management6 (3): 157-168.
11.
Boyd, B. K. , G. G. Dess, and A.M.A. Rasheed. 1993. Divergence between archival and perceptual measures of the environment: Causes and consequences. Academy of Management Review18 (2): 204-223.
12.
Boyd, B. K. , and J. Fulk. 1996. Executive scanning and perceived uncertainty: A multidimensional model. Journal of Management22 (spring): 1-21.
13.
Burns, L. R.1999. Polarity management: The key challenge for integrated health systems. Journal of Healthcare Management44:14-31.
14.
Burns, L. R. , G. J. Bazzoli, L. Dynan, and D. R. Wholey. 1997. Managed care, market stages, and integrated delivery systems: Is there a relationship?Health Affairs1 (6): 204-218.
15.
Burns, L. R. , G. J. Bazzoli, L. Dynan, and D. R. Wholey. 2000. Impact of HMO market structure on physician-hospital alliances. Health Services Research35 (1): 101-132.
16.
Burns, L. R. , T. Connolly, and R. DeGraaff. 1999. The impact of physicians’ perceptions of malpractice and adaptive changes on intentions to cease obstetrical practice. Journal of Rural Health15 (2): 134-146.
17.
Burns, L. , M. Morrisey, and J. Alexander. 1998. Managed care and processes to integrate physicians and hospitals. Health Care Management Review23 (4): 70-80.
18.
Burns, L. R. , S. M. Shortell, and R. M. Andersen. 1998. Does familiarity breed contentment? Attitudes and behaviors of integrated physicians. In Research in the sociology of health care, edited by J. Kronenfeld, vol. 15. Greenwich, CT: JAI Press.
19.
Burns, L. R. , and D. P. Thorpe. 1995. Managed care and integrated healthcare. In Health care management: Managed care, edited by H. Jolt, 101-108. Philadelphia: Hanley-Belfus.
20.
Burns, L. R. , and D. R. Wholey. 1992. Factors affecting physician loyalty and exit: A longitudinal analysis of physician-hospital relationships. Health Services Research27 (1): 1-24.
21.
Burns, L. R. , and D. R. Wholey. 2000. Responding to a consolidating healthcare system: Options for physician organizations. In The future of integrated delivery systems, edited by J. Blair, 261-323. Greenwich, CT: JAI Press.
22.
Calori, R. , G. Johnson, and P. Sarnin. 1994. CEOs’ cognitive maps and the scope of the organization. Strategic Management Journal15:437-457.
23.
Child, J.1972. Organizational structure, environment, and performance: The role of strategic choice. Sociology6:1-22.
24.
Conrad, D. A. , and S. M. Shortell. 1996. Integrated health systems: Promise and performance. Frontiers of Health Services Management13 (1): 3-40.
25.
Daniels, K. , G. Johnson, and L. De Chernatony. 1994. Differences in managerial cognitions of competition. British Journal of Management5:S21-S29.
26.
De Chernatony, L. , K. Daniels, and G. Johnson. 1993. A cognitive perspective on managers’ perceptions of competition. Journal of Marketing Management9:373-381.
27.
Denison, D. R. , J. E. Dutton, J. A. Kahn, and S. L. Hart. 1996. Organizational context and the interpretation of strategic issues: A note on CEOs’ interpretations of foreign investment. Journal of Management Studies33 (4): 453-474.
28.
DiMaggio, P. , and W. W. Powell. 1984. The iron cage revisited: Institutional isomorphism and collective rationality in organizational fields. American Sociological Review48:147-160.
29.
Feldman, R. , H.-C. Chan, J. Kralewski, B. Dowd, and J. Shapiro. 1990. Effects of HMOs on the creation of competitive markets for hospital services. Journal of Health Economics9 (2): 207-222.
30.
Fombrun, C. , and E. Zajac. 1987. Structural and perceptual influences on intraindustry stratification. Academy of Management Journal30 (1): 33-50.
31.
Friend, P. M. , and S. Meighan. 1994. Driving forces behind integration: Weigh your options. Healthcare Executive9 (3): 12-15.
32.
Glandon, G. L. , and M. A. Morrisey. 1986. Redefining the hospital-physician relationship under prospective payment. Inquiry23:166-175.
33.
Gregory, D.1992. Strategic alliances between physicians and hospitals in multi-hospital systems. Hospital and Health Services Administration37 (2): 247-258.
34.
Hagen, A. F. , and S. G. Amin. 1995. Corporate executives and environmental scanning activities: An empirical investigation. SAM Advanced Management Journal60 (2): 41-47.
35.
Hodgkinson, G. P.1997. The cognitive analysis of competitive structures: A review and critique. Human Relations50 (6): 625-654.
36.
Hodgkinson, G. P. , and G. Johnson. 1994. Exploring mental models of competitive strategies: The case for a processual approach. Journal of Management Studies31:525-551.
37.
Jaklevic, M. C.1996. PHOs: A popular managed care strategy. Modern Healthcare26 (6): 33-34.
38.
Kennedy, P.1998. A guide to econometrics. 4th ed.Cambridge, MA: MIT Press.
39.
Kurtz, M. E.1987. Role of the physician as manager. Physical Medicine and Rehabilitation: State of the Art Reviews1 (2): 185-196.
40.
Melnick, G. A. , J. Zwanziger, A. Bamezai, and R. Pattison. 1992. The effects of market structure and bargaining position on hospital prices. Journal of Health Economics11 (3): 217-233.
41.
Melone, N. P.1994. Reasoning in the executive suite: The influence of role/experience-based expertise on decision processes of corporate executives. Organization Science5 (3): 438-455.
42.
Morrisey, M. A.1994. Cost shifting in health care. Washington, DC: AEI Press.
43.
Morrisey, M. A. , J. A. Alexander, L. R. Burns, and V. Johnson. 1996. Managed care and physician/hospital integration. Health Affairs15 (4): 62-73.
44.
Morrisey, M. A. , J. A. Alexander, L. R. Burns, and V. Johnson.1999. The effects of managed care on physician and clinical integration. Medical Care37 (4): 350-361.
45.
Nystrom, P. C.1994. Departmental affiliation and selective perceptions of competitive strategies. International Journal of Management11 (4): 865-870.
46.
Ocasio, W.1995. The enactment of economic diversity: A reconciliation of theories of failure-induced change and threat rigidity. Research in Organizational Behavior17:287-331.
47.
Porac, J. F. , H. Thomas, and C. Baden-Fuller. 1989. Competitive groups as cognitive communities: The case of Scottish knitwear manufacturers. Journal of Management Studies26 (4): 397-416.
48.
Priem, R. L.1994. Executive judgment, organizational congruence, and firm performance. Organization Science5 (3): 421-437.
49.
Prospective Payment Assessment Commission . 1995. Hospital-physician relations: A national survey of hospital chief executive officers and chiefs of medical staff. Intramural Report I-95-02. Washington, DC: Author.
50.
Rice, T.1997. Physician payment policies: Impacts and implications. Annual Review of Public Health18:549-565.
51.
Robinson, J. R.1997. Physician-hospital integration and the economic theory of the firm. Medical Care Research and Review54 (1): 13-24.
52.
Robinson, J. R. , and L. P. Casalino. 1996. Vertical integration and organizational networks in health care. Health Affairs15 (1): 7-22.
53.
Rousseau, D. M.1998. Why workers still won’t identify with organizations. Journal of Organizational Behavior19:217-233.
54.
Scott, W. R.1995. Institutions and organizations. Thousand Oaks, CA: Sage.
55.
Shortell, S. M.1991. Effective hospital-physician relationships. Ann Arbor, MI: Health Administration Press.
56.
Shortell, S. M. , R. R. Gillies, D. A. Anderson, K. M. Erickson, and J. B. Mitchell. 1996. Remaking health care in America. San Francisco: Jossey-Bass.
57.
Shortell, S. M. , and E. J. Zajac. 1990. Perceptual and archival measures of Miles and Snow’s strategic types: A comprehensive assessment of reliability and validity. Academy of Management Journal33 (4): 817-832.
58.
Simon, C. J. , W. D. White, P. Born, and D. Dranove. 1996. Managed care and the physician marketplace. In Managed care and changing health care markets, edited by M. A. Morrisey, 95-120. Washington, DC: AEI Press.
59.
Smircich, L. , and C. Stubbart. 1985. Strategic management in an enacted world. Academy of Management Review10 (4): 724-736.
60.
Smith, H. L. , R. A. Reid, and N. F. Piland. 1990. Managing hospital-physician relations: A strategy scorecard. Health Care Management Review15 (4): 23-33.
61.
Sparrow, P. R.1994. The psychology of strategic management: Emerging themes of diversity and cognition. International Review of Industrial and Organizational Psychology9:147-181.
62.
Steers, R. M.1977. Antecedents and outcomes of organizational commitment. Administrative Science Quarterly22:46-56.
63.
Stigler, G.1968. The measurement of concentration. In The organization of industry, edited by G. Stigler, 29-38. Homewood, IL: Richard D. Irwin.
64.
Thomas, J. B. , and R. R. McDaniel, Jr.1990. Interpreting strategic issues: Effects of strategy and the information-processing structure of top management teams. Academy of Management Journal33 (2): 286-306.
65.
Thomas, J. B. , R. R. McDaniel, Jr., and R. A. Anderson. 1991. Hospitals as interpretation systems. Health Services Research25 (6): 859-880.
66.
Tyler, B. B. , and H. K. Steensma. 1998. The effects of executives’ experiences and perceptions on their assessment of potential technological alliances. Strategic Management Journal19 (10): 939-965.
67.
Walsh, J. P.1995. Managerial and organizational cognition: Notes from a trip down memory lane. Organization Science6 (3): 280-321.
68.
Weick, K.1979. The social psychology of organizing. 2d ed.Reading, MA: Addison-Wesley.
69.
Wholey, D. R. , R. Feldman, and J. L. Christianson. 1995. The effects of market structure on HMO premiums. Journal of Health Economics14 (1): 81-106.
70.
Wolinsky, F. D. , and W. D. Marder. 1985. The organization of medical practice and the practice of medicine. Ann Arbor, MI: Health Administration Press.
71.
Zahra, S. A. , and S. S. Chaples. 1993. Blind spots in competitive analysis. Academy of Management Executive7 (2): 7-28.
72.
Zwanziger, J. , and A. Meirowitz. 1998. Strategic factors in hospital selection for HMO and PPO networks. In Managed care and changing health care markets, edited by M. A. Morrisey, 77-94. Washington, DC: AEI Press.
