Subject(s)
Family Practice/organization & administration , Practice Management, Medical , Practice Patterns, Physicians' , Systems Theory , Delivery of Health Care , Family Practice/standards , Health Services Research , Humans , Organizational Case Studies , Organizational Innovation , Practice Guidelines as Topic , Preventive Health Services/organization & administration , Quality of Health Care , United StatesABSTRACT
This article examines the intersection of professionalism and complexity science as a source of new insights for improving the health care industry from both a clinical and business point of view. Viewing health care organizations as professional complex adaptive systems suggests eight leadership tasks for addressing the circumstances that engulf health care. Managers who adopt this view will be able to create new levers for positive movement in their organizations.
Subject(s)
Health Services Administration/organization & administration , Health Services Research/organization & administration , Leadership , Professional Competence , Science/organization & administration , Commerce/organization & administration , Decision Making, Organizational , Humans , Job Description , Models, Organizational , Nonlinear Dynamics , Organizational Objectives , Systems Theory , Total Quality Management/organization & administration , United StatesABSTRACT
When hospitals are viewed as complex adaptive systems, simple rules can lead to behavior that emerges as complex and that enables creative, adaptive organizational responses. Based on empirical findings from a decade of research on hospital strategic decision making this article offers the simple rule of letting physicians help decide strategic issues. Seven managerial guidelines for implementing this rule are presented.
Subject(s)
Decision Making, Organizational , Health Services Administration/organization & administration , Medical Staff, Hospital/organization & administration , Medical Staff, Hospital/psychology , Cooperative Behavior , Efficiency, Organizational , Guidelines as Topic , Health Services Research , Humans , Interprofessional Relations , Leadership , Organizational Innovation , Organizational Objectives , Problem Solving , Systems Theory , Total Quality Management/organization & administrationABSTRACT
In the study on which this article is based, nursing homes with the most improvements in resident outcomes had greater registered nurse (RN) participation in decision making than did homes with the least improvements. The results suggest that nursing homes that want to improve quality can use RN participation to make improvements without significantly increasing costs. Complexity theory served as a framework for the study.
Subject(s)
Decision Making, Organizational , Homes for the Aged/organization & administration , Nursing Homes/organization & administration , Nursing Staff/organization & administration , Female , Humans , Linear Models , Male , Multivariate Analysis , Outcome Assessment, Health Care , TexasABSTRACT
Nurse managers face unique challenges as they cope with mergers and acquisitions among health care organizations. These challenges can be better understood if it is recognized that health care institutions are professional organizations and that the transformations required are extremely difficult. These difficulties are caused, in part, by the institutionalized nature of professional organizations, and this nature is explicated. Professional organizations are stubborn. They are repositories of expertise and values that are societal in origin and difficult to change. When professional organizations are understood as complex adaptive systems, complexity theory offers insight that provide strategies for managing mergers and acquisitions that may not be apparent when more traditional conceptualizations of professional organizations are used. Specific managerial techniques consistent with both the institutionalized characteristics and the complex adaptive systems characteristics of professional organizations are offered to nurse managers.
Subject(s)
Adaptation, Psychological , Health Facility Merger/organization & administration , Job Description , Models, Organizational , Nurse Administrators/organization & administration , Nurse Administrators/psychology , Nursing, Supervisory/organization & administration , Systems Theory , Humans , Nonlinear Dynamics , Organizational Innovation , Organizational ObjectivesABSTRACT
One way hospitals complicate themselves is by increasing the participation of clinical professionals and middle managers in making strategic decisions. Using a survey methodology this article investigates the relationships between the participation of clinical professionals (MDs and RNs) and middle managers with hospital costs, as well as the possible moderating effect of strategic complexity.
Subject(s)
Hospital Costs/trends , Institutional Management Teams/economics , Medical Staff, Hospital/economics , Nursing Staff, Hospital/economics , Cost-Benefit Analysis/trends , Decision Making, Organizational , Efficiency, Organizational/economics , Forecasting , Hospital Administrators , Humans , United StatesABSTRACT
In this study of data obtained from nursing home administrators and directors of nursing, we found that intensity of registered nurses' (RNs') participation in nursing home decision making varied with decision content and decision level. The primary decision activity in which RNs participated was raising the issue. The decision activity in which they participated least was choosing the alternative. The primary mechanism for RN involvement was through informal meetings. Patterns of participation varied across nursing homes and were important in explaining the extent to which RNs influence decision outcomes. RN influence over the final choice was explained by their involvement in the decision activity of raising the issue and by their involvement through informal meetings.
Subject(s)
Decision Making, Organizational , Nurses , Nursing Homes , Analysis of Variance , Chi-Square Distribution , Humans , Regression Analysis , Surveys and QuestionnairesABSTRACT
Viewing health care from the perspective of chaos and quantum theories offers new insights into management techniques for effective and efficient delivery of health care services. This article introduces these concepts and gives specific prescriptions for managerial action.
Subject(s)
Delivery of Health Care, Integrated/organization & administration , Leadership , Nonlinear Dynamics , Quantum Theory , Administrative Personnel , Humans , Managed Care Programs , Models, Organizational , Organizational Innovation , United StatesABSTRACT
This study examines the participation of six internal stakeholder groups in hospital strategic decision-making. Results show that internal stakeholder group participation is affected by strategic decision content and by the nature of the hospital's strategy. Results show that the participation of internal stakeholdergroups is associated with lower cost per full-time employee (fte). In particular, when the low participation stakeholder groups do participate, hospitals experience lower cost per fte.
Subject(s)
Decision Making, Organizational , Group Processes , Hospital Administration , Humans , Investments , Medical Staff, Hospital , Models, Organizational , Physicians , United StatesABSTRACT
Despite state laws and professional norms, administrators intervene in different ways in response to chemically dependent nurses. The purpose of this study was to examine how context and interpretation affect these interventions. Nurse administrators from 322 hospitals participated in the study. Regression analysis revealed a relationship between interpretation (threat or nonthreat) of chemically dependent nurses and the interventions. The higher the degree of threat perceived in relation to these nurses, the higher the tendency to terminate them (p<.01), and the lower the tendency to refer them to treatment (p<.05), reintegrate them (p<.01), and hire them (p<.01). Two context variables, professionalization and communication, were related to reintegration (p<.05). Understanding the relationship between context and interpretation on decision making will allow for progress toward improved management of the health care environment.
Subject(s)
Nursing Staff, Hospital , Occupational Diseases/therapy , Professional Impairment , Substance-Related Disorders/therapy , Communication , Educational Status , Humans , Nurse Administrators , Nursing Staff, Hospital/organization & administration , Nursing Staff, Hospital/statistics & numerical data , Regression Analysis , Substance-Related Disorders/epidemiology , Surveys and Questionnaires , United States/epidemiologyABSTRACT
Theory suggests that organizations should respond to external complexity with internal complexity. We examine whether "environmentally sensitive" hospitals are more internally complex than "environmentally insensitive" hospitals. Results show that environmentally sensitive and insensitive hospitals differed on three of the measures of internal complexity: goal complexity, strategic complexity, and relational complexity.
Subject(s)
Hospital Administration/statistics & numerical data , Organizational Innovation , Social Environment , Chief Executive Officers, Hospital , Data Collection , Decision Making, Organizational , Health Care Surveys/methods , Interdepartmental Relations , Interprofessional Relations , Models, Organizational , Organizational Objectives , Surveys and Questionnaires , TexasABSTRACT
Traditional approaches to competition may be inappropriate for healthcare providers. Neoclassical economics makes the implicit assumption that a single actor embodies consumption, compensation, and benefit from a transaction. In healthcare, this assumption does not hold. Instead, such actions are accomplished by three separate actors--consumers (physicians), customers (third-party payers), and clients (patients). A hospital simultaneously competes in three arenas. Hospitals compete for physicians along a technological dimension. Competition for third-party payers takes on a financial dimension. Hospitals compete for patients along a marketing dimension. Because of the complex marketplace interactions among hospital, patient, physician, and third-party payer, the role of price in controlling behavior is difficult to establish. The dynamics underlying the hospital selection decision--that is, the decision maker's expectations of services and the convenience of accessing services--must also be considered. Healthcare managers must understand the interrelationships involved in the three-pronged competitive perspective for several reasons. This perspective clarifies the multiple facets of competition a hospital faces. It also disentangles the actions previously fulfilled by the traditional single buyer. It illuminates the critical skills underlying the competition for each audience. Finally, it defines the primary criterion each audience uses in sorting among hospitals. Recognition of the multifaceted nature of competition among healthcare providers will help demystify market behavior and thereby improve internal organizational communication systems, managers' ability to focus on appropriate activities, and the hospital's ability to adapt to changing market conditions.
Subject(s)
Consumer Behavior/economics , Economic Competition/classification , Hospitals, Religious/economics , Multi-Institutional Systems/economics , Catholicism , Insurance Carriers , Marketing of Health Services , Patient Satisfaction , Physicians , United StatesABSTRACT
In this study of 14 effective nursing homes, patterns of participation were found to be different from those proposed by traditional organizational theories; environmental turbulence was positively correlated with participation in decision making by RNs and negatively correlated with participation by LVNs. The findings suggest that RNs are the focus of information processing when environmental turbulence is high. Information processing and decision-making theories are used to explain the results describing the theoretical implications of relevant characteristics of nursing practice settings.
Subject(s)
Decision Making , Health Facility Environment/standards , Interior Design and Furnishings/standards , Nurse Administrators/psychology , Nursing Homes/standards , Nursing Staff/psychology , Humans , Nursing Administration Research , Nursing Homes/organization & administration , TexasABSTRACT
Because of the wide diversity among health care organizations, interorganizational relationships (IORs) among them are difficult to manage. This article describes three case studies that, taken together, suggest that IOR performance is related to IOR development processes. Specifically, IOR performance is related to the way managers process information to manage uncertainty and ambiguity.
Subject(s)
Decision Support Techniques , Hospital Administration/methods , Organizational Affiliation , Chief Executive Officers, Hospital , Communication , Data Collection/methods , Decision Making, Organizational , Health Services Research/methods , Hospital Administration/standards , Humans , Leadership , New England , Ownership , Planning TechniquesABSTRACT
An exploratory study examined variation in the participation of physicians in hospital strategic decision making as a function of (1) strategic decision content or (2) hospital strategy, or both. The findings revealed that who participates is a function of decision content while how physicians participate is a function of decision content and the interaction of decision content and hospital strategy.
Subject(s)
Decision Making, Organizational , Hospital Planning/organization & administration , Physician's Role , Decision Theory , Humans , Interprofessional Relations , Marketing of Health Services , Organizational Objectives , Planning TechniquesABSTRACT
In this study of 162 hospitals, it was found that the chief executive officer's (CEO's) interpretation of strategic issues is related to the existing hospital strategy and the hospital's information processing structure. Strategy was related to interpretation in terms of the extent to which a given strategic issue was perceived as controllable or uncontrollable. Structure was related to the extent to which an issue was defined as positive or negative, was labeled as controllable or uncontrollable, and was perceived as leading to a gain or a loss. Together, strategy and structure accounted for a significant part of the variance in CEO interpretations of strategic events. The theoretical and managerial implications of these findings are discussed.
Subject(s)
Decision Making, Organizational , Hospital Administration , Hospital Administrators/psychology , Institutional Management Teams , Perception , Humans , Organizational Culture , Philosophy , Planning Techniques , Product Line Management , Research Design , Statistics as Topic , Surveys and Questionnaires , TexasABSTRACT
A new study performed in conjunction with THA uncovers how different types of hospitals involve physicians in strategic planning and operations decisions, and how they can do a better job of getting doctors to play a role in making key decisions.
