ABSTRACT
OBJECTIVE: To conceptualize community orientation-defined as the generation, dissemination, and use of community health-need intelligence-as a strategic response to environmental pressures, and to test a theoretically justified model of the predictors of community orientation in hospitals. DATA SOURCES: The analysis used data for 4,578 hospitals obtained from the 1994 and 1995 American Hospital Association (AHA) Annual Survey and the 1994 Medicare Hospital Cost Report data sets. Market-level data came from the Area Resource File. STUDY DESIGN: Multiple regression analysis was used to examine the effects of hospital size, dependence on managed care, ownership, network, system and alliance memberships, and level of diffusion of community-orientation practices in the area on the degree of community orientation in hospitals. The model, based on Oliver's (1991) framework of organizational responsiveness to environmental pressures, controlled for the effects of industry concentration and lagged profitability. PRINCIPAL FINDINGS: Degree of community orientation is significantly related to hospital size; ownership; dependence on managed care; and membership in a network, system, or alliance. It is also significantly related to the diffusion of community-orientation practices among other area hospitals. CONCLUSIONS: Degree of community orientation is influenced by the nature of environmental pressures and by hospital interests. It is higher in hospitals that are large, nonprofit, or members of a network, system, or alliance; in hospitals that are more dependent on managed care; and in hospitals that operate in areas with higher diffusion of community-orientation activities.
Subject(s)
Community Health Planning/organization & administration , Community-Institutional Relations , Hospital Administration/statistics & numerical data , Needs Assessment/organization & administration , American Hospital Association , Data Collection , Diffusion of Innovation , Factor Analysis, Statistical , Health Facility Size/statistics & numerical data , Health Services Research , Hospital Administration/classification , Humans , Managed Care Programs/organization & administration , Medicare , Organizational Affiliation/statistics & numerical data , Organizational Policy , Ownership/statistics & numerical data , Regression Analysis , United StatesABSTRACT
Employee reactions to managed care get less managerial and research attention than organizational reactions to it. This article examines the manner in which health services employees react to managed care and finds that their reaction affects perceived job insecurity, organizational commitment, and job satisfaction. Organization-based self-esteem, role conflict, and supervisory support moderate these relationships. The managerial implications of these findings are discussed.
Subject(s)
Attitude of Health Personnel , Attitude to Health , Managed Care Programs/organization & administration , Personnel, Hospital/psychology , Conflict, Psychological , Humans , Job Satisfaction , Models, Psychological , New England , Personnel Loyalty , Regression Analysis , Role , Self Concept , Social Support , Surveys and QuestionnairesABSTRACT
The management of community health needs has become a focal point in the drive to contain health care costs, enhance service quality, and improve access to care. This article presents a concept of community orientation that health services organizations can use to provide community-focused care. It also discusses the organizational antecedents and consequences of community orientation in health services organizations and develops research propositions.
Subject(s)
Community Health Planning/organization & administration , Community Participation , Health Care Coalitions/organization & administration , Health Services Needs and Demand/organization & administration , Community Health Planning/economics , Cost Control/organization & administration , Health Care Coalitions/economics , Health Plan Implementation/economics , Health Plan Implementation/organization & administration , Health Priorities/economics , Health Priorities/organization & administration , Health Services Accessibility/economics , Health Services Accessibility/organization & administration , Health Services Needs and Demand/economics , Health Services Research , Humans , Organizational Innovation , Quality Assurance, Health Care/economics , Quality Assurance, Health Care/organization & administration , United StatesABSTRACT
The management of a health care system requires making decisions and establishing policies that can affect the process of patient care. Clinicians often complain that these decisions and policies are made by people without clinical training. Clinical knowledge is not a prerequisite for a career in health policy or management. Even graduates of accredited health administration programs are not required to understand the process of clinical decision making or the nature of medical practice. Much of the health services literature advocates a shared decision-making model for clinicians and managers. However, most of the literature focuses on how to involve physicians in management decision making; almost none discusses management involvement in clinical decisions. This paper briefly examines how non-clinician managers can support the clinical decision-making process and then specifies the knowledge and skills required for them to play this role.
Subject(s)
Clinical Medicine/standards , Decision Making, Organizational , Decision Making , Hospital Administrators , Hospital-Physician Relations , Medical Staff, Hospital , Clinical Medicine/education , Efficiency, Organizational , Goals , Humans , Organizational Objectives , Patient Care Planning/standards , Physician-Patient Relations , Practice Patterns, Physicians' , Professional Autonomy , Professional Competence , Quality Assurance, Health Care , United StatesABSTRACT
Health care organizations can avoid substantial turnover costs through retention strategies geared to the varying needs of employees. The study on which this article is based examined retention needs of registered nurses in nursing homes and found that they varied by tenure. Low tenure nurses preferred learning opportunities and advancement potential while high tenure nurses favored work flexibility. Implications for retention policy in nursing homes are discussed.
Subject(s)
Nursing Homes , Nursing Staff/psychology , Nursing Staff/supply & distribution , Personnel Turnover , Adult , Analysis of Variance , Attitude of Health Personnel , Career Mobility , Factor Analysis, Statistical , Humans , Job Satisfaction , Middle Aged , Nursing Administration Research , Organizational Culture , Surveys and Questionnaires , Time Factors , WorkforceABSTRACT
Applicant attraction theories stipulate that employment inducements be customized to meet the desires and specific characteristics of potential applicants. This study examined the relationship between nurses' level of work experience and perceived importance of organization and job attributes in attracting them to nursing home jobs. Importance ratings of recruitment factors varied significantly by nurses' level of work experience. Unique variation was attributed to education opportunities, potential for career advancement, compensation issues, benefits, and work flexibility.
Subject(s)
Attitude of Health Personnel , Nursing Homes , Nursing Staff/psychology , Personnel Selection/methods , Professional Practice Location , Analysis of Variance , Career Mobility , Clinical Competence/standards , Factor Analysis, Statistical , Humans , Job Satisfaction , Nursing Administration Research , Nursing Staff/supply & distribution , Surveys and Questionnaires , United States , WorkforceABSTRACT
Market and regulatory pressures are requiring health care organizations to find new ways to compete. This article introduces the concept of time-based competition, a strategy adopted by firms in the manufacturing sector to strengthen their competitive positions, as a new strategy for health care organizations. The Just-in-Time technique and set-up time reduction activities are used to demonstrate the adoption of this paradigm by health care organizations. A case study comparing the movement of elderly patient through the health care delivery system under traditional and time-based competition practices is used to illustrate gains from adopting the new paradigm.
Subject(s)
Economic Competition , Health Care Sector , Case Management , Continuity of Patient Care/economics , Continuity of Patient Care/organization & administration , Cost Control , Critical Pathways , Health Services Research , Information Services , Quality of Health Care , Time Factors , United StatesABSTRACT
Hospitals have been advised to respond to environmental pressures by changing from a product to a market orientation. Such changes are difficult to accomplish because of the entrenched behaviors and attitudes of hospitals employees. This article proposes organizational cultures as the avenue to a market orientation. It describes the role of hospital culture as an antecedent to market orientation. It also suggests ways to develop and maintain a market-oriented culture in hospitals.
Subject(s)
Hospital Administration/trends , Marketing of Health Services/organization & administration , Organizational Culture , Attitude of Health Personnel , Behavior Therapy , Consumer Behavior , Humans , Interdepartmental Relations , Interpersonal Relations , Interprofessional Relations , Marketing of Health Services/standards , Models, Organizational , Personnel, Hospital/psychology , Personnel, Hospital/standards , United StatesABSTRACT
Insufficient attention to organizational issues has prevented outcomes management from achieving its full potential. This article examines the impact of structural, cultural, and cognitive factors on outcomes management. Organic structures differ from mechanistic ones in regard to the organization and implementation of the outcomes management function. Organizational cultures determine the degree of acquisition, sharing, and use of outcomes information by organization members. Cognitive factors affect the level of member compliance with outcomes management initiatives. This article also discusses managerial implications and develops research propositions.