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This study tests the contingency theory proposition that a nursing facility's strategy moderated by its management structure improves performance. Strategy is modeled in terms of degree of innovation; while structure is modeled as organic versus mechanistic. Payor mix, measured as the proportion of Medicaid residents, is used as an indicator of financial performance. Facilities in eight states comprise the sample (N = 308). The data are analyzed via hierarchical moderated regression analysis. The primary finding is that facilities that are both innovative and have an organic structure are more likely to have a lower proportion of Medicaid residents, an indicator of stronger financial performance.

Deficiencies in the theory and practice of Total Quality Management (TQM) and challenges to its succesful implementation in healthcare organizations are examined in the context of TQM's strict systems-level focus. Theoretical and empirical work in organizational behavior is offered as a means to improve healthcare management practice in the area of Total Quality Management. Research on goal setting and, specifically, the use of proximal learning goals is offered as a way to address the gap created by motivational inadequacies in TQM theory. Finally, evidence of the lack of technical TQM knowledge in healthcare organizations is presented and goal-setting theory is applied to that particular challenge in TQM practice.

While both health services and management research have been discussed in different literature streams in recent years, there has been no research on how scholars who conduct health care management research view the research process. How do they conceptualize it: what are the dominant themes? The present study is the first to examine the research process from the perspective of the health care management researcher. Focus group meetings were held during the Health Care Management Division's pre-conference workshop at the 1996 Academy of Management meeting. In these meetings, a nominal group technique method was employed to get participants to generate attributes that were personally salient in terms of what “research” meant to them. Thirty distinct attributes were eventually derived, and these were inscribed onto sets (decks) of thirty index cards.

Professions are loose aggregations of practitioners and professional associations that are involved in dynamic and often conflictual relationships with buyers, regulators, teachers/researchers, substitutes, and suppliers. Professions manage their adaptation to environmental change through these linkages. Health professions in the past two decades have been challenged to show resilience and adaptability, particularly in their new, closer interdependence with buyer organizations. As organizations manage the production processes of professionals in new ways, professions are both reshaped and reshape the organizations with which they work. Those organizations that balance organizational and professional interests are likely to be more effective in the new marketplace.

Competition in the managed care industry has intensified as the industry has reached maturity. The current competitive environment of the industry and an increasing industry-wide ephasis on cost containment have resulted in declining profits, lower levels of member satisfaction, and increasing member disenrollment. Many health maintenance organizations (HMOs) have begun to reorient their approach to competitive advantage in the industry by offering theiry members open access to specialits. HMO executives believe that open access will reduce the degree of differentiation achieved by free-for-service (FFS) plans and thereby will allow HMOs to attract additional employers and members away from FFS plans and to improve overall member retention. Unfortunately, there is no empirical evidence to support this assumption. This study is the first empirical test of the strategic importance of member autonomy and open access in a managed care environment. The study expands the model of consumer satisfaction with a health care system proposed by Luft 1981 and tested by Mummalaneni and Gopalakrishna 1997 and incorporates Porter's 1980 theory of competition in mature industries. The model utilized in this study assesses the relative importance of autonomy in selecting specialists (open access), service convenience, value/pricing, and HMO resources on member satisfaction with care and intentions to remain with the HMO. Results show that all four factors significantly influence satisfaction and that subsequently, satisfaction influences intentions to remain enrolled in the plan. In addition, the importance of autonomy is demonstrated by significant direct and indirect paths to intentions to remain in the plan.

This paper presents a study which goes beyond the process of constructing performance measures in hospital Intensive Care Units (ICUs). The making of input-output measures in ICUs should be based on richer information than statistics normally found in the hospitals' patient administrative systems. A study of national sample of ICUs was conducted in Norwegian hospitals to analyse the relations between abstract and more concrete measures of unit performance. We found that there are not necessarily conflicts between abstract perceptional measures and more concrete efficiency measures in high-reliability organisations like ICUs. Reliable performance requires a well-developed collective mind to form an attentive, complex system tied together by trust. To improve health care management more attention should be directed towards the practical implications of the interrelationships between different elements of performance measures.

The health care industry involves the continual introduction of new clinical interventions and technologies designed to improve patient and business outcomes. This article argues for the integration of two possible improvement strategies, namely the use of work groups to generate and implement new ideas and the development of leadership capacity to promote innovativeness in others. A longitudinal study of 45 groups of employees at a specialist metropolitan teaching hospital revealed that the adoption of transformational styles of leadership in the workplace influences innovation by producing high levels of group morale that, in turn, results in work group interventions having measurable benefit to patients.