Search results

Purpose – Research on hospital system organization is dated and cross-sectional. We analyze trends in system structure during 2000–2010 to ascertain whether they have become more centralized or decentralized.

Design/Methodology/Approach – We test hypotheses drawn from organization theory and estimate empirical models to study the structural transitions that systems make between different “clusters” defined by the American Hospital Association.

Findings – There is a clear trend toward system fragmentation during most of this period, with a small recent shift to centralization in some systems. Systems decentralize as they increase their members and geographic dispersion. This is particularly true for systems that span multiple states; it is less true for smaller regional systems and local systems that adopt a hub-and-spoke configuration around a teaching hospital.

Research Limitations – Our time series ends in 2010 just as health care reform was implemented. We also rely on a single measure of system centralization.

Research Implications – Systems that appear to be able to centrally coordinate their services are those that operate in local or regional markets. Larger systems that span several states are likely to decentralize or fragment.

Practical Implications – System fragmentation may thwart policy aims pursued in health care reform. The potential of Accountable Care Organizations rests on their ability to coordinate multiple providers via centralized governance. Hospitals systems are likely to be central players in many ACOs, but may lack the necessary coherence to effectively play this governance role.

Originality/Value – Not all hospital systems act in a systemic manner. Those systems that are centralized (and presumably capable of acting in concerted fashion) are in the minority and have declined in prevalence over most of the past decade.

Extensions/applications/revisions of the Marxian vision of socialism can broadly be categorized into two polar strands: the centralized and the decentralized strands of socialist economic systems. Explores the main postulates of a decentralized version of a socialist economic system as provided by Kautsky, Luxembourg, Bernstein, Bukharin and Lange. The centralized strand of socialist economic systems has been elaborated drawing mainly from the writings of Lenin, Trotsky, Dobb, Sweezy and Baran.

The purpose of this paper is to investigate driving factors that improve the project management efficiency (PME) in centralized public procurement systems.

Employees in four public-sector organizations in China were surveyed. The structural equation modeling was employed to examine the relationship amongst those variables.

Organizational culture (OC) is an effective method to improve PME, and employee quality is the most critical factor of OC in this system. Job satisfaction (JS) is another significant contributor to PME and satisfaction with fairness of salary in this system being the key factor of JS. Job analysis (JA) has indirect influence on PME through JS and OC, whereas the job structure in this system is the most critical factor for JA.

An operational way to improve PME is to implement it from the perspectives of employee, organization and technique. At the organizational level, it is imperative to strengthen the OC by a well-structured recruitment system and to improve PME via well-design training. At the person level, both financial (i.e. income and welfare) and career incentives (i.e. promotion opportunities and a sense of belonging) are proposed to achieve employees’ JS to improve PME. At the technique level, JA approach (i.e. job rotation) is recommended to enlarge the positive influence of OC and JS on PME. These can not only ensure the management professionalism in a centralized public procurement system but can also motivate employees and maximize PME.

PME in a centralized public procurement system will be improved by addressing these key factors and their interrelationships. This provides detailed pathways for the centralized public procurement system to achieve better PME via optimal OC and JS and reasonable JA in China. In addition, the institutional and administrative traditions may vary significantly across cities, regions and countries. Therefore, such contextual differences should be taken into consideration for the improvement of PME in a centralized public procurement system.

This paper provides novel empirical evidence on the impact of bank internal organization structure characteristics on costs and productive efficiency. The specific internal organization characteristics examined include centralized versus decentralized 1) decision‐making, 2) service delivery systems, and 3) back‐office operations, e.g. accounting, computing, and advertising, among others. The analysis is conducted using average data drawn from a sample of 118 large US commercial banks for the years 1989 and 1990. The analysis reveals that centralized decision‐making tends to increase costs. Likewise, centralized service delivery systems either increase or have an insignificant impact on costs. In no case was it found that centralized service delivery systems reduce costs as is often envisioned by proponents of centralization. Centralized back‐office operations were found to reduce costs significantly and is consistent with the existence of scale economies in bank back‐office operations.

The purpose of this paper is to critically evaluate the different market‐making systems found in most developed capital markets and to provide guidance to emerging market regulators for a possible implementation of such a system.

The paper looks closely at the market design of seven developed countries focusing on the obligations and privileges of market makers. Through a case study and empirical evidence the paper identifies advantage and disadvantage of a possible implementation of a similar design to an emerging market.

The paper identifies three forms of market making applied today: the quote‐driven, the centralized and non‐centralized systems. Four factors are proposed that regulatory authorities in emerging markets should consider when deciding whether, and which of, the three market‐making systems they should implement. These are: current exchange design and the costs of restructuring, international and domestic investors' sentiment towards the exchange, size of the emerging market and the market designs in countries hosting the target foreign capital.

The paper looks at the implementation of a market‐making system in an emerging market. Further research may investigate other ways of how emerging markets authorities can restructure their markets into more efficient, compatible and trustworthy financial venues in order to attract both domestic and foreign investors.

The area of emerging markets' microstructure design and market quality is still relatively under‐studied. We provide evidence of the challenges and benefits of the implementation of a market‐making system in those markets.

This study aims to examine the economic factors that determine innovation pattern in centralized and decentralized economies and organizations.

Empirical evidence on innovation in the centralized economy of the Soviet Union is reviewed. Existing theoretical literature in this area relies on the incentives of decision-makers in centralized organizations and on the concept of soft budget constraint in centralized command economies and hard budget constraint in market economies. This study advocates applying the hierarchy/polyarchy model of innovation screening to explain the pattern of innovation in centralized economic systems.

Screening and development of innovation projects can be organized in a centralized or decentralized fashion. The differences in innovation between centralized and decentralized economic systems may be explained by elements of the principal-agent theory, the soft budget constraint model, and the theory of decision-making in hierarchies and polyarchies. Empirical evidence shows a sharp slowdown in both innovation and economic growth in the Soviet economy following the economic decision-making reform of 1965. The theoretical explanation most consistent with this evidence is the hierarchy decision-making model.

Comparisons of innovation in centralized and decentralized economies traditionally relied on decision-makers' incentives and the concept of soft budget constraint. Upon analysis of empirical evidence from the centralized Soviet economy, this study advocates explaining innovation patterns based on decision-making theory of hierarchy.

In order to decrease patient waiting time and improve efficiency, healthcare systems in some countries have recently begun to shift away from decentralized systems of patient referral from general practitioners (GPs) to specialists toward centralized ones. From a queueing theory perspective, centralized referral systems can decrease waiting time by reducing the variation in the referral process. However, from a social psychological perspective, a close relationship between referring physician and specialist, which is characteristic of decentralized referral systems, may safeguard against high referral rates; since GPs refer patients directly to the specialists whom they know, they may be reluctant to damage that relationship with an inappropriate referral. The purpose of this paper is to examine the effect upon referral behavior of a relationship between physicians, as is found in a decentralized referral system, vs a centralized referral system, which is characterized by an anonymous GP-specialist relationship. In a controlled experiment where family practice residents made decisions concerning referral to specialists, physicians displaying high confidence referred significantly fewer patients in a close relationship condition than in a centralized referral system, suggesting that for some physicians, referral behavior can be affected by the design of the service system and will, in turn, affect system performance.

The authors used a controlled experiment to test the research hypotheses.

Physicians displaying high confidence referred significantly fewer patients in a close relationship condition than in a centralized referral system, suggesting that for some physicians, referral behavior can be affected by system attributes and will, in turn, affect system performance.

The current study has some limitations, however. First, the sample consisted only of family practice residents and did not have the knowledge and experience of GPs regarding the referral process. Second, the authors used hypothetical patient case descriptions instead of real-world patients. Repeating this experiment with primary care physicians in real setting would be beneficial.

The study indicates that decentralized referral systems may act (rightly or wrongly) as a restraint on the rate of referrals to specialists. Thus, an implementation of a centralized referral system should be expected to produce an increase in referrals simply due to the change in the operational system setup. Even if centralized referral systems are more efficient and can facilitate the referral process by creating a central queue rather than multiple single queues for patients, the removal of social ties such as long-term social relationships that are developed between GPs and specialists in decentralized referral systems may act to counterbalance these theoretical gains.

This study provide support for the idea that non-clinical factors play an important role in referrals to specialists and hence in the quality of provided care, as was suggested by previous studies in this area (Hajjaj et al., 2010; Reid et al., 1999). The design of the service system may inadvertently influence some doctors to refer too many patients to specialists when there is no need for a specialist visit. In high-utilization health systems, this may cause some patients to be delayed (or even denied) in obtaining specialist access. Healthcare systems may be able to implement behavioral-based techniques in order to mitigate the negative consequences of a shift to centralized referral systems. One approach would be to try to create a feeling of close relationship among doctors in centralized referral systems. High communication and frequent interaction among GPs and specialists can boost the feelings of teamwork and personal efficacy through social comparison (Schunk, 1989, 1991) and vicarious learning (Zimmerman, 2000), which can in turn motivate GPs to take control of the patient care process when appropriate, instead of referring patients to specialists.

The authors’ study is the first examining the effect of social relationships between GPs and specialists on the referral patterns. Considering the significant implications of referral decisions on patients, doctors, and the healthcare systems, the study can shed light into a better understanding of the social and behavioral aspects of the referral process.

The purpose of this paper is to investigate the intentional formation of business networks in the wastewater industry. It enriches the theory‐building of the formation of business networks by drawing on theoretical contributions to business networks and capabilities. The paper describes, assesses and predicts scenarios relevant to the formation of business networks in the wastewater industry.

The research methodology employed is based on multiple sources of data in a multi‐method design, interpreting potential scenarios of business networks.

The findings reveal that water scarcity, population growth and economic constrains jeopardize existing business networks in the wastewater industry. Two potential scenarios: re‐inventing the centralized system through on‐site systems for mass‐markets; and expanding on‐site systems into mass‐markets seem realizable. A comparison of the two scenarios suggests that the first scenario is in a superior position to utilize the business opportunities offered.

Research limitations arise from the qualitative nature of the research undertaken.

Capability alignments and barriers suggest that the re‐inventing the centralized system through on‐site systems for mass‐markets scenario, is the most suitable for implementation. The knowledge gained allows managers to outline a specific approach for developing the capabilities required, in order to take advantage of the alignments and overcome the barriers that may exist.

The paper highlights that building theories of business networks may benefit from combining the formation of business networks with dynamic and operational capabilities.

Distributed trust technologies, such as blockchain, propose to permit peer-to-peer transactions without trusted third parties. Yet not all implementations of such technologies fully decentralize. Information professionals make strategic choices about the level of decentralization when implementing such solutions, and many organizations are taking a hybrid (i.e. partially decentralized) approach to the implementation of distributed trust technologies. This paper conjectures that while hybrid approaches may resolve some challenges of decentralizing information governance, they also introduce others. To better understand these challenges, this paper aims first to elaborate a framework that conceptualizes a centralized–decentralized information governance continuum along three distinct dimensions: custody, ownership and right to access data. This paper then applies this framework to two illustrative blockchain case studies – a pilot Brazilian land transfer recording solution and a Canadian health data consent sharing project – to exemplify how the current transition state of blockchain pilots straddles both the old (centralized) and new (decentralized) worlds. Finally, this paper outlines the novel challenges that hybrid approaches introduce for information governance and what information professionals should do to navigate this thorny transition period. Counterintuitively, it may be much better for information professionals to embrace decentralization when implementing distributed trust technologies, as hybrid models could offer the worst of both the centralized and future decentralized worlds when consideration is given to the balance between information governance risks and new strategic business opportunities.

This paper illustrates how blockchain is transforming organizations and societies by highlighting new strategic information governance challenges using our original analytic framework in two detailed blockchain case studies – a pilot solution in Brazil to record land transfers (Flores et al., 2018) and another in Canada to handle health data sharing consent (Hofman et al., 2018). The two case studies represent research output of the first phase of an ongoing multidisciplinary research project focused on gaining an understanding of how blockchain technology generates organizational, societal and data transformations and challenges. The analytic framework was developed inductively from a thematic synthesis of the findings of the case studies conducted under the auspices of this research project. Each case discussed in detail in this paper was chosen from among the project's case studies, as it represents a desire to move away from the old centralized world of information governance to a new decentralized one. However, each case study also represents and embodies a transition state between the old and new worlds and highlights many of the associated strategic information governance challenges.

Decentralization continues to disrupt organizations and societies. New emerging distributed trust technologies such as blockchain break the old rules with respect to the trust and authority structures of organizations and how records and data are created, managed and used. While governments and businesses around the world clearly see value in this technology to drive business efficiency, open up new market opportunities and create new forms of value, these advantages will not come without challenges. For information executives then, the question is not if they will be disrupted, but how. Understanding the how as will be discussed in this paper provides the business know how to leverage the incredible innovation and transformation that decentralized trust technology enables before being leapfrogged by another organization. It requires a change of mindset to consider an organization as one part of a broader ecosystem, and for those who successfully do so, this paper views this as a strategic opportunity for those responsible for strategic information governance to design the future instead of being disrupted by it.

This paper presents a novel analytic framework for strategic information governance challenges as we transition from a traditional world of centralized records and information management to a new decentralized world. This paper analyzes these transitions and their implications for strategic information governance along three trajectories: custody, ownership and right to access records and data, illustrating with reference to our case studies.

This paper predicts a large number of organizations will miss the opportunities of the new decentralized trust world, resulting in a rather major churning of organizations, as those who successfully participate in building the new model will outcompete those stuck in the old world or the extremely problematic hybrid transition state. Counterintuitively, this paper argues that it may be much less complex for information executives to embrace decentralization as fast as they can, as in some ways the hybrid model seems to offer the worst of both the centralized and future decentralized worlds with respect to information governance risks.

This paper anticipates broader societal consequences of the predicted organization churn, in particular with respect to uncertainty about the evidence that records provide for public accountability and contractual rights and entitlements.

Decentralized trust technologies, such as blockchain, permit peer-to-peer transactions without trusted third parties. Of course, such radical shifts do not happen overnight. The current transition state of blockchain pilots straddles both the old and new worlds. This paper presents a theoretical framework categorizing strategic information governance challenges on a spectrum of centralized to decentralized in three primary areas: custody, ownership and right to access records and data. To illustrate how decentralized trust is transforming organizations and societies, this paper presents these strategic information governance challenges in two blockchain case studies – a pilot Brazilian land transfer recording solution and a Canadian health data consent sharing project. Drawing on the theoretical framework and case studies, this paper outlines what information executives should do to navigate this thorny transition period.

Using a document analysis methodology, the study analyzes official policy documents produced by the centralized Israeli Ministry of Education and by the State Comptroller responsible for reviewing the Israeli government's policies and operations. Coordination is assessed using three lenses: coordination among policy plans initiated by different governmental ministries; coordination among policy plans initiated by the Ministry of Education; and coordination within policy plans, referring to the congruence among various components comprising a particular policy.

Following previous studies testifying to the significance of coordination for organizational effectiveness and to the contribution of centralized structures for coordination, the current study attempts to assess whether centralized complex educational systems exhibit coordination among their articulated policy plans.

In spite of the highly centralized nature of Israeli governance, coordination among policy plans articulated by different governmental ministries is limited. This also applies to the coordination found among various educational policy plans or among various components comprising particular policy plans articulated by the Ministry of Education.

While centralized structures produce administrative bottlenecks creating ideal grounds for coordination, it appears that the assumed connection between centralization and coordination may not be applicable to educational systems and that coordination among and within policy plans in complex systems is not a zero-sum game. Implications are further discussed.