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Advances in Health Care Management
Type: Book
ISBN: 978-0-76230-684-8

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Book part
Publication date: 4 October 2012

Lawton Robert Burns, Douglas R. Wholey, Jeffrey S. McCullough, Peter Kralovec and Ralph Muller

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…

Abstract

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.

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Annual Review of Health Care Management: Strategy and Policy Perspectives on Reforming Health Systems
Type: Book
ISBN: 978-1-78190-191-5

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Book part
Publication date: 4 October 2012

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Annual Review of Health Care Management: Strategy and Policy Perspectives on Reforming Health Systems
Type: Book
ISBN: 978-1-78190-191-5

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Book part
Publication date: 20 December 2000

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Advances in Health Care Management
Type: Book
ISBN: 978-0-76230-684-8

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Book part
Publication date: 25 March 2010

Terry L. Amburgey

Every paper needs a theme. Luckily, the venue defines the theme for me; how did the initial conditions at Stanford affect the development and diffusion of population…

Abstract

Every paper needs a theme. Luckily, the venue defines the theme for me; how did the initial conditions at Stanford affect the development and diffusion of population ecology as a theoretical research program. I use the term theoretical research program reluctantly, especially considering the context of the department of sociology at Stanford University during the 1970s and 1980s (Lakatos & Musgrave, 1970). Nonetheless, I believe that population ecology can be usefully described as such. It is not a theory but rather a collection of theories developing over time with progressive problem shifts. There are methodological rules that define what paths of research to pursue and to avoid (Pfeffer, 1993, p. 613).

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Stanford's Organization Theory Renaissance, 1970–2000
Type: Book
ISBN: 978-1-84950-930-5

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Article
Publication date: 1 April 2005

Deondra S. Conner and Scott C. Douglas

This paper offers a model that illustrates the relationship between organizational structure, work stress and perceived strain based on the concept of bureaucratic orientation.

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Abstract

Purpose

This paper offers a model that illustrates the relationship between organizational structure, work stress and perceived strain based on the concept of bureaucratic orientation.

Design/methodology/approach

After a brief review of the stress and structure literatures, a number of propositions are developed concerning organizationally‐induced stressors that are fostered by mechanistic or organic structures. Next, a model is presented illustrating the impact of members' bureaucratic orientation on the organizationally induced stressor‐strain relationship.

Findings

It is argued that highly‐mechanized structures manifest different stressors for employees from highly organic structures. The model also demonstrates how organizationally‐induced stressors such as role conflict and ambiguity mediate the relation between structure and strain. However, the extent to which these stressors result in perceived strain is also dependent on employees' predisposition toward dominance, autonomy, achievement, ambiguity and control. Based on the model and propositions presented, conclusions and suggestions for future research are provided.

Practical implications

Noted implications include more flexible workplace rules for female executives to eliminate stress associated with work‐family conflict as well as improved effectiveness of social support and person‐organization fit based on individual bureaucratic orientation.

Originality/value

This paper uniquely advocates consideration of employee bureaucratic orientation and organizational structure in relation to person‐organization fit and work stress. The propositions offered are of value to practitioners and researchers due to their implications for fostering person‐organization fit and reducing work stress.

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Personnel Review, vol. 34 no. 2
Type: Research Article
ISSN: 0048-3486

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Article
Publication date: 1 March 2003

Wendy L. Hassett and Douglas J. Watson

An annual citizen survey can be a valuable component of the municipal budgeting process for cities that elect to institutionalize the process as a way to translate citizen…

Abstract

An annual citizen survey can be a valuable component of the municipal budgeting process for cities that elect to institutionalize the process as a way to translate citizen feedback into budgetary priorities. This article explores uses of citizen surveys in identifying latent needs of the community that may not be detected through public hearings or other citizen participation methods. The authors suggest that properly developed and conducted citizen surveys can provide decision-makers with research data that will lead to more responsive public spending and debt financing decisions. The article concludes with a case study of Auburn, Alabama, a city that has successfully used citizen surveys in its budgeting system for the past seventeen years.

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Journal of Public Budgeting, Accounting & Financial Management, vol. 15 no. 4
Type: Research Article
ISSN: 1096-3367

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Book part
Publication date: 1 December 2004

LuAnne R. Johnson and David Knoke

We construct a theory of team collaboration to explain how social actors activate their network ties to gain access to and acquire the use of social capital held by other…

Abstract

We construct a theory of team collaboration to explain how social actors activate their network ties to gain access to and acquire the use of social capital held by other network actors. Drawing from weak-strong tie theory and closure-brokerage models of network structures, our theory specifies dynamic processes in which relations vary in their potential for activation, and thus, project teams have differential probabilities of mobilizing and gaining collective use of the varied resources held by their network alters inside and outside the team. The theoretical scope is interorganizational team whose members are employed by two partnering organizations and are assigned to a joint project with a single task or goal to be accomplished within a limited period. We present and discuss a set of propositions about factors that affect the ability of a team to access its members’ social capital for use in a project task.

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Complex Collaboration: Building the Capabilities for Working Across Boundaries
Type: Book
ISBN: 978-1-84950-288-7

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Book part
Publication date: 1 December 2004

Kenneth W. Koput and Walter W. Powell

In this chapter, we make the argument that science-based firms in the life sciences are expected to actively expand the volume and scope of collaborations, and broaden the…

Abstract

In this chapter, we make the argument that science-based firms in the life sciences are expected to actively expand the volume and scope of collaborations, and broaden the kinds of partners with whom they collaborate, as they grow larger, older, and become successful. We base our arguments on a general process of organizational learning in which organizations with diverse ties are exposed to a broader stock of knowledge, heterogeneity in the portfolio of collaborators facilitates innovation, and repeat contracting enables organizations to deepen their protocols for the exchange of information and resources. We draw from these ideas the conclusion that interfirm collaboration is not a transitional stage, or stepping stone, to success or maturity, but a significant organizational practice in technologically advanced fields. Extending this argument, we suggest this strategy of interfirm collaboration represents neither dependency nor specialization but an alternative way of accessing knowledge and resources.

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Complex Collaboration: Building the Capabilities for Working Across Boundaries
Type: Book
ISBN: 978-1-84950-288-7

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Article
Publication date: 1 October 1987

Li‐teh Sun

Contemporary American economists are almost universally proud of their contribution to the enhancement of human welfare. They will readily and honestly dismiss the once…

Abstract

Contemporary American economists are almost universally proud of their contribution to the enhancement of human welfare. They will readily and honestly dismiss the once famous nickname of economics, the dismal science. However, despite the fact that the United States economic growth in the past has been impressive, the individual actor in the economic world appears to remain a dismal creature. “Dismal” not in the Malthusian sense of population trap, but in the sense that the actor never seems to be satisfied with what he has — even though what he has has greatly increased. In other words, economic man did collectively generate the wealth of the nation, but the increased wealth does not seem to have led the majority of people individually to a more satisfying life. In the meantime, economists have begun to focus on Democracy in Deficit, The Economy in Deficit, and America's Great Consumption Binge.

Details

International Journal of Social Economics, vol. 14 no. 10
Type: Research Article
ISSN: 0306-8293

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