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.

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).

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.

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.

One of the lessons learned from the recent financial-sector crisis is that institutions may sometimes sow the seeds of their own destruction. We offer a two-tiered analysis of how the diffusion of innovative practices – in this case, issuing and securitizing subprime mortgages – can lead to an unanticipated breakdown of established institutions. At the institutional level, we demonstrate that the lack of effective external regulatory presence, the emergence of new norms through the introduction of a new institutional logic, and intense mimetic and competitive pressures may lead organizational actors to exploit a suboptimal innovation. At the organizational level, we argue that over-embeddedness of central actors within relatively closed networks and superstitious learning processes can exacerbate the biases to which decision makers are susceptible, leading to the institutionalization of a suboptimal organizational practice. These two parallel sets of processes led to severe consequences at the institutional level, which we label “terminal isomorphism.” We end by discussing consequences for institutional theory, future research directions, and recommendations for policy makers.

Purpose – To develop a framework for studying financial incentive program implementation mechanisms, the means by which physician practices and physicians translate incentive program goals into their specific office setting. Understanding how new financial incentives fit with the structure of physician practices and individual providers’ work may shed some insight on the variable effects of physician incentives documented in numerous reviews and meta-analyses.

Design/Methodology/Approach – Reviewing select articles on pay-for-performance evaluations to identify and characterize the presence of implementation mechanisms for designing, communicating, implementing, and maintaining financial incentive programs as well as recognizing participants’ success and effects on patient care.

Findings – Although uncommonly included in evaluations, evidence from 26 articles reveals financial incentive program sponsors and participants utilized a variety of strategies to facilitate communication about program goals and intentions, to provide feedback about participants’ progress, and to assist practices in providing recommended services. Despite diversity in programs’ geographic locations, clinical targets, scope, and market context, sponsors and participants deployed common strategies. While these methods largely pertained to communication between program sponsors and participants and the provision of information about performance through reports and registries, they also included other activities such as efforts to engage patients and ways to change staff roles.

Limitations – This review covers a limited body of research to develop a conceptual framework for future research; it did not exhaustively search for new articles and cannot definitively link particular implementation mechanisms to outcomes.

Practical Implications – Our results underscore the effects implementation mechanisms may have on how practices incorporate new programs into existing systems of care which implicates both the potential rewards from small changes as well as the resources which may be required to obtain buy-in and support.

Originality/Value – We identify gaps in previous research regarding actual changes occurring in physician practices in response to physician incentive programs. We offer suggestions for future evaluation by proposing a framework for understanding implementation. Our model will assist future scholars in translating site-specific experiences with incentive programs into more broadly relevant guidance for practices by facilitating comparisons across seemingly disparate programs.