HEALTH MAINTENANCE ORGANIZATION ENVIRONMENT: AN EMPIRICAL STUDY OF THE RELATIONSHIP OF EXTERNAL CONTEXT AND PERFORMANCE

The research project is an extension of a series of administrative science and health care research projects evaluating the influence of external context, organizational strategy, and organizational structure upon organizational success or performance. The research will rely on the assumption that there is not one single best approach to the management of organizations (the contingency theory). As organizational effectiveness is dependent on an appropriate mix of factors, organizations may be equally effective based on differing combinations of factors. The external context of the organization is expected to influence internal organizational strategy and structure and in turn the internal measures affect performance (discriminant theory). The research considers the relationship of external context and organization performance.^ The unit of study for the research will be the health maintenance organization (HMO); an organization the accepts in exchange for a fixed, advance capitation payment, contractual responsibility to assure the delivery of a stated range of health sevices to a voluntary enrolled population. With the current Federal resurgence of interest in the Health Maintenance Organization (HMO) as a major component in the health care system, attention must be directed at maximizing development of HMOs from the limited resources available. Increased skills are needed in both Federal and private evaluation of HMO feasibility in order to prevent resource investment and in projects that will fail while concurrently identifying potentially successful projects that will not be considered using current standards.^ The research considers 192 factors measuring contextual milieu (social, educational, economic, legal, demographic, health and technological factors). Through intercorrelation and principle components data reduction techniques this was reduced to 12 variables. Two measures of HMO performance were identified, they are (1) HMO status (operational or defunct), and (2) a principle components factor score considering eight measures of performance. The relationship between HMO context and performance was analysed using correlation and stepwise multiple regression methods. In each case it has been concluded that the external contextual variables are not predictive of success or failure of study Health Maintenance Organizations. This suggests that performance of an HMO may rely on internal organizational factors. These findings have policy implications as contextual measures are used as a major determinant in HMO feasibility analysis, and as a factor in the allocation of limited Federal funds. ^

COMPARISON OF THE ORGANIZATIONAL STRUCTURES AND EFFECTIVENESS OF THE INVESTOR-OWNED AND VOLUNTARY MULTIHOSPITAL SECTORS

Objectives. The central objective of this study was to systematically examine the internal structure of multihospital systems, determining the management principles used and the performance levels achieved in medical care and administrative areas.^ The Universe. The study universe consisted of short-term general American hospitals owned and operated by multihospital corporations. Corporations compared were the investor-owned (for-profit) and the voluntary multihospital systems. The individual hospital was the unit of analysis for the study.^ Theoretical Considerations. The contingency theory, using selected aspects of the classical and human relations schools of thought, seemed well suited to describe multihospital organization and was used in this research.^ The Study Hypotheses. The main null hypotheses generated were that there are no significant differences between the voluntary and the investor-owned multihospital sectors in their (1) hospital structures and (2) patient care and administrative performance levels.^ The Sample. A stratified random sample of 212 hospitals owned by multihospital systems was selected to equally represent the two study sectors. Of the sampled hospitals approached, 90.1% responded.^ The Analysis. Sixteen scales were constructed in conjunction with 16 structural variables developed from the major questions and sub-items of the questionnaire. This was followed by analysis of an additional 7 structural and 24 effectiveness (performance) measures, using frequency distributions. Finally, summary statistics and statistical testing for each variable and sub-items were completed and recorded in 38 tables.^ Study Findings. While it has been argued that there are great differences between the two sectors, this study found that with a few exceptions the null hypotheses of no difference in organizational and operational characteristics of non-profit and for-profit hospitals was accepted. However, there were several significant differences found in the structural variables: functional specialization, and autonomy were significantly higher in the voluntary sector. Only centralization was significantly different in the investor owned. Among the effectiveness measures, occupancy rate, cost of data processing, total manhours worked, F.T.E. ratios, and personnel per occupied bed were significantly higher in the voluntary sector. The findings indicated that both voluntary and for-profit systems were converging toward a common hierarchical corporate management approach. Factors of size and management style may be better descriptors to characterize a specific multihospital group than its profit or nonprofit status. (Abstract shortened with permission of author.) ^

The relationship between hospital financial performance and information technology integration strategy selection

In light of the new healthcare regulations, hospitals are increasingly reevaluating their IT integration strategies to meet expanded healthcare information exchange requirements. Nevertheless, hospital executives do not have all the information they need to differentiate between the available strategies and recognize what may better fit their organizational needs. ^ In the interest of providing the desired information, this study explored the relationships between hospital financial performance, integration strategy selection, and strategy change. The integration strategies examined – applied as binary logistic regression dependent variables and in the order from most to least integrated – were Single-Vendor (SV), Best-of-Suite (BoS), and Best-of-Breed (BoB). In addition, the financial measurements adopted as independent variables for the models were two administrative labor efficiency and six industry standard financial ratios designed to provide a broad proxy of hospital financial performance. Furthermore, descriptive statistical analyses were carried out to evaluate recent trends in hospital integration strategy change. Overall six research questions were proposed for this study. ^ The first research question sought to answer if financial performance was related to the selection of integration strategies. The next questions, however, explored whether hospitals were more likely to change strategies or remain the same when there was no external stimulus to change, and if they did change, they would prefer strategies closer to the existing ones. These were followed by a question that inquired if financial performance was also related to strategy change. Nevertheless, rounding up the questions, the last two probed if the new Health Information Technology for Economic and Clinical Health (HITECH) Act had any impact on the frequency and direction of strategy change. ^ The results confirmed that financial performance is related to both IT integration strategy selection and strategy change, while concurred with prior studies that suggested hospital and environmental characteristics are associated factors as well. Specifically this study noted that the most integrated SV strategy is related to increased administrative labor efficiency and the hybrid BoS strategy is associated with improved financial health (based on operating margin and equity financing ratios). On the other hand, no financial indicators were found to be related to the least integrated BoB strategy, except for short-term liquidity (current ratio) when involving strategy change. ^ Ultimately, this study concluded that when making IT integration strategy decisions hospitals closely follow the resource dependence view of minimizing uncertainty. As each integration strategy may favor certain organizational characteristics, hospitals traditionally preferred not to make strategy changes and when they did, they selected strategies that were more closely related to the existing ones. However, as new regulations further heighten revenue uncertainty while require increased information integration, moving forward, as evidence already suggests a growing trend of organizations shifting towards more integrated strategies, hospitals may be more limited in their strategy selection choices.^

Improving manufacturing performance by standardization of interprocess communication

A number of environmental forces such as increasing value chain network complexity, decreasing product life-cycle cost, and time-to-market requirements or increasing product complexity act upon manufacturing organizations, enhancing the acute need for organizational routines that foster efficient and effective communication between processes. Such organizational routines erode quickly in the absence of common standards for knowledge sharing, that is why successful manufacturing systems benefit from interprocess standardization. The purpose of this paper is to offer a standardization model of interprocess communication that increases manufacturing operational performance (MOP). First, we propose a novel holistic model that makes standardized interprocess communication possible in manufacturing organizations. Second, we propose a model for quantifying the implications of standardizing interprocess communication upon MOP. Finally, as a matter of application, we show the results of its successful implementation in one Japanese manufacturing organization.

Performing the personal within the organizational: Communicating professional identities through Taiwanese commercial airline pilots' personal narratives

This dissertation project explored professionalism and the performance of identities by examining Taiwanese commercial airline pilots' discursive practices in everyday life. The intentions for this project were to not only expand current knowledge of organizational communication from a critical rhetorical perspective, but to further explore the under-appreciated concept of professionalism of organizational members. Theoretically, I traced theoretical analysis in the sociology of professions and further investigated scholarship from identity research in organizational communication studies. This research agenda helped to advance communication-based understandings of the meanings and practices of professional identity as a complement to the sociological conception. I further merged a performance paradigm and critical rhetorical perspective to examine the discursive practices of organizational members and to challenge the bias of traditional textual approaches. Methodologically, I conducted ethnographic interviews with Taiwanese commercial airline pilots in order to understand how they construct their personal, social, and professional identities. Five narrative themes were identified and demonstrated in this project: (1) It takes a lot to become a commercial airline pilot, (2) Being a professional commercial airline pilot is to build up sufficient knowledge, beyond average skill, and correct attitude, (3) Pilots' resistance and dissent toward company management, (4) Popular (re)presentation influences professionalism, (5) Power and fear affect professionalism. Pilots' personal narratives were presented in performative writing and in poetic transcription to make word alive with sounds featuring their meanings. Their personal storytelling created a dialogic space to not only let pilots' voice to be heard but also revealed how identities are created within and against a larger organizational identity. Overall, this project demonstrated the interdisciplinary examination of the meanings, functions, and consequence of discursive practices in everyday professional life. It also critiqued relationships between power, domination, and resistance while reintroducing the roles of the body and materiality in the domain of professionalism, and provides ethical readings of larger and complex organizational cultures. Applying communication-oriented analysis to study professionalism indeed challenged the long time neglected phenomena regarding the power of the symbolic in sociological approaches and raised the awareness of structural, material, and bodily condition of work.

Quality Management, Environmental Management and Organizational Design in the Hotel Industry: A Qualitative Study

The purpose of this paper is twofold. First, the paper analyzes the relationship between quality management and environmental management and their effects on hotel performance. Second, the article examines the relationship between these two management systems and organizational design. The paper uses an exploratory, qualitative approach based on interviews with managers and experts in the hotel industry. Based on a content analysis of interviews, the results lead to several propositions. Specifically, quality and environmental management influence hotel performance through mediating variables. Moreover, the implementation of quality management facilitates the implementation of environmental management. Furthermore, the implementation of these two management systems is associated with an increase of formalization and decentralization. The paper contributes to the analysis of quality management, environmental management, organizational design and performance in a joint manner, which has not been attempted before in the hotel industry. In addition, it helps extend the findings about these links in manufacturing and service organizations to the hotel industry.

Knowledge-Bearing Elites and Industrial Performance in France and Germany. CES Germany & Europe Working Papers, No. 04.5, December 1993

Most comparative studies of public policies for competitiveness focus on the links among public agencies and industrial sectors. This paper argues that the professions---or knowledge-bearing elites-that animate these organizational links are equally significant. For public policies to promote technological advance, the visions and self-images of knowledge-bearing elites are par­ ticularly important. By examining administrative and technical elites in France and Germany in the 1980s, the paper identifies characteristics that enable these elites to implement policy in some cases, but not in others. France's "state-created" elites were well-positioned to initiate and implement large technology projects, such as digitizing the telecommunications network. Germany's state-recognized elites were, by contrast, better positioned to facilitate framework­ oriented programs that aimed at the diffusion of new technologies throughout industry. The linkages among administrative and technical elites also explain why French policymakers had difficulty adapting policy to changing circumstances over time while German policymakers managed in many cases to learn more from previous policy experiences and to adapt subsequent initiatives accordingly.

Socioemotional Wealth, Ambidexterity, and Family Firm Performance: An Empirical Study

While family business literature agrees that family firms are driven by both non-economic and financial motives, it is unclear how the prioritization of socioemotional wealth (SEW) over financial considerations affects family firms' financial performance. Based on a sample of 343 family firm owners from German-speaking Europe, this study reveals a significant and positive relationship between the firm owners' SEW considerations and their family businesses' financial performance. This relationship, in turn, is found to be mediated by organizational ambidexterity. A fine-grained analysis of the different SEW dimensions indicates that this pattern may be driven by two elements of socioemotional wealth only (family members' identification with the firm and emotional attachment). Our findings demonstrate that business families do not necessarily face a trade-off when prioritizing the preservation of their SEW over stabilizing or improving the financial performance of their business. The study enriches several streams of literature and opens up numerous avenues for future research.

The Performance of Swiss and German Family Firms: Investigating Strategies, Orientations and SEW as Determinants

In this chapter we center our attention on the performance drivers of family firms in Switzerland and Germany and compare the corresponding results with the findings generated in the US. Investigating family firms is justified as this organizational form not only constitutes the majority of all firms globally (Sharma and Carney, 2012), but in particular in Switzerland and Germany. In fact, more than 88 percent of all firms in Switzerland are defined as family firms (Frey, Halter, Klein, and Zellweger, 2004), and numbers for Germany are similar (Klein, 2000). While more than 99 percent of all companies in Switzerland are small and medium-sized (Frey et al., 2004), the share of family firms varies with firm size; more specifically, the share of family firms decreases with increasing firm size, which is in line with findings from Germany (Klein, 2000). The social and economic impact of family firms is remarkable. In Germany for instance, family controlled firms provide 60 percent of all jobs and account for 51 percent of the total sales of the German economy (cf. www.familienunternehmen.de). Even though the interest of both academics and practitioners in family firms has been rising significantly in recent years, the existing body of knowledge in the field is still rather fragmented (Sharma, 2004; Sharma and Carney, 2012).

Mesure de la performance dans les organisations de réadaptation en déficience physique

La présente thèse vise à évaluer le degré d’implantation et d’utilisation de systèmes de mesure de la performance (SMP) par les décideurs des organisations de réadaptation et à comprendre les facteurs contextuels ayant influencé leur implantation. Pour ce faire, une étude de cas multiples a été réalisée comprenant deux sources de données: des entrevues individuelles avec des cadres supérieurs des organisations de réadaptation du Québec et des documents organisationnels. Le cadre conceptuel Consolidated Framework for Implementation Research a été utilisé pour guider la collecte et l’analyse des données. Une analyse intra-cas ainsi qu’une analyse inter-cas ont été réalisées. Nos résultats montrent que le niveau de préparation organisationnelle à l’implantation d’un SMP était élevé et que les SMP ont été implantés avec succès et utilisés de plusieurs façons. Les organisations les ont utilisés de façon passive (comme outil d’information), de façon ciblée (pour tenter d’améliorer des domaines sous-performants) et de façon politique (comme outil de négociation auprès des autorités gouvernementales). Cette utilisation diversifiée des SMP est suscitée par l’interaction complexe de facteurs provenant du contexte interne propre à chaque organisation, des caractéristiques du SMP, du processus d’implantation appliqué et du contexte externe dans lequel évoluent ces organisations. Au niveau du contexte interne, l’engagement continu et le leadership de la haute direction ont été décisifs dans l’implantation du SMP de par leur influence sur l’identification du besoin d’un SMP, l’engagement des utilisateurs visés dans le projet, la priorité organisationnelle accordée au SMP ainsi que les ressources octroyées à son implantation, la qualité des communications et le climat d’apprentissage organisationnel. Toutefois, même si certains de ces facteurs, comme les ressources octroyées à l’implantation, la priorité organisationnelle du SMP et le climat d’apprentissage se sont révélés être des barrières à l’implantation, ultimement, ces barrières n’étaient pas suffisamment importantes pour entraver l’utilisation du SMP. Cette étude a également confirmé l’importance des caractéristiques du SMP, particulièrement la perception de qualité et d’utilité de l’information. Cependant, à elles seules, ces caractéristiques sont insuffisantes pour assurer le succès d’implantation. Cette analyse d’implantation a également révélé que, même si le processus d’implantation ne suit pas des étapes formelles, un plan de développement du SMP, la participation et l’engagement des décideurs ainsi que la désignation d’un responsable de projet ont tous facilité son implantation. Cependant, l’absence d’évaluation et de réflexion collective sur le processus d’implantation a limité le potentiel d’apprentissage organisationnel, un prérequis à l’amélioration de la performance. Quant au contexte externe, le soutien d’un organisme externe s’est avéré un facilitateur indispensable pour favoriser l’implantation de SMP par les organisations de réadaptation malgré l’absence de politiques et incitatifs gouvernementaux à cet effet. Cette étude contribue à accroître les connaissances sur les facteurs contextuels ainsi que sur leurs interactions dans l’utilisation d’innovations tels les SMP et confirme l’importance d’aborder l’analyse de l’implantation avec une perspective systémique.

The adaptability of older workers to technological change; performance of older and younger workers in industrial retraining courses

"Organizational Behavior and Change Programs, February, 1961."

Organizational aspects of e-referrals

Three different, well established systems for e-referral were examined. They ranged from a system in a single country handling a large number of cases (60,000 per year) to a global system covering many countries which handled fewer cases (150 per year). Nonetheless, there appeared to be a number of common features. Whether the purpose is e-transfer or e-consultation, the underlying model of the e-referral process is: the referrer initiates an e-request; the organization managing the process receives it, the organization allocates it for reply; the responder replies to the initiator. Various things can go wrong and the organization managing the e-referral process needs to be able to track requests through the system; this requires various performance metrics. E-referral can be conducted using email, or as messages passed either directly between computer systems or via a Web-link to a server. The experience of the three systems studied shows that significant changes in work practice are needed to launch an e-referral service successfully. The use of e-referral between primary and secondary care improves access to services and can be shown to be cost-effective.

Uncertainty during organizational change: Types, consequences, and management strategies

This research tested a model that classifies change uncertainty into three interrelated types: strategic, structural, and job-related. We predicted that control would mediate the effects of job-related uncertainty upon psychological strain, and that management communication and participation in decision-making (PDM) would reduce uncertainty and increase feelings of control. The model was tested in a public sector organization and the results supported it. Control was found to mediate the effects of job-related uncertainty upon psychological strain. Management communication was negatively related to strategic uncertainty, whereas PDM was negatively related to structural and job-related uncertainty, suggesting different mechanisms to deal with the types of uncertainty during change. Finally, PDM was positively associated with feelings of control and negatively associated with psychological strain. These results suggest that PDM can short-circuit the damaging effects of uncertainty by allowing employees to have a say in change related organizational affairs, thereby instilling a sense of control over their circumstances.

A study of organizational citizenship behaviors in a retail setting

This study investigates the potential antecedents of organizational citizenship behaviors (OCBs) in a retail setting. Much remains unknown about the factors affecting OCBs in retail settings. Several characteristics of retail jobs, as compared with other organizational behavior contexts, suggest the need to examine antecedents of OCBs. Job attitudes (job satisfaction and organizational commitment) are proposed as direct predictors of OCBs. Leadership support, professional development, and empowerment are posited as indirect predictors of OCBs and direct predictors of job attitudes. The possible moderating impacts of employee demographics and job types on the modeled relationships are also examined. The research hypotheses are tested using data collected from 211 frontline employees who work in a retail setting. The employees have customer-contact roles in the upscale food and grocery retailer that participated in the study. The pattern of results is more complex than hypothesized. Job attitudes are related to OCBs but the mediating role of job attitudes is not supported. The relationships between leadership support, professional development, and empowerment, and OCBs and job attitudes differ systematically. Evidence of how employee demographics can alter the modeled relationships is also presented. The findings have significant implications for the theory and practice of managing frontline employees. Limitations of the study are discussed and a program of further research is sketched. (C) 2003 Elsevier Inc. All rights reserved.

Subordinate-manager gender combination and perceived leadership style influence on emotions, self-esteem and organizational commitment

A theoretical model was developed to investigate the relationships among subordinate-manager gender combinations, perceived leadership style, experienced frustration and optimism, organization-based self-esteem and organizational commitment. The model was tested within the context of a probabilistic structural model, a discrete Bayesian network, using cross-sectional data from a global pharmaceutical company. The Bayesian network allowed forward inference to assess the relative influence of gender combination and leadership style on the emotions, self-esteem and commitment consequence variables. Further, diagnostics from backward inference were used to assess the relative influence of variables antecedent to organizational commitment. The results showed that gender combination was independent of leadership style and had a direct impact on subordinates' levels of frustration and optimism. Female manager-female subordinate had the largest probability of optimism, while male manager teamed with a male subordinate had the largest probability of frustration. Furthermore, having a female manager teamed up with a male subordinate resulted in the lowest possibility of frustration. However, the findings show that the gender issue is not simply female managers versus male managers, but is concerned with the interaction of the subordinate-manager gender combination and leadership style in a nonlinear manner. (C) 2003 Elsevier Inc. All rights reserved.