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Institutional change and healthcare organizations: from professional dominance to managed care

Author: Scott, W. Richard ; Caronna, Carol A. ; Ruef, Martin ; Mendel, Peter J.Publisher: University of Chicago Press, 2000.Language: EnglishDescription: 427 p. : Graphs/Maps ; 24 cm.ISBN: 0226743098Type of document: BookBibliography/Index: Includes bibliographical references and index and glossary
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Item type Current location Collection Call number Status Date due Barcode Item holds
Book Europe Campus
Main Collection
Print RA971 .S36 2000
(Browse shelf)
Available 001236045
Total holds: 0

Includes bibliographical references and index and glossary


Institutional Change and Healthcare Organizations From Professional Dominance to Managed Care Contents List of Figures and Tables xi List of Case Illustrations xv Preface xvii Acknowledgments xxi 1. A WORLD IN TRANSITION 1 Overview of Study 2 Theoretical Framework 5 Precursor Studies 5 Limitations That Point the Way 8 Integrating Levels and Perspectives 9 Environments 17 Limitations of Our Research 22 The Larger Issues 24 Profound Institutional Change 24 Congruence 26 Structuration 26 2. THE CASE OF THE SAN FRANCISCO BAY AREA: FOCAL POPULATIONS AND ORGANIZATIONS 28 San Francisco Bay Area 28 Organizational Actors in the Healthcare Field 32 Types of Social Actors 32 Functions of Social Actors 33 Institutional Roles of Social Actors 35 Focal Populations of Organizations 36 Selecting the Populations 36 Data Collected on Focal Populations 38 Hospitals 39 Health Maintenance Organizations 40 Home Health Agencies 44 End-Stage Renal Disease Centers 46 Multihospital and Integrated Healthcare Systems 47 Other Organizational Populations 49 Medical Groups 49 Preferred Provider Organizations 50 Focal Organizational Case Studies 51 Kaiser Permanente Medical Care Program 51 Palo Alto Medical Clinic 53 Stanford University Hospital 53 San Jose Hospital 54 Data Sources 55 Conclusion: Diverse Data, Multiple Levels 55 3. CHANGING HEALTHCARE DELIVERY SYSTEMS 57 Major Trends in U.S. Healthcare Delivery Systems 57 Increased Concentration 58 Increased Specialization 58 Increased Integration and Diversification 59 Increased Linkages among Healthcare Organizations 60 Increased Privatization 60 Increased Market Orientation 61 Theories of Organizational Change 62 A General Typology 62 Internal versus External Sources of Change 63 Intentional versus Unintentional Change 65 Incremental versus Discontinuous Change 67 Changes in Populations of Healthcare Organizations 69 Trends in Focal Organizational Populations 70 Trends in Two Other Populations 86 Comparing Population Trends 88 Blurred and Shifting Boundaries 91 Conclusion 95 4. PROCESSES SHAPING ORGANIZATIONAL POPULATIONS: ECOLOGICAL AND ADAPTIVE CHANGE 96 Changes in Hospital Characteristics 97 Hospital Size 97 Hospital Attributes 103 Changes in Organizational Ownership 109 Trend toward Proprietary Forms 110 Trend toward Privatization 118 Changes in Organizational Subtypes 119 Generalist versus Specialist Hospitals 119 Forms of Physician Organization among HMOs 120 Conclusion 121 5. RESOURCE ENVIRONMENTS AND ORGANIZATIONAL DYNAMICS 124 Perspectives on Material-Resource Environments 124 Health Economics 125 Industrial Organization Economics 128 Trends in Material-Resource Environments in the Bay Area and Beyond 130 Changes of Characteristics Affecting Demand 130 Changes in Characteristics Affecting Supply 139 Changes in Technology 144 Rise in Healthcare Expenditures 146 Resource Environments and Healthcare Organizations 148 Resource Partitioning 148 Institutional Effects on Resource Environments 149 Entries into Organizational Populations 150 Exits from Organizational Populations 156 Effects of Institutional Eras on Resource Environments 161 Conclusion 164 6. THE CHANGING INSTITUTIONAL ENVIRONMENT 166 Conceptualizing and Studying Institutional Environments 167 Three Institutional Elements 167 Three Institutional Components 170 Charting Change in Healthcare Institutional Components 175 Institutional Eras in American Healthcare 175 The Era of Professional Dominance (1945-65) 178 The Era of Federal Involvement (1966-82) 195 The Era of Managerial Control and Market Mechanisms (1983--present) 217 Conclusion 234 7. INSTITUTIONAL ENVIRONMENTS AND ORGANIZATIONAL LEGITIMACY 236 Governance Structures and Healthcare Organizations 236 Legitimacy and Organizational Survival 237 Normative Legitimacy 238 Cognitive Legitimacy 248 Regulative Legitimacy 250 Legitimacy, Performance, and Organizational Survival 258 Conclusion 263 8. HORIZONTAL, VERTICAL, AND VIRTUAL INTEGRATION OF HEALTHCARE ORGANIZATIONS 265 Multihospital Systems 267 The Development of Hospital Associations and Multihospital Systems 267 Trends in Bay Area Systems 271 Governance Structures in Systems 276 Determinants of System Membership 280 Integrated Healthcare Systems 287 Loci of Integration 287 Modes of Integration and Interdependence 288 Types of Integration 290 Combining Forms of Interdependence and Modes of Integration 296 Evidence of Rising Integration in the Bay Area 296 Analysis of "Make" or "Buy" Decisions 301 Conclusion: The Changing Structure of Linkages among Healthcare Organizations 308 9. INSTITUTIONAL ENVIRONMENTS AND THE ORGANIZATIONAL FIELD 312 Depicting Profound Institutional Change 312 Institutional Logics 312 Institutional Fragmentation 317 Dynamics of Institutional Change 324 Decline of Professional Dominance 326 Advance of Managerial-Market Orientation 328 Field-level Forces and Organizational Populations 329 Field-level Forces and Fitness of Forms 330 Empirical Evidence 333 Summary and Conclusion 337 10. INSTITUTIONAL CHANGE AND STRUCTURATION PROCESSES 340 Modes of Governance and the Welfare State 340 Identifying Profound Change in Social Systems: Reviewing Criteria and Evidence 345 Multilevel Change 345 Discontinuous Change 346 New Rules and Governance Mechanisms 348 New Logics 349 New Types of Actors 351 New Meanings 353 New Relations among Actors 354 Changes in Organizational Boundaries 355 Change in Field Boundaries 356 The Structuration and Destructuration of Organizational Fields 358 A Concluding Comment 363 APPENDIX A: DATA SOURCES FOR ORGANIZATIONAL POPULATIONS 365 APPENDIX B: SUPPLEMENTAL DATA AND ANALYSES 367 Statistical Comparison of Ecological and Adaptive Change 367 Evidence of Discontinuous Change 368 APPENDIX C: QUANTITATIVE METHODOLOGY 373 Organizational Entries 373 Organizational Exits 374 Organizational Adaptation 375 Factor Analysis 376 Glossary of Abbreviations and Acronyms 379 References 383 Index 419

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