Basil S. Georgopoulos

Organizations in a Changing World.

Organizations today are under challenge as a result of the break with traditional authority, the growth of democratic ideology, economic affluence and consequent changes in needs and motive patterns, and the accelerated rate of change. Adaptive subsystems have not kept pace with other organizational subsystems, and hence new inputs tend to be either rejected in blanket fashion or else incorporated without assimilation to the dominant patterns. Organizational leaders are preoccupied with their tasks of mediation between conflicting demands, and the problem of the reconceptualization of values has been left to the rebelling factions. There is hope, however, that a new consensus may emerge about organizational restructuring which acknowledges both the role of direct democracy in the smaller units and representative democracy in the larger system.

Organization structure and the performance of hospital emergency services.

A comparative study of 30 hospital emergency departments (EDs) and nearly 1,500 individuals associated with them was conducted. Data were obtained from institutional records, physicians, patients, and other sources. The object was to investigate the relationship between the organization and performance of these health service systems. The study assessed the quality of medical care, the quality of nursing care, and the economic efficiency of hospital EDs. The results show substantial interinstitutional differences in these criteria. They also show a significant relationship between medical and nursing care, but not between the quality of care and economic efficiency. Differences in ED performance are related to medical staffing patterns, medical teaching affiliation, personnel training, scope of emergency services, number of patient visits processed, and hospital size and complexity. Not all of these variables, however, correlate positively with all three criteria of performance, nor are they equally important to each.

Hospital-physician relations under hospital prepayment.

Fundamental changes now occurring in the field of health services may make it increasingly difficult to develop or maintain satisfactory hospital-physician relations. This paper examines the nature of hospital-physician relations following the introduction of an experimental hospital prepayment program that capped budgets in nine hospitals for a 5-year period. Results from longitudinal analyses based on data from key physicians, hospital administrators, and board members indicate generally positive “effects” on hospital-physician relations, except for increased strain in the system. In most respects, there were no adverse effects on the work relations of physicians, in the perceived quality of medical care, or in the institutional performance of physicians at the nine participating hospitals after the introduction of prepayment. Moreover, to some extent, the prepayment program appears to have been effective in controlling hospital costs and is perceived by the principal participants to have been successful.