Brian R. Golden

Perceived managerial discretion : A study of cause and effect

The notion that managers encounter differing levels of discretion across industries and organizations is becoming central to discussions of strategy formulation and implementation. However, discretion can be exercised or created only to the extent it is perceived, and theories of cognition and decision making suggest that managers’ perceptions of discretion may vary significantly. Despite the importance of perceptions to Hambrick and Finkelstein’s (1987) theoretical model of managerial discretion, no empirical tests examining perceived discretion have been published to date. Drawing on theories of issue interpretation and impression management, we find that managers differ systematically in the amount of discretion they perceive. Specifically, we find support for the predicted relationship between locus of control, a stable personality difference, and perceptions of managerial discretion. We also find that perceived discretion predicts managerial power, but only in situations in which the manager actually has little discretion. The dynamic model presented and tested here suggests that managers, in part through impression management activities and their ability to attend to critical contingencies, may both increase their power and enlarge their latitude for action. Implications for strategy formulation and implementation are discussed.

Further Remarks on Retrospective Accounts on Organizational and Strategic Management Research

Miller, Cardinal, and Glick (1997) challenged the conclusions in Golden (1992b), which examined the use of retrospective data in strategic management research. Further, the authors suggest that my ...

How CIOs obtain peer commitment to strategic IS proposals: barriers and facilitators

Effective initiation and execution of strategic information systems/technology (IS/T) projects has become a critical competence for many organizations. One key to this is the ability of the senior executive responsible for IS/T, called the Chief Information Officer (CIO), to obtain peer commitment to implement strategic IS/T projects. This paper explores the barriers and facilitators of peer commitment to the implementation of such projects. Peer commitment barriers and facilitators include the firms external and internal IS/T environment, appropriateness of the IS/T initiatives, peer relationships, the ability to use the peers preferred influence behaviors, and post-commitment implementation realities.

Response Audit of an Internet Survey of Health Care Providers and Administrators: Implications for Determination of Response Rates

Background Internet survey modalities often compare unfavorably with traditional survey modalities, particularly with respect to response rates. Response to Internet surveys can be affected by the distribution options and response/collection features employed as well as the existence of automated (out-of-office) replies, automated forwarding, server rejection, and organizational or personal spam filters. However, Internet surveys also provide unparalleled opportunities to track study subjects and examine many of the factors influencing the determination of response rates. Tracking data available for Internet surveys provide detailed information and immediate feedback on a significant component of response that other survey modalities cannot match. This paper presents a response audit of a large Internet survey of more than 5000 cancer care providers and administrators in Ontario, Canada. Objective Building upon the CHEcklist for Reporting Results of Internet E-Surveys (CHERRIES), the main objectives of the paper are to (a) assess the impact of a range of factors on the determination of response rates for Internet surveys and (b) recommend steps for improving published descriptions of Internet survey methods. Methods We audited the survey response data, analyzing the factors that affected the numerator and denominator in the ultimate determination of response. We also conducted a sensitivity analysis to account for the inherent uncertainty associated with the impact of some of the factors on the response rates. Results The survey was initially sent out to 5636 health care providers and administrators. The determination of the numerator was influenced by duplicate/unattached responses and response completeness. The numerator varied from a maximum of 2031 crude (unadjusted) responses to 1849 unique views, 1769 participants, and 1616 complete responses. The determination of the denominator was influenced by forwarding of the invitation email to unknown individuals, server rejections, automated replies, spam filters, and ‘opt out’ options. Based on these factors, the denominator varied from a minimum of 5106 to a maximum of 5922. Considering the different assumptions for the numerator and the denominator, the sensitivity analysis resulted in a 12.5% variation in the response rate (from minimum of 27.3% to maximum of 39.8%) with a best estimate of 32.8%. Conclusions Depending on how the numerator and denominator are chosen, the resulting response rates can vary widely. The CHERRIES statement was an important advance in identifying key characteristics of Internet surveys that can influence response rates. This response audit suggests the need to further clarify some of these factors when reporting on Internet surveys for health care providers and administrators, particularly when using commercially available Internet survey packages for specified, rather than convenience, samples.

The Interpretation And Resolution Of Resource Allocation Issues In Professional Organizations: A Critical Examination Of The Professional-Manager Dichotomy*

Professional organizations have long been depicted as rife with conflict between professionals, who are assumed to represent the interests of their profession, and managers, who are assumed to represent the potentially competing interests of the organization. This study examines the validity of this assumption. Based on past research on both professional organizations and knowledge structure development, we predict that to the extent that professionals and managers conflict, they may do so because they interpret ‘identical’ issues differently. The results of a study of resource allocation decision preferences with 350 chief financial officers, chief medical officers, and physicians revealed strong support for our issue interpretation predictions, and virtually no support for the simple professional–manager dichotomy. Specifically, using structural equation modeling, we found that: (1) single resource allocation issues could be interpreted in multiple ways; (2) issue interpretations were strong predictors of decision preferences; (3) professionals and managers tended to interpret issues differently, although many of the differences were not consistent with past theorizing about professionals; (4) the interpretations and decision preferences of professionals who occupied management positions were like those of other professionals but different from those of managers; and (5) decision maker status (i.e., professional and/or manager) was only modestly related to decision preference. Our findings suggest that the sources and manifestations of a professional–manager dichotomy are more complex than previously reported.

Health policy/original researchEvaluation of an Emergency Department Lean Process Improvement Program to Reduce Length of Stay

STUDY OBJECTIVE In recent years, lean principles have been applied to improve wait times in the emergency department (ED). In 2009, an ED process improvement program based on lean methods was introduced in Ontario as part of a broad strategy to reduce ED length of stay and improve patient flow. This study seeks to determine the effect of this program on ED wait times and quality of care. METHODS We conducted a retrospective cohort study of all ED visits at program and control sites during 3 program waves from April 1, 2007, to June 30, 2011, in Ontario, Canada. Time series analyses of outcomes before and after the program and difference-in-differences analyses comparing changes in program sites with control sites were conducted. RESULTS In before-after models among program sites alone, 90th percentile ED length of stay did not change in wave 1 (-14 minutes [95% confidence interval {CI} -47 to 20]) but decreased after wave 2 (-87 [95% CI -108 to -66]) and wave 3 (-33 [95% CI -50 to -17]); median ED length of stay decreased after wave 1 (-18 [95% CI -24 to -12]), wave 2 (-23 [95% CI -27 to -19]), and wave 3 (-15 [95% CI -18 to -12]). In all waves, decreases were observed in time to physician assessment, left-without-being-seen rates, and 72-hour ED revisit rates. In the difference-in-difference models, in which changes in program sites were compared with controls, the program was associated with no change in 90th percentile ED length of stay in wave 2 (17 [95% CI -0.2 to 33]) and increases in wave 1 (23 [95% CI 0.9 to 45]) and wave 3 (31 [95% CI 10 to 51]), modest reductions in median ED length of stay in waves 2 and 3 alone, and a decrease in time to physician assessment in wave 3 alone. CONCLUSION Although the program reduced ED waiting times, it appeared that its benefits were diminished or disappeared when compared with that of control sites, which were exposed to system-wide initiatives such as public reporting and pay for performance. This study suggests that further evaluation of the effectiveness of lean methods in the ED is warranted before widespread implementation.

Challenges to Evidence-Based Prescribing in Clinical Practice

Although there appears to be widespread support of evidence-based medicine as a basis for rational prescribing, the challenges to it are signilicant and often justified. A multitude of factors other than evidence drive clinical decision-making, including patient preferences and social circumstances, presence of diseasedrug and drug-drug interactions, clinical experience, competing demands from more pressing clinical conditions, marketing and promotional activity, and systemlevel drug policies.

Theory of constraints for publicly funded health systems

Originally developed in the context of publicly traded for-profit companies, theory of constraints (TOC) improves system performance through leveraging the constraint(s). While the theory seems to be a natural fit for resource-constrained publicly funded health systems, there is a lack of literature addressing the modifications required to adopt TOC and define the goal and performance measures. This paper develops a system dynamics representation of the classical TOC’s system-wide goal and performance measures for publicly traded for-profit companies, which forms the basis for developing a similar model for publicly funded health systems. The model is then expanded to include some of the factors that affect system performance, providing a framework to apply TOC’s process of ongoing improvement in publicly funded health systems. Future research is required to more accurately define the factors affecting system performance and populate the model with evidence-based estimates for various parameters in order to use the model to guide TOC’s process of ongoing improvement.

Improving Hospital Efficiency: A Process Model of Organizational Change Commitments

Improving hospital efficiency is a critical goal for managers and policy makers. We draw on participant observation of the perioperative coaching program in seven Ontario hospitals to develop knowledge of the process by which the content of change initiatives to increase hospital efficiency is defined. The coaching program was a change initiative involving the use of external facilitators with the goal of increasing perioperative efficiency. Focusing on the role of subjective understandings in shaping initiatives to improve efficiency, we show that physicians, nurses, administrators, and external facilitators all have differing frames of the problems that limit efficiency, and propose different changes that could enhance efficiency. Dynamics of strategic and contested framing ultimately shaped hospital change commitments. We build on work identifying factors that enhance the success of change efforts to improve hospital efficiency, highlighting the importance of subjective understandings and the politics of meaning-making in defining what hospitals change.

Explaining the Selection of Routines for Change during Organizational Search

We examine how organizations select some routines to be changed, but not others, during organizational search. Selection is a critical step that links an exogenous trigger for change, change in individual routines, and larger processes of organizational adaptation. Drawing on participant observation of an initiative to improve perioperative efficiency in seven Ontario hospitals, we find that organizational roles shape selection by influencing both politics and frames in organizational search. Roles shape politics by defining the role-specific goals of the people who have authority to change a routine. Organizations will not select a routine for change unless at least some elites—people with role-based authority—frame the existing routine as negatively affecting their role-specific goals. Roles also shape individuals’ frames. Because people are only partially exposed to interdependencies between routines in their day-to-day work, they may not be fully aware of the diverse impact that an existing routine can have on their goals. Proponents for change can use strategic framing to focus attention on interdependencies between routines to get elites to better see how an existing routine negatively affects their goals. They can also change elites’ goals by using strategic framing to focus attention on new and broader goals that the change in routine would promote.