James E. Veney

Innovation of health services: a comparative study of hospitals and health departments.

al variables affecting the innovation of high-risk versus low-risk health service programs in two types of health care organizations: hospitals and health departments. It was found that variables are differentially related to both the type of program and the type of organization. Organizational size was a critical factor in program innovation as it relates to high-risk services in hospitals and low-risk services in health departments. Excluding size, characteristics of the staff, such as cosmopolitan orientation and training, were prime predictors for both high- and low-risk programs in health departments and low-risk programs in hospitals. The degree of formalization was the primary predictor of innovation of high-risk programs in hospitals. Cosmpolitan orientation of the administrator was a critical factor in the innovation of high-risk programs in both hospitals and health departments. The assessment of change in health care organizations, and particularly program innovation, has received increasing attention by social scientists. Using a wide range of explanatory variables, research, with few exceptions, has tended to concentrate on explaining variation in the innovation of a single program or that of aggregate change. For a review of these studies see Kaluzny (1972). While this represents progress, it is important to consider two underlying problem areas. First, it is necessary to inquire into the general area of programmatic change and whether factors associated with program innovation differ by type of program innovated. Essentially, this exploration involves assessment of a set of services and activities that have common characteristics, making possible generalization from known determinants of innovation of one program to other programs with similar characteristics. Secondly, explanation of differences by type of organization is necessary to provide insight into the specific organizational setting under which

Attributes of health services as factors in program implementation.

This paper investigates the relationship between attributes of thirty-two innovative health services and their level of implementation in a national sample of hospitals and health departments. It was found that services implemented in hospitals are primarily characterized by high payoff, a low rate of cost recovery, and low social approval. For health department services perceived primarily as having high divisibility, a high association with the preventive orientation of the department, and a relatively low payoff had a high level of implementation. The respective attribute patterns acounted for 58 per cent of the variance in the implementation of health services in hospitals and 50 per cent of the variance in health departments.

Strategies for implementing standards: the effects of involvement and assessment in local official health agencies.

Managers of service delivery agencies should view assessment and involvement as desirable strategies for implementing standards in their agencies. Both approaches have the potential to influence the impact of standards