Margarete Arndt

Presenting Structural Innovation in an Institutional Environment: Hospitals' Use of Impression Management

This research examines how the first organizations to abandon an institutionalized, taken-for-granted structure and adopt a radically different form presented the innovation to important stakeholders. A content analysis of hospitals annual reports reveals that organizations that differed on other dimensions uniformly made preventive use of defensive impression management in announcing the change to a diversified corporate structure. The organizations invoked coercive and mimetic pressures to account for and justify the new structure, and they associated the innovation with legitimated organizational activities. The findings make two contributions that link the “old” institutionalism and neoinstitutionalism: they point to organizational agency in the preventive use of the very institutional forces that create isomorphism and suggest the presence of institutional forces even during the early stages of innovation.

Evidence-based management in health care organizations: a cautionary note.

Background: Health care managers are urged to adopt evidence-based management as a new and exemplary decision-making process. Three assumptions underlie advocacy for the practice: (a) Decisions based on evidence will yield anticipated results, (b) these results are generalizable across organizations, and (c) evidence is objective and context free. Purpose: This article explores evidence-based management through contextual and conceptual lenses that question these underlying assumptions. Methods: A review of extant literature on evidence-based management was conducted. Findings: Calls for evidence-based management are based mostly on conceptual arguments that it constitutes best practice because there is not yet any empirical research that demonstrates its effectiveness. We raise a cautionary note about the assumptions underlying the calls for evidence-based management. Given the complexity of decision making and of the health care environment, as well as differences among health care organizations, decisions do not necessarily lead to expected outcomes, and results may not be replicable across organizations. Moreover, evidence is an artifact of social interactions and limited by the difficulties inherent in studying complex organizational phenomena. Conclusion: Research is needed into the diffusion of evidence-based management in health care and into the results achieved by organizations that used the practice compared with organizations that did not. Practice Implications: Managers should use all available information and data when planning and implementing decisions, and evidence from research should play a role in that. At the same time, in a turbulent and uncertain environment, creativity and risk taking also will be important, and unanticipated outcomes may result from, among other factors, limits on human cognition, unknowable differences in initial conditions in organizations, and adaptive responses to change as it is implemented.

Professionalizing and Masculinizing a Female Occupation: The Reconceptualization of Hospital Administration in the Early 1900s

This paper examines the earliest boundary work for a female-dominated occupation that portrayed men rather than women as the appropriate practitioners. According to the concept of gender primacy, men would not enter a female-dominated occupation in large numbers because it is associated with gender essentialism. Hospital administration is one of the rare female occupations that did masculinize. Our analysis of archival texts on hospital administration in the early 1900s describes that in establishing a jurisdiction, body of knowledge, and educational requirements, the male-dominated professional association created a male sex boundary. Extracting and elaborating functions consistent with gender primacy and sloughing off functions associated with gender essentialism reframed the occupation as male. Rhetorical use of gender created a male image of the generic practitioner and the occupation, while an internal boundary segregated women within the occupation. The study points to differences in how occupations feminize and masculinize and suggests the latter does not occur solely in response to societal factors, as has been assumed, but can originate within the occupation.

Toward the creation of an institutional logic for the management of hospitals: efficiency in the early nineteen hundreds.

This research focuses on the creation of an institutional logic—efficiency—and on its organizing principles of standardization and business practices through a study of the American Hospital Association and its publication, the Modern Hospital. In the early years of the 20th century, efficiency began to emerge as a first institutional logic for the management of hospitals. The term was defined broadly, encompassing not only economy but also quality and breadth of services, as well as access to care. This early emphasis on efficiency foreshadowed three issues that affect health policy and hospital management to this day: the pressure on hospitals to introduce new technology while containing cost, the assumption that hospitals should act like businesses, and the practice of offering large hospitals as the model for other providers.

Corporate political strategy: incorporating the management of public policy issues into hospital strategy.

Hospitals engage in a variety of strategies designed to anticipate, shape, and respond to public policy issues. This article describes corporate political strategy and argues for its need throughout a public policy issues life cycle.

Indications for Hysterectomy: Variation within and Across Hospitals

This study investigates the factors associated with the probability of finding specific clinical indicators (benign or malignant tumor, cancer in situfibroid, abscess/empyema, or positive culture of salpinx,fallopian tubefetus, or uterus) that validate necessity for hysterectomy. Data for the4,660 cases in the study come from 42 Pennsylvania hospitals. The probability that validating indicators were present varied significantly at the hospital level but not at the level of individual surgeons within hospital, suggesting that physicians in different hospitals adopted different practice styles. The results at the hospital level indicate that higher hysterectomy volume increased the probability of validating findings, whereas presence of an OB/GYN program was associated with lower probability of validating findings. The policy and management implications of these results are discussed.