Mary L. Fennell

Professional work : a sociological approach

List of Figures.List of Tables.Acknowledgements.1. Professional and Managerial Work in the 21st Century. 2. Conceptual Background: The Expert Division of Labor and Professional Work. 3. Managers and Managerial Work in the 20th Century. 4. The Neoentrepreneurial Workplace.5. Theoretical Models of Professional Work. 6. Change in the Organizational Context of Managerial and Professional Work. 7. Interest Diversity and Demographic Diversity Among Professionals. 8. Organizations as Vehicles for Producing Stratification Among Professionals. 9. Conclusion: The Rise of the Postorganizational Workplace. Additional Readings on Professions. References. Index.

Leadership instability in hospitals: the influence of Board-CEO relations and organizational growth and decline.

This study tested whether leadership instability--a systemic pattern of frequent succession in the top management position of an organization--was associated with sociopolitical structures that define the relationship between the board and chief executive officer (CEO), controlling for temporal patterns of the organizational life-cycle stage. In organizations that are not profit maximizing and subject to considerable uncertainty, such governance properties were hypothesized to affect leadership instability independent of organizational growth or decline. Results of regression analyses demonstrate strong main effects of board-CEO relations, net of the impact of organizational life cycle, on leadership instability.

Factors associated with site of death: A national study of where people die

Objectives. Recent public attention has focused on quality of care for the dying. Where one dies is an important individual and public health concern. Materials and methods. The 1993 National Mortality Followback Survey (NMFS) was used to estimate the proportion of deaths occurring at home, in a hospital, or in a nursing home. Sociodemographic variables, underlying cause of death, geographic region, hospice use, social support, health insurance, patients’ physical limitations, and physical decline were considered as possible predictors of site of death. The relationship between these predictors and site death with multinomial logistic regression methods was analyzed. Results. Nearly 60% of deaths occurred in hospitals, and approximately 20% of deaths took place at home or in nursing homes. Decedents, who were black, less educated, and enrolled in an HMO were more likely to die in the hospital. After adjustment, functional decline in the last 5 months of life was an important predictor of dying at home (for loss of 3 or more ADLs [OR, 1.57; 95% CI, 1.11–2.21]). Having functional limitations 1 year before death, and experiencing functional decline in the last 5 months of life were both associated with dying in a nursing home. Conclusions. Rapid physical decline during the last 5 months was associated with dying at home or in a nursing home, whereas earlier functional loss was associated with dying in a nursing home.

The Organization of Multidisciplinary Care Teams: Modeling Internal and External Influences on Cancer Care Quality

Quality cancer treatment depends upon careful coordination between multiple treatments and treatment providers, the exchange of technical information, and regular communication between all providers and physician disciplines involved in treatment. This article will examine a particular type of organizational structure purported to regularize and streamline the communication between multiple specialists and support services involved in cancer treatment: the multidisciplinary treatment care (MDC) team. We present a targeted review of what is known about various types of MDC team structures and their impact on the quality of treatment care, and we outline a conceptual model of the connections between team context, structure, process, and performance and their subsequent effects on cancer treatment care processes and patient outcomes. Finally, we will discuss future research directions to understand how MDC teams improve patient outcomes and how characteristics of team structure, culture, leadership, and context (organizational setting and local environment) contribute to optimal multidisciplinary cancer care.

Organizational Boundary Spanning in Institutionalized Environments

Using an institutional framework, this study tested hypotheses concerning the differences in boundary-spanning strategies between freestanding organizations and organizations that are members of mu...

Introduction: Understanding and Influencing Multilevel Factors Across the Cancer Care Continuum

Health care in the United States is notoriously expensive while often failing to deliver the care recommended in published guidelines. There is, therefore, a need to consider our approach to health-care delivery. Cancer care is a good example for consideration because it spans the continuum of health-care issues from primary prevention through long-term survival and end-of-life care. In this monograph, we emphasize that health-care delivery occurs in a multilevel system that includes organizations, teams, and individuals. To achieve health-care delivery consistent with the Institute of Medicines six quality aims (safety, effectiveness, timeliness, efficiency, patient-centeredness, and equity), we must influence multiple levels of that multilevel system. The notion that multiple levels of contextual influence affect behaviors through interdependent interactions is a well-established ecological view. This view has been used to analyze health-care delivery and health disparities. However, experience considering multilevel interventions in health care is much less robust. This monograph includes 13 chapters relevant to expanding the foundation of research for multilevel interventions in health-care delivery. Subjects include clinical cases of multilevel thinking in health-care delivery, the state of knowledge regarding multilevel interventions, study design and measurement considerations, methods for combining interventions, time as a consideration in the evaluation of effects, measurement of effects, simulations, application of multilevel thinking to health-care systems and disparities, and implementation of the Affordable Care Act of 2010. Our goal is to outline an agenda to proceed with multilevel intervention research, not because it guarantees improvement in our current approach to health care, but because ignoring the complexity of the multilevel environment in which care occurs has not achieved the desired improvements in care quality outlined by the Institute of Medicine at the turn of the millennium.

The effects of environmental characteristics on the structure of hospital clusters.

The population ecology view that variation in sets or clusters of organizations should be isomorphic with variation in cluster environment was used here to explain structural variation among hospital clusters. The structural characteristics studied were range of services offered within the cluster, average size of hospitals in the cluster, and cluster differentiation. In the causal model that was developed and evaluated, variation in the patient environment and variation in the supplier environment were compared. Four lagged panels of data on a national sample of fifteen hospital clusters demonstrated the relative superiority of supplier variables over patient variables. Supplier group preferences were more powerful than patient needs in determining the range of services offered by the cluster. Furthermore, increasing the range of services in the cluster had a positive, significant effect on average hospital size, whereas size apparently exerted no effect on range of cluster facilities. Cluster differentiation seems to be causally affected by range of services, average hospital size, and by the periodic closing of hospitals over time.

Synergy, Influence, and Information in the Adoption of Administrative Innovations

The adoption processes of two related administrative innovations in the private sector dealing with employee health are examined. Results of multiple logistic regressions using survey data on a sample of Illinois firms suggest that these two innovations are synergistically linked, such that the adoption of one increases the likelihood of the subsequent adoption of the other.

Gender, Interaction, and Leadership

This article describes research on gender and processes of power and prestige in task groups. We depart from standard analyses and use a measure of opinion change to describe leadership on power and prestige orders. We use data from laboratory studies of single-gender and mixed-gender groups to test gender-role socialization, status characteristic, and legitimation arguments. We find that all-female and all-male groups are equally likely to develop power and prestige orders. Among initially leaderless, mixed-gender groups, males are five times more likely than females to exercise opinion leadership. Gender differences vanish, however, when we make a pretask assignment of leaders to mixed-gender groups. These findings are most consistent with status characteristic and legitimation theories, which correctly predict the outcomes of three out offour studies. Gender-role arguments predict only one outcome out of four. Finally, our analyses of sociometric data provide evidence of gender bias in peer evaluations of female and male members of mixed-gender groups. We conclude by discussing the implications of our research for additional work on gender and leadership processes.

Through the lenses of organizational sociology: the role of organizational theory and research in conceptualizing and examining our health care system

This paper reviews various theoretical perspectives on organizational change which have been and could be applied to medical organizations. These perspectives are discussed as both filters influencing our observations (research) and mirrors of the shifting dynamics of delivery system reform (policy). We conclude with an examination of how such theories can provide useful insights into our rapidly changing health care system.