Thomas D'Aunno

Isomorphism and External Support in Conflicting Institutional Environments: A Study Of Drug Abuse Treatment Units

Using institutional theory, we developed predictions about organizational units that moved from an environment making consistent demands to one making conflicting demands. Many community mental health centers have diversified into drug abuse treatment. The units providing those services face conflicting demands from the traditional mental health sector and the new drug abuse treatment sector about which clients to serve, how to assess their problems, and who should provide treatment. We propose that in response to such demands these units will adopt apparently conflicting practices. Also, isomorphism with the traditional sector will be positively associated with external support from parent mental health centers and other actors in the mental health sector. Results generally support those predictions.

The Role of Institutional and Market Forces in Divergent Organizational Change

This paper focuses on a radical change, in which organizations abandon an institutionalized template for arranging their core activities, that is likely to occur in organizational fields that have strong, local market forces and strong but heterogeneous institutional forces. We examine the role of market forces and heterogeneous institutional elements in promoting divergent change in core activities among all U.S. rural hospitals from 1984 to 1991. Results support the view that divergent change depends on both market forces (proximity to competitors, disadvantages in service mix) and institutional forces (state regulation, ownership and governance norms, and mimicry of models of divergent change).

Decreasing Organizational Size: Untangling the Effects of Money and People

Literature on declining organizations focuses on two indicators of decreasing size—loss of financial resources and work force reduction. This effort to integrate the decline and size literatures combines psychological and sociological perspectives to distinguish between the effects of these two variables. Following the psychological threat-rigidity thesis, loss of financial resources is proposed to cause mechanistic shifts in organizational structures and jobs. We advance a more complex model about the influence of work force reduction that combines psychological and sociological perspectives. In the short term, the threat provoked by work force reduction brings about mechanistic shifts in structures and jobs. In the long term, however, the threat wanes and, following sociological theory, a second set of shifts occurs, in which less mechanistic means of coordination and control are used for the smaller work force.

Perspectives on how goverments matter

This special topic forum explores how governments matter in a number of ways: the extent to which government action can foster industry creation and economic development, the impact of corrupt governments on firm-level decision making by managers of multinational enterprises, the concept of the attractiveness of political markets and the impacts they can have on firm-level strategies, and how deregulation can affect the governance mechanisms of firms. Here we offer readers four views on research issues intended to complement the STF articles and to suggest other avenues for fruitful research.

Psychological sense of community in the workplace

For working adults, the workplace may be a key referent for the psychological sense of community. Unfortunately, community psychologists have devoted little attention to workers or work organizations. This article provides a preliminary conceptual approach to the referents, determinants, and consequences of a sense of community at work. New directions for research and theory-building on work organizations and the experience of work are suggested.

Changes in Methadone Treatment Practices: Results from a Panel Study, 1988-1995

Results from several studies conducted in the late 1980s and early 1990s showed that the majority of the nations methadone treatment units did not use effective treatment practices. Since then, however, many efforts have been made to improve critical treatment practices. This paper examines the extent to which key methadone treatment practices (dose levels, treatment duration, client influence in dose decisions) changed from 1988 to 1995 in a panel sample of methadone maintenance units. We also examine factors that may account for variation in methadone treatment practices. We use panel data from a national random sample of 172 units in 1988 (82% response rate), 140 units in 1990 (87% response rate), and 116 units in 1995 (89% response rate). Unit directors and clinical supervisors provided phone survey data on clients influence on doses, upper limits on doses, average dose levels, unit emphasis on decreasing doses, time when clients are encouraged to detoxify, and average length of treatment. Results from random effects regression analyses indicate that treatment practices concerning methadone dose levels, client influence in dose decisions, and treatment duration improved significantly between 1988 and 1995. Several characteristics of clients (race, age) and treatment units (staff, ownership, geographic location) are associated with the use of less-effective treatment practices. Efforts to improve treatment practices appear to be making progress and certainly need to be continued.

The Responses of Drug Abuse Treatment Organizations to Financial Adversity: A Partial Test of the Threat-Rigidity Thesis

This article derives hypotheses from the threat-rigidity model about organizational responses tofinancial adversity. These hypotheses are tested in a national sample of 72 randomly selected drug abuse treatment organizations. We propose that decreasing funding levels and numbers of funding sources will be associated with four classes of rigidities in organizations: (a) restriction in information processing (rigid use of existing organizational procedures), (b) constriction of control (less participative decision making), (c) conservation of resources (work force reduction), and (d) competition among members. The threat-rigidity thesis is supported by findings that decreases in total budgets are associated with rigid use of existing procedures, work force reduction, and competition among organization members. Further; decreases in number offunding sources are associated with less participative decision making, work force reduction, and more competition among members.

8 Leadership Research in Healthcare: A Review and Roadmap

Abstract This chapters purpose is to advance leadership research in the healthcare field in particular and in organizational studies more broadly. Based on a review of 60 empirical papers, we conclude that leadership is positively and significantly associated with individual work satisfaction, turnover, and performance. Despite these important results, however, we argue that researchers are missing opportunities to develop general leadership theory in the health sector, for example, by (a) examining the role of professionals as leaders and (b) developing understanding of the role of gender in leadership. Nonetheless, we also argue that we are not likely to advance leadership research until we address barriers to collaborative, multidisciplinary studies that develop conceptual models of leadership that makes it neither heroic nor impotent.

Ownership and performance of outpatient substance abuse treatment centers.

BACKGROUND Little is known about the organization and performance of outpatient substance abuse treatment (OSAT) centers. We examine several performance measures of OSAT units, including clients treated, services provided, revenue sources, financial performance, and access to care, in relation to ownership of the center. METHODS Data were drawn from a national random sample of 575 OSAT centers (85.8% response rate) participating in a telephone survey conducted in 1988. Analysis of variance by ownership was conducted on each performance measure, with differences subjected to tests of statistical significance. RESULTS Descriptive results show that major funding sources differ by ownership. Private for-profit centers generate higher profits, charge higher prices, and achieve higher levels of financial performance than public and not-for-profit centers. Public centers provide better access to care for persons who are unable to pay. CONCLUSIONS There appear to be substantial and interrelated differences by ownership type in the financing and operation of OSAT units.

Hospital alliances: cooperative strategy in a competitive environment.

The resource dependence perspective is used to describe the formation of hospital alliances. Characteristics of alliances and their various strategies and structures are discussed. A life cycle model provides a framework for viewing the development and growth of alliances. Several dimensions for assessing alliance performance are proposed.