You-Ta Chuang

Dancing with Strangers: Aspiration Performance and the Search for Underwriting Syndicate Partners:

In this paper, we introduce performance feedback models to specify conditions under which organizations decision makers are more (or less) likely to accept the risk and uncertainty of nonlocal interorganizational partnership ties rather than prefer embedded ties with partners with which they have either past direct or third-party ties. Learning theory suggests that organizations performing far from historical and social aspirations may be more willing to accept the uncertainty and risk of such nonlocal ties with relative strangers. An analysis of Canadian investment banks underwriting syndicate ties from 1952 to 1990 supports predictions from learning theory and, in addition, indicates that inconsistent performance feedback (i.e., performance above either historical or social aspirations but below the other) triggers the greatest risk taking in selecting partners.

It's All in the Name: Failure-Induced Learning by Multiunit Chains

We examine factors leading multiunit chains to adopt a common naming strategy, that is, naming components in a manner that identifies them with each other and the overall chain, rather than a local naming strategy that identifies a chains components with their locations but not each other. Because chains naming strategies have been shown to be critical to their success, we examine the effects of component failures on naming strategies. We advance organizational and interorganizational learning processes to explain chains adoption of local naming strategies, which stress local adaptation, or common naming strategies, which emphasize standardization. In contrast to past research emphasizing learning from success, we focus on learning from the failure of strategy, specifically, the failure of a chains own and other chains commonly and locally named components. Two fundamental results emerge from our analysis of Ontario nursing home chains naming strategies from 1971 to 1996. One is that nursing home chains learned from their own and others failures, and the second is that the chains learned less from failures when they had a historical investment in the failing strategy.

The Relationship between Organizational Leadership for Safety and Learning from Patient Safety Events

OBJECTIVEnTo examine the relationship between organizational leadership for patient safety and five types of learning from patient safety events (PSEs).nnnSTUDY SETTINGnForty-nine general acute care hospitals in Ontario, Canada.nnnSTUDY DESIGNnA nonexperimental design using cross-sectional surveys of hospital patient safety officers (PSOs) and patient care managers (PCMs). PSOs provided data on organization-level learning from (a) minor events, (b) moderate events, (c) major near misses, (d) major event analysis, and (e) major event dissemination/communication. PCMs provided data on organizational leadership (formal and informal) for patient safety.nnnEXTRACTION METHODSnHospitals were the unit of analysis. Seemingly unrelated regression was used to examine the influence of formal and informal leadership for safety on the five types of learning from PSEs. The interaction between leadership and hospital size was also examined.nnnPRINCIPAL FINDINGSnFormal organizational leadership for patient safety is an important predictor of learning from minor, moderate, and major near-miss events, and major event dissemination. This relationship is significantly stronger for small hospitals (<100 beds).nnnCONCLUSIONSnWe find support for the relationship between patient safety leadership and patient safety behaviors such as learning from safety events. Formal leadership support for safety is of particular importance in small organizations where the economic burden of safety programs is disproportionately large and formal leadership is closer to the front lines.

Learning from preventable adverse events in health care organizations: development of a multilevel model of learning and propositions.

Background: Preventable adverse events represent learning opportunities. Indeed, understanding and learning from preventable adverse events are the new organizational imperatives in health care. However, health services researchers note that there is a dearth of research on learning from failure in health care and, in industry, a limited capacity to learn from incidents and failure. Purpose: We address the gap between awareness of preventable adverse events and knowledge that relates to how to respond to them effectively. We develop a multilevel model of learning and theorize factors that influence learning from preventable adverse events. Methodology: Drawing upon theories of organizational learning and organizational behavior, we develop a multilevel model of learning from failure, where perceived characteristics of the events, group composition and dynamics, and the behavioral and structural arrangements of health care organizations are proposed to play important roles. Practical Implications: Our model highlights factors that facilitate learning from failure and others that impede it. Awareness and attention to these factors can help health care managers extract learning from failures, like preventable adverse events, and may ultimately contribute to reducing the occurrence of preventable adverse events and improving quality of care.

Taking Sides: The Interactive Influences of Institutional Mechanisms on the Adoption of Same-Sex Partner Health Benefits by Fortune 500 Corporations, 1990--2003

We draw upon institutional theory to investigate the interactive influences of institutional mechanisms---coercive, mimetic, and normative---on the diffusion of a controversial and socially stigmatized practice, same-sex partner health benefits, in Fortune 500 corporations between 1990 and 2003. Given the social stigma associated with domestic partnerships of lesbians and gay men during the period of the study, the provision of these benefits was highly controversial and induced intense contestation between proponents and opponents of the institution of equal treatment for lesbian and gay employees. We explore the diffusion of theses benefits using data on cumulative adoptions by similar others, state laws forbidding discrimination based on sexual orientation, and overall tenor in press coverage of the benefits. Our analysis shows that the cumulative number of adoptions within industry increased the positive effect of state laws on the corporations decision to provide the benefits. However, the cumulative number of adoptions in the state of the corporations headquarters decreased the positive effects of both state laws and overall tenor in press coverage on such a decision. Accordingly, our study contributes to institutional theory by pointing to complex interactive influences of institutional mechanisms on the institutionalization of contested practices, and to the literature on lesbian and gay issues in the workplace by studying factors influencing organizational decisions to adopt policies supportive of lesbian and gay employees.

Development of a Measure of Patient Safety Event Learning Responses

OBJECTIVEnTo define patient safety event (PSE) learning response and to provide preliminary validation of a measure of PSE learning response.nnnDATA SOURCESnTen focus groups with front-line staff and managers, an expert panel, and cross-sectional survey data from patient safety officers in 54 general acute hospitals.nnnSTUDY DESIGNnA mixed methods study to define a measure of learning responses to patient safety failures that is rooted in theory, expert knowledge, and organizational practice realities.nnnEXTRACTION METHODSnLearning response items developed from the literature were modified and validated in front-line staff and manager focus groups and by an expert panel and second group of external experts. Actual learning responses gleaned from survey data were examined using exploratory factor analyses and reliability analysis.nnnPRINCIPAL FINDINGSnUnique learning response items were identified for minor, moderate, major events, and major near misses by an expert panel. A two-factor model of major event learning response was identified (factor 1=event analysis, factor 2=dissemination/communication of learnings). Organizations engage in greater learning responses following major events than less severe events and, for major events, organizations engage in more factor 1 responses than factor 2 learning responses.nnnCONCLUSIONSnEleven to 13 items can measure learning responses to PSEs of differing severity. The items are feasible, grounded in theory, and reflect expert opinion as well as practice setting realities. The items have the potential for use to assess current practice in organizations and set future improvement goals.

Patient safety climate (PSC) perceptions of frontline staff in acute care hospitals: examining the role of ease of reporting, unit norms of openness, and participative leadership.

Background: Increased awareness regarding the importance of patient safety issues has led to the proliferation of theoretical conceptualizations, frameworks, and articles that apply safety experiences from high-reliability industries to medical settings. However, empirical research on patient safety and patient safety climate in medical settings still lags far behind the theoretical literature on these topics. Purpose: The broader organizational literature suggests that ease of reporting, unit norms of openness, and participative leadership might be important variables for improving patient safety. The aim of this empirical study is to examine in detail how these three variables influence frontline staff perceptions of patient safety climate within health care organizations. Methodology: A cross-sectional study design was used. Data were collected using a questionnaire composed of previously validated scales. Findings: The results of the study show that ease of reporting, unit norms of openness, and participative leadership are positively related to staff perceptions of patient safety climate. Practice Implications: Health care management needs to involve frontline staff during the development and implementation stages of an error reporting system to ensure staff perceive error reporting to be easy and efficient. Senior and supervisory leaders at health care organizations must be provided with learning opportunities to improve their participative leadership skills so they can better integrate frontline staff ideas and concerns while making safety-related decisions. Finally, health care management must ensure that frontline staff are able to freely communicate safety concerns without fear of being punished or ridiculed by others.

Staff, space, and time as dimensions of organizational slack: A psychometric assessment

Background: In the theoretical and research literature, organizational slack has been largely described in terms of financial resources and its impact on organizational outcomes. However, empirical research is limited by unclear definitions and lack of standardized measures. Purpose: The aim of this study was to assess the psychometric properties of a new organizational slack measure in health care settings. Methods: A total of 752 nurses and 197 allied health care professionals (AHCPs) employed in seven pediatric Canadian hospitals completed the Alberta Context Tool, an instrument measuring organizational context, which includes the newly developed organizational slack measure. The nine-item, 5-point Likert organizational slack measure includes items assessing staff perceptions of available human resources (staffing), time, and space. We report psychometric assessments, bivariate analyses, and data aggregation indices for the measure. Findings: The findings indicate that the measure has three subscales (staff, space, and time) with acceptable internal consistency reliability (alphas for staff, space, and time, respectively:.83,.63, and.74 for nurses;.81,.52, and.76 for AHCPs), links theory and hypotheses (construct validity), and is related to other relevant variables. Within-group reliability measures indicate stronger agreement among nurses than AHCPs, more reliable aggregation results in all three subscales at the unit versus facility level, and higher explained variance and validity of aggregated scores at the unit level. Practice Implications: The proposed organizational slack measure assesses modifiable organizational factors in hospitals and has the potential to explain variance in important health care system outcomes. Further assessments of the psychometric properties of the organizational slack measure in acute and long-term care facilities are underway.

Effects of Movements and Opportunities on the Adoption of Same-Sex Partner Health Benefits by Corporations

In this study, we draw upon a social movement perspective to examine how movements and institutional opportunity (political and cultural) influenced a sample of Fortune 500 corporations’ adoption of a controversial organizational practice—same-sex partner health benefits. Our results show that while corporations’ gay, lesbian, bisexual, and transgender (GLBT) employee resource groups increased the rate of the corporations’ benefits adoption, the effect of the GLBT employee resource groups became weaker when the degree of resource concentration of local GLBT advocacy organizations was high. Political opportunity derived from state legal environments and cultural opportunity derived from the tenor of moral legitimacy in leading national press coverage had little influence on the rate of benefits adoption. Furthermore, the influence of a GLBT employee resource group on the rate of benefits adoption by its corporation became weaker when cultural opportunity, derived from increases in positive tenor of pragmatic legitimacy discourse used by movement and countermovement organizations in the press, was present. Accordingly, our study shows the complicated effects of movements within and outside corporations and cultural opportunity on the adoption of a controversial practice and reveals the importance of mobilizing structure (both internal and external movements) and cultural opportunity in the adoption.

Multimarket Contact, Strategic Alliances, and Firm Performance

Research on multimarket contact and firm performance has produced mixed results. To reconcile this discrepancy, we theorize how varying levels of multimarket contact may generate mutual forbearance that influences firm performance. We also examine how strategic alliances moderate the relationship between levels of multimarket contact and firm performance. Our analysis of 233 semiconductor firms across 52 markets reveals that multimarket contact has an inverted U-shaped relationship with a multimarket firm’s market share. The number of strategic alliances that a firm has helps to further extend the positive effect of multimarket contact and mitigate its negative effect on the firm’s market share. Accordingly, our study contributes to the literature on multimarket competition by shedding light on the conditions under which multimarket contact may increase/decrease firm performance.