BURNS, LAWTON ROBERT; PHD
THE UNIVERSITY OF CHICAGO, 1981
HEALTH SCIENCES, HEALTH CARE MANAGEMENT (0769)
This study seeks to explain the adoption of an innovation in hospital management
and to describe the
process of its diffusion across large general hospitals. The particular innovation
is called patient unit
management. It involves the decentralization of administrative functions to
the patient unit level and the
installation of local level managers to coordinate activities on the unit. The
population of large general
hospitals is selected for study because of their high proportionate adoption
of unit management and
because of the theoretical relevance of decentralization for the management
of large, complex
organizations. As its first agenda, the study describes the types of general
hospitals most likely to adopt
unit management and the extent of their adoption over time. The study also describes
the path of the
diffusion of unit management and seeks to explain how the innovation spreads
across hospitals.
Research findings indicate that hospitals with a strong historical involvement
in teaching exhibit the
highest levels of adoption. Indeed, the degree of teaching involvement is linearly
related to the extent of
adoption. Over time, unit management programs diffuse from hospitals with strong
teaching involvement
to hospitals with medium teaching involvement and, finally, to hospitals with
little teaching activity. The
most important factor influencing the diffusion process is the presence of other
hospitals in the same city
with the innovation. Further evidence suggests that early innovators in a city
act as demonstration
models, thereby reducing the risks and costs involved in implementing unit management.
As its second
agenda, the study compares the ability of various theoretical models to explain
the adoption of unit
management. These models are formulated from research on hospital size and diversity,
corporate
growth and decentralization, administrator characteristics and innovation, and
innovation diffusion. The
predictive power of these models is decomposed into their common and unique
effects. Research
findings indicate that hospital size and diversity explain most of the variation
in adoption, either directly or
indirectly through their associations with variables in the other models. There
is strong evidence for the
existence of threshold effects of size and diversity; however, there is only
weak evidence for the
presence of developmental (growth) effects of size and diversity. Thus, the
evidence reveals that
hospitals adopting unit management during different time periods attain the
same level of scale and
complexity during those periods. These findings suggest that such hospitals
have exceeded the
structural limits within which the traditional administration of patient units
may operate. The coordination
of patient care activities required under conditions of large scale and high
complexity exceeds the ability
of head nurses and physicians to provide it. This lack of fit between structure
and administration, and the
coordinative problems left unattended, leads to the adoption of unit management.
The findings also
reveal that administrator characteristics and the volume of program demonstration
models in the local
environment explain some of the variation in adoption. Administrators with longer
middle-management
experience in their hospital and higher professional education are more likely
to promote the adoption of
unit management. Similarly, hospitals are more likely to adopt when there is
a large number of ongoing
unit management programs in neighboring hospitals. Both sets of findings suggest
that the adoption
process is characterized by 'system delay': more prestigious hospitals and their
administrators delay
adoption until they have observed the results of programs implemented by their
less prestigious
counterparts. As its final agenda, the study compares the reasons for adoption
in older versus newer
hospitals. The results indicate that structural effects are less important in
newer organizations, and that
administrative and external influences are more important.
Social
Systems Simulation Group
P.O. Box 6904 San Diego, CA 92166-0904 Roland Werner, Principal Phone/FAX (619) 660-1603 |