Riview

HEALTH CARE MANAGEMENT
Conference Paper Abstracts

UNDERSTANDING MENTAL HEALTH TREATMENT IN
PRIMARY CARE WITH PATIENT-PHYSICIAN INTERACTION
DATA
Tai-Seale, Ming; Texas A&M U.; mtaiseale@srph.tamhsc.edu
Objective: To examine the mental health treatment process in primary care settings using interactioinal
data to capture what happens in practice and how it may be improved. Study Design: This was an
observational study informed by videotapes of patient-physician interactions and patient and physician
surveys. Videotaped visits came from an Academic Medical Center (AMC), a managed care group
practice (MCG), and an urban private group practice (UPG). The Assessment of Doctor-Elderly Patient
Transactions (ADEPT) system scored videotapes regarding physicians discussion of affective disorders
and the use of formal depression diagnostic tools. A random-effects logit model was used to analyze the
effects of patient health, competing clinical demands, and racial and gender concordance on the
propensity of physicians discussing affective issues. Results: The probability of having a discussion on
affective issues ranged from 4% in UPG to 20% in AMC. The use of formal depression assessment tools
was very rare. Affective discussion was less likely if the patient has high emotional role functioning. It was
also less likely to occur in gender and racial concordant patient-physician dyads. The propensity of
affective discussion was higher in visits that covered multiple topics. Patients mental health needs were
often unaddressed or marginalized. Conclusions: Micro-level videotaped interaction data offer valuable
information on the process of mental health care which can benefit quality of care investigations in
examining how well physicians translate knowledge and guidelines into actual patient care practices.
Keywords: Affective disorder, primary care, patient-physician interaction
VERTICAL INTEGRATION BETWEEN COMMUNITY HOSPITALS

AND NURSING FACILITIES
Lo, Jen-Pei; NSYSU., Kaohsiung, Taiwan; erosann@ms23.hinet.net
Yeh, Shu-Chuan Jennifer; NSYSU., Kaohsiung, Taiwan; syeh@cm.nsysu.edu.tw
Resource dependency theory suggests that no organization can be completely independent from their
social environments. To reduce uncertainty and increase organizational power, they procure the
necessary resources by interacting with other organizations which dominate the available resources in
their environment. Using a resource dependence theory perspective, we hypothesize that the relationship
between organizational and environmental characteristics and vertically integration are positively
associated. In support of most of these hypotheses, results demonstrated that community hospitals with
provisions of ventilating care, dialysis, home care services, higher ratio of licensed practical nurses to
staffed beds, and those located in the areas of higher elderly population and higher competition index are
more likely to vertically integrate into nursing facilities. Decisions related to vertically integrate into nursing
facilities have important implication for survival. Yet, despite the assumption of cost-effectiveness, we
really don't know if, or how, the community hospitals benefits from this strategy. Future studies need to
focus on the nature of these linkages to assess their impact on continuum of care, as well as their costeffectiveness. Small, rural hospitals that face a struggle to survive in the post-reform environment may not
Health Care Management Paper Abstracts -- 1
need to own a nursing facility but should pursue formal alliances and other tight linkages with area
nursing facilities.
Keywords: resource dependence theory, community hospital, vertical integration
DOWNSTREAM INTEGRATION AND COMPETITIVE

STRATEGIES IN THE US PHARMACEUTICAL INDUSTRY
Simonet, Daniel; Nanyang Technological U.; adaniel@ntu.edu.sg
This article review vertical or quasi-vertical integration that characterized the pharmaceutical industry in
the middle of the 1990s. These acquisitions and vertical partnerships that linked Pharmacy Benefits
Managers and drug manufacturers modified the structure of the market. What were the motivations of
those agreements? Did they induce any distortion in competition on the drugs market? Why did they fail?
The paper uses an established theoretical perspective as the basis for a descriptive analysis that
documents a strategic decision of vertical integration that did not obtain the intended results. The adopted
perspective could serve as a framework to examine vertical integration strategies in other industries.
Keywords: Drug Firms, PBM, Vertical Integration
A RESOURCE BASED VIEW OF PARTNERSHIP STRATEGIES

IN HEALTH CARE ORGANIZATIONS
Yarbrough, Amy K.; U. of Alabama, Birmingham; ayarbrough@uabmc.edu
Powers, Thomas L; U. of Alabama, Birmingham; tpowers@uab.edu
Health care organizations use partnership strategies to gain access to valuable resources possessed by
other firms. The distribution of organizational forms in the rural hospital sector has been shifting from
independent ownership to interorganizational relationships with other firms including health care systems,
networks, and management contract arrangements. A shortage of resources has been cited as one
cause for such collaboration among facilities. The resource-based view of the firm suggests that
organizations differentiate between strategic alliances and acquisition strategies based on a firm's internal
resources and the types of resources a potential partner organization possesses. This paper provides a
review of the literature on resource-based theory, alliances, and mergers and acquisitions. A model of
alliances and mergers/acquisitions that can be tested in the rural hospital sector is presented.
Keywords: Alliances, Acquisitions, Resources
HUMAN RESOURCES MANAGEMENT, ORGANIZATIONAL

CULTURE, AND HOSPITAL PERFORMANCE
Hernandez, S Robert; U. of Alabama at Birmingham; hernande@uab.edu
Platonova, Elena; U. of Alabama, Birmingham; hernande@uab.edu
Shewchuk, Richard; U. of Alabama, Birmingham; shewchuk@uab.edu
It is generally assumed that organizations managing their employees well and maintaining positive
organizational cultures have a competitive advantage over their rivals. This intuitively appealing
relationship is based on an assumption that better human resource practices result in better employee
performance. It is also assumed that organizational culture may affect organizational performance.
Though there is general agreement that human resource management (HRM) and performance are
linked, the nature of the relationship is still not well-understood. Some theorists speculate that the
uncertainty about the relationship between HRM and performance may be potentially explained by the
mediating role of organizational culture. They are convinced that culture may offer the highest potential
for HRM to improve organizational financial outcomes. Recent research indicates that organizational
culture is related to performance and it may mediate the relationship between HRM and performance.
While there is some empirical evidence of the contribution of HRM practices to organizational
performance and culture in general business settings, few studies have discussed these relationships in
healthcare organizations. Thus, this paper will propose that progressive HRM practices positively affect
organizational cultures and organizational performance in the healthcare industry. First, the relationships
from HRM practices to organizational culture and performance found in general business settings will be
reviewed. Next, the contribution of selected cultural dimensions to organizational performance will be
presented. Then, a proposed model of the relationship among HRM, organizational culture and hospital
performance will be presented. Finally, implications that findings will have for improved management of
hospitals are provided.
Keywords: human resources management, organizational culture, organization performance
STUDYING PATIENT SAFETY IN HEALTH CARE

ORGANIZATIONS: VALUING A RANGE OF APPROACHES
Hoff, Timothy; State U. of New York, Albany; thoff@albany.edu
The study of patient safety in health care organizations can benefit from greater methodological diversity.
This diversity is needed not only to improve scientific knowledge of patient safety but also to increase the
effectiveness and tailoring of strategies aimed at improving it. The current paper makes the case in
particular for adding qualitative approaches since they can help to illuminate the complexity and
dynamism of health care organizational settings, while enhancing the prospects for more real-time
examinations of safety and error. An action agenda is included for how organizations can better
implement and promote the use of qualitative methods in this regard. Successful implementation is
defined in this instance as the establishment of positive organizational dynamics dealing with trust,
honesty, worker participation, and communication, in addition to using qualitative methods in an efficient
and resourceful manner.
Keywords: patient safety, qualitative methods, research methods
THE EMERGENCE OF RADICALLY NEW HEALTH CARE

TECHNOLOGIES: INVENTIVE USERS AS INNOVATION
NETWORKERS
Lettl, Christopher Ulrich; Berlin TU; christopher.lettl@tim.tu-berlin.de
Besides a large body of research on user innovation, little is known which role users play in the
emergence of radically new health care technologies. Such technologies are new-to-the-world, highly
complex, shift market structures, and require user learning as they often induce significant behaviour
changes on side of the users. In a multi-case-study-analysis we identified an entrepreneurial role of
inventive users. Those surgeons that were the original inventors of radically new health care technologies
established and organized the required innovation networks. They identified relevant partners, formed a
network of experts with complementary knowledge bases, and coordinated this network. These
innovation networks were required to transform their radically new ideas into first physical prototypes. To
better understand the observed phenomenon we analysed factors that might explain this exclusive role.
We find that a high problem pressure, an active role of users in the idea generation phase, a high degree
of innovativeness of the prospective product, and missing competencies as well as missing resources
explain the networking activities of inventive users. The findings shed light on the role of users in the
emergence of radically new health care technologies.
Keywords: User, Radical Innovation, Innovation Networking
MESO- AND MACRO-LEVEL BARRIERS AND FACILITATORS

TO CLINICAL PRACTICE GUIDELINE IMPLEMENTATION
Gilbart, Erin; U. of Toronto; erin.gilbart@utoronto.ca
In this mixed-methods study, I analyze meso- and macro-level barriers and facilitators to implementing
clinical practice guidelines (CPGs) in long-term care (LTC) facilities in Ontario, Canada. CPGs have the
potential for streamlining care and improving resident outcomes, however their uptake has been
disappointing. The theoretical framework for this study derived from three distinct research literatures to
develop a conceptual model of CPG implementation in LTC that includes the identification of factors that
facilitate, and others that impede CPG implementation. Most CPG literature has focused on micro-level
factors influencing the practice patterns of individual providers with the autonomy to make care decisions.
This literature has largely ignored meso- and macro-level factors and has not considered situations in
which care providers have reduced autonomy. In order to develop a more comprehensive conceptual
model, the literature on organizational behaviour and innovation was used to inform meso-level factors
affecting CPG implementation, while neo-institutionalism assisted in addressing macro-level system
factors such as funding and regulation. A combination of research methods were used in this study:
qualitative interviews of key informants from the LTC sector, a teleconference with a panel of experts, and
a province-wide survey of Directors of Care. I find that macro-level system pressures exert considerable
influence on CPG implementation across the LTC sector in Ontario, thereby challenging some of the
assumptions often made in the CPG literature about the importance of micro-level factors. This model has
broader implications for other healthcare settings and management practices where the balance of
influence may lie elsewhere.
Keywords: clinical practice guidelines, implementation barriers and facilitators, long-term care
JOB DEMANDS, BURNOUT, AND TURNOVER INTENT AMONG

NURSING ASSISTANTS: MEDIATING AND MODERATING
EFFECTS
Proenca, Jose; Widener U.; jxp0003@mail.widener.edu
Carpenter, Caryl; Widener U.; cec0001@mail.widener.edu
Goldman, Beryl; Kendal Corp.; bgoldman@kcorp.kendal.org
Concern over high turnover among certified nursing assistants (CNAs) in long-term care has generated a
significant amount of research and a long list of probable causes. Yet, the problem of CNA turnover
remains as prevalent and critical as it has ever been. It has been suggested that we need a better
understanding of the mechanisms by which organizational and individual factors affect turnover and the
contingencies that moderate the process. This research contributes to organization theory, and our
understanding of CNA turnover, by (1) investigating the role of burnout as a mediator in the turnover
process, and (2) examining the moderating effects of job control, empowerment, and context satisfaction
on this process. We found that burnout mediates the relationship between job demands and intent to
turnover. Empowerment and job control moderate the link between job demands and burnout, and
context satisfaction moderates the link between burnout and turnover intention. The implication for
management practice is that, although direct care jobs can be physically and mentally demanding, the
negative effects of such characteristics can be mitigated by creating conditions that empower and satisfy
CNAs.
Keywords: Burnout, Turnover, Certified Nursing Assistants
THE CHALLENGES FOR HRM AND PERFORMANCE IN THE

VICTORIAN (AUSTRALIAN) PUBLIC HEALTH SYSTEM.
Stanton, Pauline; La Trobe U.; p.stanton@latrobe.edu.au
Bartram, Timothy; La Trobe U.; t.bartram@latrobe.edu.au
Harbridge, Raymond; La Trobe U.; r.harbridge@latrobe.edu.ua
Leggat, Sandra; La Trobe U.; s.leggat@latrobe.edu.au
Fraser, Benjamin; La Trobe U.; b.fraser@latrobe.edu.au
Garreffa, Terese; La Trobe U.; t.garreffa@latrobe.edu.au
Using data collected in 2004 of 132 Victorian (Australia) public health facilities we investigate the adoption
of HRM from the experiences of chief executive officers (CEOs), human resource directors (HRDs) and
general functional managers (GFMs) across four health divisions. This paper is comprised of four
investigations of HRM. First, using one-way ANOVA we investigate the adoption of HRM from the
perspectives of CEOs, HRDs and GFMs. Second, we explore their responses to three qualitative
questions concerning the positive aspects of HRM in health care organisations, barriers to practicing
HRM and areas for improvement of HRM. Third, using one-way ANOVA, an exploratory investigation was
also conducted to improve our understanding of how the CEOs across the four divisions of health
services in Victoria think about performance and the methods they use to monitor performance. Fourth,
zero-order correlations were performed between the Strategic HRM index, measures of the HRM
functions, and HRM outcomes. Findings suggest a number of barriers and challenges facing the Victorian
public health sector in its attempt to adopt HRM, such the relationship between the three levels of
managers, management training of GFMs, fiscal restraint by the government, a lack of performance
monitoring and measurement of HRM and integration with the strategic goals of the organisation. There is
some support for the relationship between strategic HRM and improved organisational outcomes.
Implications of these findings are drawn for managerial practice. This paper also contributes to
organisational theory by improving our understanding of the practice of HRM within complex health
settings.
Keywords: human resource management, public health, Australia
PATIENT TURNOVER AND NURSING STAFF ADEQUACY

Unruh, Lynn; U. of Central Florida; lunruh@mail.ucf.edu
Fottler, Myron D; U. of Central Florida; Fottler@mail.ucf.edu
ABSTRACT Objective. To assess the difference in nurse staffing using measures that adjust for patient
turnover and severity versus those that do not. Data Sources. Numbers of registered nurses (RNs),
adjusted patient days of care (APDC), length of stay, and patient severity information from acute-care
general hospitals in Pennsylvania 1994-2001, obtained from the Pennsylvania Department of Health, the
American Hospital Association, and the Atlas MediQual system. Study Design. After examining the trends
in patient turnover and severity and their relationship to RN staffing, we apply two patient turnover indices
with and without patient acuity adjustments to RN staffing measures, and test the difference between the
original and adjusted measures using paired sample t-tests. Data Extraction Methods. Data sets were
match-merged by hospital ID, and patient turnover and severity indices were created, using 1994 as the
base year. RN staffing measures were developed using unadjusted APDC and APDC adjusted for patient
turnover and both patient turnover and severity. Principal Findings. Patient turnover increased
significantly from 1994 to 2001. The difference between RN staffing measures adjusted for patient
turnover and severity and those not adjusted was increasingly significant from 1999 on. Unadjusted RN
staffing showed a 1 percent decline over the eight year period compared to decreases of from 10 to 26
percent after adjustments. Conclusions. These results indicate that the assessment of unadjusted RN
staffing by RN to patient ratios alone significantly underestimates nursing needs and overstates RN
staffing levels. Patient turnover, as well as acuity, should be taken into account in staffing assessment
and decision-making.
Keywords: patient throughput, patient throughput, RN staffing, RN staffing, length of stay
ORGANIZATIONAL TRUST IN HOSPITAL NURSING STAFFS

Lafferty, Christina L.; National Defense U.; laffertyc@ndu.edu
This study used Sashkins theory of organizational trust to examine the relationship between
organizational trust in nursing staffs and three performance indicators of organizational effectiveness in a
ten-hospital system. The quantitative study used a nonexperimental correlational descriptive design
relating nursing staff organizational trust, as measured by the Management Behavior Climate
Assessment, to turnover rate and cost, employee compensation cost, and patient satisfaction. Findings
support hypotheses that nursing staff organizational trust is negatively correlated system-wide with
nursing staff turnover rate, employee compensation cost, and positively correlated with non-urban
hospital patient satisfaction. The findings suggest a strong relationship between organizational trust and
certain performance indicators of organizational effectiveness that may be tied directly to health care cost.
Keywords: organizational trust, organizational effectiveness, performance
HR AND IT CAPABILITIES AND COMPLEMENTARITIES IN

HEALTH CARE ORGANIZATIONS
Khatri, Naresh; U. of Missouri, Columbia; KhatriN@Health.Missouri.edu
Hicks, Lanis L; University of Missouri - Columbia; HicksL@health.mossiuri.edu
Brown, Gordon D; University of Missouri - Columbia; BrownG@health.missouri.edu
In this paper, we look at how health care organizations can enhance their competitiveness via their
human resources (HR) and information technologies (IT). Health care organizations are knowledge-based
and service-oriented. HR and IT are thought to be fundamental to such organizations. We consider three
issues in this paper. First, we review the literature on the resource-based view to identify mechanisms
through which HR and IT can provide competitive advantage to health care organizations. Second, based
on the review of the literature, we develop comprehensive conceptions of the two important, but less
studied, constructs of HR and IT capabilities. Third, we explore the complementarities between HR and
IT. We discuss a number of implications of our theoretical framework for research and practice.
Keywords: human resource capability, information technology capability, resource-based view
GAINING LEGITIMACY, KNOWLEDGE CREATION AND

HOSPITAL SURVIVAL
Fang, Shih-Chieh; National Kaohsiung First U.; fang@ccms.nkfust.edu.tw
Yang, Chen-Wei; Fooying U. and I-Shou U.; weiger789@yahoo.com.tw
Huang, Wei-Min; The Health Bureau of Peng-Hu County Government, , Taiwan;
wayneh@isu.edu.tw
There are three purposes of this study: (1) to examine the legitimacy gaining model (the relationship
between legitimation strategies and legitimacy) in the context of hospital industry, (2) to explore the
influence of legitimacy gaining model on the process through which knowledge is created within hospital
industry. (3) to explore the impact of hospital organizations knowledge creation on hospital survival .This
paper proposes an legitimacy gaining model as the determinants of hospitals knowledge creation
activities. Then we argue that the legitimation model of knowledge creation will further influence the
survival chance of hospitals. We further suggest the managerial implication and theoretical implication at
the end of this paper. The main managerial implication is that to comprehend the legitimacy- gaining
model of legitimation strategies and legitimacy elements may help hospitals managers to make effective
strategies to create new, innovative knowledge and identify useful legitimacy factors, which may both
assist and impede the creation of knowledge. The main contributions to organization theory are that we
combine the perspectives of institutional theory and knowledge creation theory and explicate the
relationship of these two concepts in the studies of health care management field.
Keywords: Legitimacy, Knowledge creation, Hospital survival
VIRTUAL TEAMS: THINKING ABOUT HOW DISTANCE &

DIGITAL MEDIATION AFFECT PATIENT CARE TEAMWORK
Goldstein, Nance L; Brandeis U.; nance.goldstein@post.harvard.edu
Healthcare organizations have recently invested in clinical information technologies (IT) to respond to
pressures to simultaneously reduce medical errors and costs. These technologies increasingly mediate
patient care teams and networks. Understanding the effects of IT-mediation becomes essential because
both interdisciplinary teams and multi- organizational care networks have become central to delivering
care services and to strategic pressures to improve quality and reduce care costs and risks. This paper
examines the healthcare literature on patient care teams. The literature rarely distinguishes either ITmediation or the cross-organizational composition of those teams as elements in their behavior or
performance. The paper then applies the US management literature to distinguish specific behavior and
performance issues in virtual teams (where IT mediates distanced collaboration). The absence of
proximity mediated by IT complicates organizations ability to improve team performance. The virtual
factor increases the time for and issues involved in communications, opportunities for misunderstanding
and conflict and the impact of pre-existing professional, rank or hierarchical inequities. The paper
suggests that (a) modeling the systemic factors that support or confound team performance and (b)
constructing larger, better specified and comparative studies will improve decisions and attitudes virtual
clinical teamwork. The article distinguishes IT-mediation and the multi- organizational network dimensions
as key yet rarely explicit factors in understanding the power of interdisciplinary teams in improving
organizational performance. The review identifies the complex social and organizational issues, not
simply the technological specifications, to consider in investing in clinical IT to improve financial and care
quality performance.
Keywords: I, I
BENEFITING FROM NETWORKS BY OCCUPYING CENTRAL

POSITIONSX THE CASE OF TAIWAN HEALTHCARE
INDUSTRY
Peng, Tzu-Ju Ann; Providence U.; tjpeng@pu.edu.tw
Lo, Fang-Yi; National Chenchi U.; 92355504@nccu.edu.tw
Lin, Chin-Shien; National Chung Hsing U.; csvincentlin@dragon.nchu.edu.tw
Yu, Chow-Ming Joseph; National Chenchi U.; yu54@nccu.edu.tw
Do network resources imply some resources available to all members in networks or only available to
those occupying structurally central positions in networks? Drawing from the resource-based view and by
unpacking two sources of resources for a firm (i.e., firm-source and network-source), the paper addresses
this issue by making distinction between network-source resources (i.e., What network-source resources
are in a network) and centrality (How to get network-source resources in a network). Network-source
resources are regarded as contextual resources, representing the types of resources a firm can
access externally; centrality is a structural position, enabling a firm to access external resources
through its structurally embedded position. Two conceptual models, one additive and one interaction, are
empirically tested regarding the impact of firm-source resources, network-source resources, and centrality
on firm performance in Taiwan Healthcare industry, an industry noted for forming alliances or networks
among hospitals. Statistical testes for ninety-eight observations have revealed that: (1) in the additive
model, hospital-source resources and centrality affect performance; and (2) in the interaction model,
centrality, the moderating variable, does not exhibit any significant impact on performance. The findings
suggest that structural positions are keys to get access to network-resources and hospitals should try to
move to positions with high centrality in networks to benefit more from collaborations.
Keywords: healthcare network, centrality, source of resources
FACE-TO-FACE WITH AIDS IN THE WORKPLACE:CONCERN

FOR FACE, FEAR OF AIDS AND ITS CONSEQUENCES
Lim, Vivien KG; National U. of Singapore; bizlimv@nus.edu.sg
ABSTRACT The Acquired Immune Deficiency Syndrome (AIDS) is affecting people at a time when they
are likely to be gainfully employed. The presence of AIDS affects the patterns of interaction and
relationships in organizations. In this paper, we argue that individuals concern for face is central to our
understanding of individuals responses to AIDS at the workplace. Drawing from previous research on
AIDS, we developed and tested a model examining concern for face as a predictor of AIDS fear and
individuals attitudes towards AIDS policies, organizational privacy and the organizational consequences
of hiring people living with HIV (PWHIV). Data were collected via a combination of survey and face-toface interviews. Respondents consisted of 160 human resource managers. Results of structural equation
modeling (SEM) provided empirical support for our hypotheses. This research contributes to
organizational theory and research on AIDS by examining concern for face as a predictor of AIDS fear in
the workplace and the outcomes of this fear. One of the essential first steps in dispelling AIDS fear is to
destigmatize the disease. An understanding of the concept of face and its role in predicting AIDS fear and
its consequences presents an effort toward this direction. Findings have significant practical implications
for structuring organizational AIDS training and human resource practices and point toward the utility of
establishing education programs and organizational policies pertaining to the treatment of PWHIV in the
workplace.
Keywords: AIDS fear, workplace, concern for face
THE EFFECT OF EXPLORATION, EXPLOITATION, AND

PROCESS ON HEALTHCARE ORGANIZATIONAL CHANGE
Walston, Stephen L; U. of Oklahoma Health Sciences Center; stephenwalston@ouhsc.edu
Chou, Ann F.; Indiana U.; achou@iupai.edu
This paper examines the effect of exploration, exploitation, and process facilitators on changes in cost
and quality following a major organizational restructuring in hospitals. Process facilitators are found to
positively influence the results of restructuring, while the presence of stronger exploitation focus
negatively influences the outcomes. We posit that process facilitators may assist to create a learning
environment and motivate more effective change, while exploitive factors constrain change and may
damage desired results during dramatic change.
Keywords: exploration, exploitation, change
WOMEN'S HEALTH ISSUES: A CASE STUDY IN SETTING

PRIORITIES
Ginter, Peter M; U. of Alabama, Birmingham; pginter@uab.edu
Duncan, W Jack; U. of Alabama, Birmingham; jduncan@uab.edu
Wingate, Martha Slay; U. of Alabama at Birmingham; mslay@uab.edu
Public sector decision makers charged with the responsibility of addressing womens health issues are
confronted with considerably more needs than they have resources, particularly given leaner state and
federal budgets for programs related to health. Therefore, setting priorities for womens health is essential
if limited resources are to be focused on addressing the most important challenges. This paper describes
priority setting techniques used by a state department of public health that are particularly useful in notfor-profit and public sector settings where traditional business concepts such as market share, industry
strength, competitive advantage, and profitability are not immediately applicable. Implications are
provided for its usefulness in womens health and other health care settings.
Keywords: priority setting, not-for-profit management, women's health
BOUNDARY OF AGENCY PREDICTIONS OF

PHYSICIANS'VHOSPITAL'S OUTCOMES: ONE OF MEDICAL
CENTERS IN TAIWAN
Wang, Hsiu Lin; Not Specified; d870303@cc.kmu.edu.tw
This study addresses hospital organizationVphysician professional exchanges from both agency theory
and work interdependence perspectives simultaneously by examining changing of physician
compensation contracts, being used to reduce the agency problem. We analyze the relationship between
compensation contracts within physician groups and hospitals outcomes: resource efficiency, patient
satisfaction, and financial performance. Also, we explore what extent interdependent work context does
tempering agency theory predictions, and outline specific contingencies that determine whether outcomebased contract is beneficial. These results are tested within healthcare industry sample drawing one
medical center case in southern Taiwan. Therefore, delineating enforcement of a code of ethics and
special problem of control within exchanges involving hospitalVphysicians to address boundary
conditions for the effects of agents. Using secondary data during 19992004 years, including 330
physicians across 23 clinical units, retrograde analytic results partially support our predictions. We
highlight the individual-level and organization-level implications of pay contract. Specifically, the
outcomeVbased contract significantly positive relates to individual performance, and increases in effort of
physicians contributes independently to overall performance; while accompanied by independent clinical
work is absence. However, the effects of outcome-based pay on hospital financial performance are
somewhat harder to predict.
Keywords: compensation contracts, agency theory, outcomes
HOSPITALS ON THE ROAD TO COMPETITIVE

ADVANTAGE? THE CASE OF IMPLEMENTING DRGS IN
GERMAN HOSPITALS
Ridder, Hans-Gerd; Hannover U.; ridder@mbox.ifb.uni-hannover.de
Martini, Susanne; Hannover U.; martini@mbox.ifb.uni-hannover.de
Doege, Vanessa; Hannover U.; doege@mbox.ifb.uni-hannover.de
This research examines the implementation of Diagnosis Related Groups (DRGs) in German hospitals.
Research concerning DRGs mostly concentrates on the system, functions, and outcomes of DRGs,
especially reduction in length of stay, decrease in costs and the improvement of the patient treatment
process. Based on a dynamic capability approach our study investigates the implementation process
itself. Data from direct observation, documents, and interviews with the occupational professionals
involved identified several influencing variables concerning successes or failures in the adoption of
DRGs. In successful clinics a higher level of acceptance is observed as these clinics accept change, gain
internal resources to compensate the lack of external support, and organize processes of implementation
by shifting their capabilities to required changes. Unsuccessful clinics resist change due to the defense of
medical and traditional values of patient treatment, and the inability to compensate lack of resources.
They organize their implementation processes due to the traditional division of labor without enhancing
their capabilities. The contribution to organizational theory lies in the adaptation of a dynamic capability
approach to the field of health care management by augmenting the categories of this approach and by
presenting empirical findings on processes of implementation regarding an administrative innovation in
hospitals. The implications of our work for management practice concerns the ability of managers and
chief physicians to consider resources and capabilities that address the change process itself and
resources and capabilities supporting a new asset position within their field.
Keywords: Diagnosis Related Groups, Dynamic capability approach, Implementation process
HAVING FUN WHILE GETTING HEALTH CARE WORK DONE:

DOES PERSONALITY MAKE A DIFFERENCE?
Karl, Katherine A; Marshall U., Lewis College of Business; karlk@marshall.edu
Peluchette, Joy VanEck; U. of Southern Indiana; jpeluche@usi.edu
This study examined the role of the Big Five personality dimensions in attitudes toward workplace fun,
experienced fun, emotional exhaustion and job satisfaction in a healthcare environment. Our results
showed that extraversion and agreeableness were positively related to attitudes toward fun. Extraversion
and emotional stability (low neuroticism) were positively related to the level of fun experienced at work. In
general, the healthcare workers in our sample had positive attitudes regarding the appropriateness,
salience and consequences of having fun at work. Additionally, those who reported experiencing greater
levels of workplace fun had significantly higher job satisfaction, lower emotional exhaustion, and lower
emotional dissonance. Health care institutions that might be considering the introduction of fun into their
organizational culture, and are concerned about how such activities would be viewed by healthcare
employees, should be encouraged by these findings.
Keywords: personality, satisfaction, fun
TECHNOLOGY ENABLERS: MANAGEMENT PRACTICES THAT

PROMOTE END-USER ACCEPTANCE OF TECHNOLOGY
Dansky, Kathryn H; Pennsylvania State U.; kxd9@psu.edu
This paper describes findings from a study of factors that influence employees attitudes towards
technology. Relationships among strategy, management practices and end-user acceptance of
technology were tested in a field study of healthcare organizations in the U.S. Data were collected from
two different sources, manager interviews and nurses surveys, over a twelve month period. Building on
the Technology Acceptance Model (TAM), this study investigated the role of organizational support as a
predictor of perceived usefulness of telehealth. Through factor analysis, we differentiated between a
technology-supportive culture and technology management practices within the organizational support
construct. Results showed that organizational support for telehealth was the greatest predictor of its
perceived usefulness, and specific technology enablers were more powerful predictors than a generally
supportive culture. Provision of resources, adequate time, and a technical support person had the highest
correlations with perceived usefulness of telehealth. We also found a significant interaction between the
strategic goal of cost containment and organizational support. This study provides empirical support for
including technology management practices in the Technology Acceptance Model. We extend the TAM
and offer a revised model of end-user acceptance to provide a framework for future research and
practice. Implications for managers who are involved in technology deployment are discussed.
Keywords: technology, end-user, enablers
BARRIERS TO CEO SUCCESSION PLANNING: A

COMPARISON OF CEO AND BOARD CHAIR PERSPECTIVES
Garman, Andrew N.; Rush U.; andy_n_garman@rush.edu
Recent research suggests that hospitals in the United States lag substantially behind other organizations
in adopting CEO succession practices. The present study seeks to better understand barriers to adoption
of these practices, by examining the respective roles of hospital CEOs and Board Chairs in the
succession planning process. Evolutionary theory (Shen, 2003) and institutional theory (Ocasio, 1999)
provide frameworks for hypothesizing the aspects of CEO and Board Chair perspectives which may
diverge when considering succession planning; these hypotheses are then tested using archival data
from a national survey of succession planning practices. Results suggest that both theories provide some
explanatory power; i.e. prior practice may significantly facilitate succession planning but other forces more
readily explained by evolutionary theory also affect whether these practices are implemented. From a
practical perspective, succession planning may be most readily implemented early in a CEOs tenure, and
development of formal board policies may ultimately provide the strongest assurance of eventual
implementation.
Keywords: executive succession, governance, succession planning
CONTEXTUAL INFLUENCES OF LEARNING IN A HOSPITAL

ENVIRONMENT.
McCaffrey, Eileen; U. of Western Australia; eileen.mccaffrey@health.wa.gov.au
Few empirical studies have examined training transfer influences using qualitative methods. This study
will address this gap in the literature by examining what influences learning transfer in an Australian
health care context. The Baldwin and Ford (1998) training transfer model is utilised as the theoretical
framework for this study. Thirty-one healthcare managers from a variety of disciplines participated in nine
focus groups. Drawing on grounded theory principles to analyse the rich data the preliminary results
indicate that the health care influences are similar to the Baldwin and Ford (1988) posited work
environment variables. However, the influences are deeply rooted in organisational culture and appear
more complex. The paper discusses implications for health care managers who desire to increase
learning transfer in hospitals.
Keywords: Hospital, Learning, Transfer
COORDINATION IN A SYSTEM OF CARE: THE INITIAL STAGE

OF A SCHOOL-BASED IMPLEMENTATION
Topping, Sharon; U. of Southern Mississippi; sharontopping@comcast.net
Crowder-Brown, Loria; Jackson State U.; loria.c.brown@ccaix.jsums.edu
Scafidi, Brenda; Mississippi Department of Mental Health; bscafidi@msdmh.org
Over the past decade, increasing emphasis has been placed on the integration of mental health and
schools in the development of systems of care. This paper uses cross case analysis (four schools:
elementary, middle, high school, and alternative) to examine the implementation of a school-based
system of care. From this, the paper identifies not only problems associated with the implementation but
also factors that facilitate the collaboration process and lead to effective coordination and integration. By
identifying six reoccurring themes from the qualitative data, the paper presents best practices that can be
used to effectively implement a coordinated school-based system of care. Actually, many of the findings
can be related to any interagency implementation involving change and innovation. In addition, most
outcomes are supported theoretically by both the health care and management literature; therefore, this
paper has implications for both theory and practice.
Keywords: Interagency Coordination, Team Collaboration, Integration
SENSE-MAKING IN DIFFICULT TIMES: EXPERIENCES OF

EMPLOYEES IN ASIA-PACIFIC HOSPITALS
Arnold, Stewart; U of Queensland; s.arnold@business.uq.edu.au
Boyle, Maree Veronica; Griffth U.; m.boyle@griffith.edu.au
Callan, Victor J.; U. of Queensland; v.callan@business.uq.edu.au
Increasingly, healthcare organizations around the world are experiencing organizational upheavals and
crises. Employees of these organizations face unique challenges in continuing to provide care for others,
while under threat themselves during such difficult times. The focus of this paper is the research question:
How do hospital employees make sense of difficult times in their organization? In addressing this
question, we contribute to organizational theory by providing a framework that draws from the literature
on organizational crises and the literature on sensemaking. We report on qualitative research conducted
at two hospitals in the Asia-Pacific region. We compared the sensemaking of employees in an Australian
hospital undergoing large-scale change to that of employees who worked in a Singaporean hospital that
was threatened by the SARS epidemic of 2003. Our findings suggest that, although the hospitals faced
different situations in different countries, their employees made sense of the difficult times through similar
approaches. The implications of our findings for managerial practice are that hospitals can help their
workforce to adjust psychologically to the challenges of difficult times by promoting their own healthcare
principles and fostering employees professionalism.
Keywords: sensemaking, organizational crises, hospitals
WORK ENVIRONMENTS, PSYCHOLOGICAL SAFETY, AND

POSITIVE AFFECT IN HEALTH CARE: A THEORETICAL
FRAMEWORK
Rathert, Cheryl; U. of Nebraska, Lincoln; RathertAC@aol.com
May, Douglas R; U. of Nebraska, Lincoln; Dmay1@unl.edu
Health care is a service that all people need at some point in their lives. In recent years the quality and
safety of health care has been questioned by researchers, patients, and care providers alike. At the same
time technological advances have enabled the development of treatments and cures not imagined just a
few years ago, thousands of patients die each year due to preventable medical errors (Institute of
Medicine, 2000). Health care staffing shortages are severe, and are predicted to get worse (Institute of
Medicine, 2004). To address some of these problems, a theoretical framework formulated from employeecustomer linkage research is articulated for health care. The model proposes that the hospital work
environment contains predictors of patient-centered care, patient satisfaction, and employee satisfaction.
Three organizational climate types are proposed to exist in top performing hospitals: (1) a climate for
patient-centered care; (2) a climate for quality improvement; and (3) a benevolent ethical climate. The
model proposes employee psychological safety and positive affect act as mediators of the work
environment-outcomes relation. The model contributes to extant research by specifying theoretical
relationships among important organizational behavior variables in a health care setting. The model
contributes to practice by identifying mechanisms in the work environment that can be managed to affect
both employee and patient outcomes.
Keywords: Work climates, Health care employee satisfaction, Patient satisfaction
WORK ENVIRONMENT PERCEPTIONS AND ORGANIZATIONAL

COMMITMENT: A STUDY OF HOSPITAL NURSES
Jernigan, I E; UNC-Charlotte; ejernign@email.uncc.edu
Beggs, Joyce M; UNC-Charlotte; jbeggs@email.uncc.edu
Kohut, Gary F; UNC-Charlotte; gfkohut@email.uncc.edu
This research contributes to organizational theory by adding to our understanding of the relationship
between an important organizational outcome (commitment) and the work environment. Using data drawn
from a sample of 418 hispital nurses, this study examines the impact of perceptions of the work
environment on multiple dimensions of organizational commitment. Results indicate significant effects for
work environment on moral, alienative and calculative commitment. Managers in all organizations are
faced with the dilemma of finding ways of creating work environments that foster commitment among
employees and that are attractive to those working in these settings. In general, the results of this study
provide some support for the belief that employees' perceptions of the work environment have an
important impact of employees' organizational commitment.
Keywords: organizational commitment, work environment, hospital nurses
INFORMATION TECHNOLOGY STRATEGY-ENVIRONMENTAL

FIT AND FINANCIAL PERFORMANCE
Burke, Darrell E.; Florida State U.; dburke@lis.fsu.edu
Despite the interest in health information technology (HIT) there remains a paucity of empirical research
that has evaluated HIT from a strategic perspective. Thus, strategic measures of HIT and the resulting
organizational outcomes remain largely unknown. This dearth of knowledge may be a contributing factor
explaining why a significant adoption of HIT is yet to occur. From a business lens, the unanswered
question is Why significantly invest in HIT if the organizational outcomes of the investment are not
known? This research attempts to answer that question, and more, by evaluating the antecedents and
financial outcomes of an organizational HIT strategy, IT munificence. IT munificence measured the extent
that an organization applied IT in all of its operations, and the degree to which information is integrated
throughout the entire organization. Diffusion of innovation theory and strategic contingency theory were
melded to conceptualize the complex relationship among the environment, organizational response to the
environment identified by IT strategy, and financial performance. The two theories were then applied in
the traditional context-process-performance framework and analyzed, using structural equation modeling,
with a sample of 1,450 hospitals. Results suggest that information processing and communication
channels were positively associated with IT munificence whereas environmental turbulence was
negatively associated with IT munificence. Moreover, from an outcomes perspective IT munificence was
associated with lower operating expenses and higher operating margin, thus answering the earlier
question.
Keywords: Information Technology, Financial Performance, Healthcare
STRATEGY, ENVIRONMENTAL SCANNING, AND FIRM

PERFORMANCE: AN ANALYSIS OF PHYSICAL THERAPY
FACILITIES
Davis, Mark Alan; U. of North Texas; davism@unt.edu
Miles, Grant; University of North Texas; miles@cobaf.unt.edu
McDowell, William Cordell; U. of North Texas; mcdowellb@unt.edu
The strategic management literature regards environmental scanning as a determinant and an outcome
of competitive strategy. Further, contingency theory posits that successful strategy/scanning alignment
leads to superior organizational performance. This study examines the influence of competitive strategy
on both scope and frequency of scanning activities using a sample of physical therapy facilities in the
state of Texas. The seldom explored moderating role of scanning on the strategy/performance
relationship is also tested. Results indicate that both market-focused and efficiency orientation are
positively related to scope and frequency of scanning activities, though preference given to the type of
scanning activity varied as a function of competitive strategy. Also, findings support the moderating role of
scanning activities on the strategy/performance relationship. As such, these data confirm contingency
theory propositions on the significance of strategy-scanning alignment to organizational performance and
support the generalizability of strategic management findings to health care organizations. Yet,
paradoxical results from the study also suggest that managers in this setting use caution when applying
these findings in practice. Specifically, clinician managers should bear in mind that the time and
resources required for strategy-scanning activities (proper alignment notwithstanding) reduce

opportunities to carry out other revenue generating tasks (i.e., evaluating and treating clients).
Keywords: scanning, strategy, health care
AN EXPLORATORY STUDY OF HEALTHCARE STRATEGIC

PLANNING IN TWO METROPOLITAN AREAS
Begun, James W; U. of Minnesota; begun001@umn.edu
Kaissi, Amer; Trinity U.; amer.kaissi@trinity.edu
Little is known about empirical variation in the extent to which healthcare organizations conduct formal
strategic planning, or the extent to which strategic planning affects performance. The theoretical
perspectives of structural contingency and complexity science offer differing interpretations of the value of
strategic planning. Structural contingency theory emphasizes adaptation to achieve organizational fit with
a changing environment, and strategic planning is viewed as a way to chart the organizations path.
Complexity science argues that planning is largely futile in changing environments. Interviews of leaders
in 20 healthcare organizations in the Twin Cities and San Antonio metropolitan areas reveal that strategic
planning is a common and valued function in healthcare organizations. Respondents emphasized the
need to continuously update strategic plans, involve physicians and the governing board, and integrate
strategic plans with other organizational plans. Most leaders expressed that strategic planning contributes
to organizational focus and stakeholder participation and commitment, in addition to achievement of
strategic goals. As the widespread belief in strategic planning largely is based on experience, intuition
and faith, we present recommendations for developing an evidence base on healthcare strategic
planning.
Keywords: healthcare organizations, strategic planning
BOUNDED KNOWLEDGE AND SOCIAL IDENTITIES IN

MULTIDISCIPLINARY WORK TEAMS.
Oborn-Barrett, Eivor; Cambridge U.; emdo2@cam.ac.uk
Dawson, Sandra; Cambridge U.; s.dawson@jims.cam.ac.uk
Development of multidisciplinary collaboration in work teams is endemic in knowledge based
organisations. However, functionally diverse teams are poorly understood and difficult to support and
sustain. Drawing from social identity theory, this paper seeks to understand how the many and shifting
identities within a multidisciplinary healthcare group impact knowledge construction and practice. We
draw from two in-depth longitudinal case studies of cancer teams to build rich descriptions of disciplinary
bodies of knowledge as well as the roles and practices these support. For example, while one disciplinary
group focuses on detail and precision, another group focuses on clarity and action. These domains of
knowledge objectify and control both patients and the disembodied diseases. Thereby they erase
ambiguity and create different medical realities. We argue that it is important for workers and managers
in multidisciplinary contexts to be attuned to the diverse discourses being constructed and question how
they could be written differently and what power structures are keeping them in place. We conclude by
highlighting the importance of opening up the categorizations that order cross-disciplinary work and
thereby to clarify and understand the boundaries that exist. We suggest directions for future research that
will improve our ability to support and facilitate multidisciplinary work teams.
Keywords: teams, multidisciplinary, knowledge
HUMAN RESOURCE MANAGEMENT PRACTICES AND

SERVICE QUALITY: THE MEDIATION ROLE OF TRUST
Tzafrir, Shay; University of Haifa; stzafrir@research.haifa.ac.il
Gur, Amit; Technion; aygur@netvision.net.il
Although earlier studies investigated several facets as possible mediators, none examined trust as a
mediating variable that affects the relationship between HRM practices and service quality. The
relationship between HRM practices and perceived service quality was examined, as well as the
contribution of organizational trust to such relations within a healthcare organization. The findings suggest
that trust affects perceived service quality directly, but also mediates the relationship between employees
perceptions of feedback and perceived service quality. Fulfilling of promises and obligations, matching
expectations, and transparency in the employment relations will be beneficial for nurturing trust between
managers/management and employees, which will result in a better service delivery to customers.
Keywords: Trust, HRM, Service Quality
LET US WORK TOGETHER - THE CHALLENGES OF

INTERACTING AT MULTIDISCPLINARY MEETINGS
Pedersen, Anne Reff; Copenhagen Business School; arp.ioa@cbs.dk
Multidisciplinary meetings play a central role in the daily life in a rehabilitative ward where a widespread
number of health care professionals are working together. Multidisciplinary meetings in a Danish
rehabilitation hospital are analyzed by means of qualitative ethnological studies using narrative interviews
The study illuminates the cooperation and interaction of health care professionals during their weekly
multidisciplinary meeting. The interaction of the meeting is analysis by three different meeting stories: the
meeting dialogue, the group realities and the meeting context. These stories point at some challenges of
multidisciplinary interaction: the silence of the nurses, the battles between group realities and the different
expectations of dialogues. In sum multidisciplinary meetings are a research topic that need more
reflections and attention to improve multidisciplinary interaction.
Keywords: interaction, multidiscplinary work, meetings
PREVENTING BURNOUT: THE EFFECTS OF LMX AND

MENTORING ON SOCIALIZATION, ROLE STRESS, AND
BURNOUT
Thomas, Christopher H.; U. of Georgia; chthomas@uga.edu
Halbesleben and Buckleys (2004) review of burnout research stressed the need to continue investigating
the relationship between social support and burnout. We address that need by investigating LeaderMember Exchange (LMX) and mentoring as sources of social support that decrease burnout through
influences on organizational socialization and role stress. Using structural equation modeling we tested a
network of relationships that showed LMX and mentoring have significant direct and indirect effects on
reports of burnout. Data from 428 hospital employees indicated LMX and mentoring were positively
associated with organizational socialization. Socialization then was negatively related to role stress which
had a strong, positive influence on burnout. LMX displayed a direct negative relationship with role stress,
while mentoring had a direct negative relationship with burnout. This study advances burnout theory by
further clarifying the role of social support in reducing burnout. Additionally, the results provide a
foundation for healthcare professionals, and organizations in general, to design workplace interventions
intended to prevent or reduce burnout.
Keywords: burnout, socialization, structural equation modeling
ASSESSING THE DIFFERENTIAL IMPACT OF HOSPITAL

DIVERSIFICATION ON FINANCIAL PERFORMANCE
Suh, Won Sik; Florida International U.; suhw@fiu.edu
Key, Susan; U. of Alabama, Birmingham; susankey@uab.edu
The purpose of this paper is to investigate the relationship between diversification and financial
performance by looking at both economy of scopethe focus of most research in diversification strategic
management--and multi-market contact. Our research which focused specifically on hospital
diversification led to three major findings: First, diversification measured through economy of scope was
significantly (negatively) associated with hospital performance. Second, diversification measured through
multi-market contact shows a positive relationship with hospital performance. And finally, the effect of
diversification on financial performance measured through multi-market contact was greater than
diversification measured through economy of scope. Therefore, the results suggest that organizations
should pay attention to both economy of scope and multi-market contact when considering diversification.
Keywords: Hospital Diversification, Multi-market contact, Financial Performance
DOING BETTER TO DO WELL: DOES INNOVATION

IMPROVE NURSING HOME PERFORMANCE?
Zinn, Jacqueline; Temple U.; jacqueline.zinn@temple.edu
Feng, Zhanlian; Brown U.; Zhanlian_Feng@Brown.Edu
Mor, Vincent; Brown U.; Vincent Mor_Brown.Edu
Intrator, Orna; Brown U.; Orna_Intrator@Brown.Edu
In this manuscript, we investigate whether innovation, as measured by an aggregate weighted innovation
score, impacts on nursing home performance, as measured by occupancy rate, payer mix and the
number of deficiencies cited on the annual Medicare/Medicaid recertification survey. Arguing from a
contingency perspective, we hypothesize that the performance of nursing home that engage in minimal
innovation will not be significantly different from those that do not innovate at all. However, those that
engage in more extensive innovation will have superior performance. Using Online Survey, Certification
and Reporting data from 1997-2002, we conducted a series of logit regressions, controlling for
organizational and market characteristics that could influence nursing home performance. The results of
these analyses support our hypotheses. From a theoretical perspective, this confirms the contingency
theory arguments that organizations that are not responsive to a changing environment will experience
declining performance. From a managerial perspective, these results support the importance of
innovative strategic leadership in the nursing home industry.
Keywords: innovation, performance, nursing homes
LEADERSHIP INCLUSIVENESS AND PROFESSIONAL STATUS

ON PSYCHOLOGICAL SAFETY AND LEARNING IN CARE
TEAMS
Nembhard, Ingrid M.; Harvard U.; inembhard@hbs.edu
Edmondson, Amy C.; Harvard U.; aedmondson@hbs.edu
This paper introduces the construct of leadership inclusiveness words and deeds exhibited by leaders
that invite and appreciate others' contributions. We propose that leadership inclusiveness helps crossdisciplinary teams overcome the inhibiting effects of status differences. The existence of a professional
hierarchy in medicine and the differential status accorded to those in different disciplines is well
established in the health care literature. We build on this foundation to suggest that status predicts
psychological safety a key antecedent of speaking up and team learning in health care teams. We
further hypothesize that the effect of status on psychological safety varies across teams, and that
leadership inclusiveness moderates the relationship between status and psychological safety.
Psychological safety is argued to predict engagement in quality improvement work and to mediate the
relationship between leadership inclusiveness and engagement. Survey data collected in 23 neonatal
intensive care units involved in quality improvement projects provide support for six out of seven study
hypotheses. The results provide insight into the antecedents of and strategies for fostering improvement
efforts in health care and other sectors in which cross-disciplinary teams must engage in collaborative
learning to improve products or services.
Keywords: status, leadership, team
HEALTH CARE STRATEGIC PLANNING FOR TWENTY-FIRST

CENTURY REALITIES: STRATEGIC PREPAREDNESS
PLANNING
Abdolrasulnia, Maziar; U. of Alabama at Birmingham; maziabdo@uab.edu
Vasconez, Rachel; U. of Alabama at Birmingham; rvascone@uab.edu
Strategic preparedness planning (SPP) is an important new imperative for many health care
organizations. SPP goes beyond traditional product/market strategic planning by focusing on the
organizational risks of crises, disasters, and organizational response roles. Health care organizations,
because of their unique mission, the types of materials they handle, and the types of patients they see
are at high risk for crises and disasters. Additionally, when crises and disasters occur, health care
organizations must develop well conceived first responder strategies. This paper argues the case for
strategic preparedness planning for health care organizations and proposes a process for this relatively
new and much needed type of planning.
Keywords: Preparedness, Disasters, Healthcare
IMPROVING CLINICAL PRACTICE THROUGH PAY-FORPERFORMANCE: BARRIERS, FACILITATORS, AND

CONSEQUENCES.
O'Connor, Stephen; U. of Alabama, Birmingham; sjo@uab.edu
Shewchuk, Richard; U. of Alabama, Birmingham; shewchuk@uab.edu
This paper examines an emerging value-based phenomenon that has recently captured the interest of
public and private sector health care purchasers: the concept of pay-for-performance (P4P). First, we
describe the concept of P4P, present a rationale for its emergence, and describe several of the major
P4P efforts currently under way. Next, we examine barriers and facilitators to implementing P4P and
gaining physician compliance. Finally, we conclude with a discussion of possible unintended
consequences of P4P, the necessary role of health care management in implementation research, and
strategies needed to realize significant future gains in health care quality.
Keywords: pay-for-performance, quality improvement, physician behavior
DANGER IN THE GUISE OF SAFETY: NEAR MISS AS A

SYSTEM FAILURE? A SUCCESS? OR A GOOD NURSE AT
WORK?
Tamuz, Michal; U. of Tennessee Health Sciences Center; mtamuz@utmem.edu
Thomas, Eric J.; U. Texas Houston Medical School; eric.thomas@uth.tmc.edu
We examine how healthcare providers and key hospital decision makers make sense of a near miss. We
ask whether they interpret a near miss as the reality of danger in the guise of safety, or are reassured
that no harm was done. Drawing on interviews with hospital-based healthcare providers and
administrators, we apply qualitative research methods to analyze their interpretations of a near miss.
Patterns in the data suggest that: 1) Health care providers and administrators vary in their near miss
interpretations. To illustrate, hospital administrators tended to see a near miss as a system breakdown,
whereas ICU nurses tended to interpret the same event as a signal the system was working. 2) The lower
the position in the hospital hierarchy, the more likely that providers would attribute the near miss to
individual accountability rather than to the hospital medication systems success or failure. 3) Providers
were more likely to ask why a near miss occurred if they perceived it as a system breakdown rather than
as a sign the system was working. 4) Some providers constructed hypothetical histories to explain a near
miss. From a practice viewpoint, providers who see near misses as signs that the system is working
would probably not see reason to take time to report them. These findings may explain the varied
success of near miss reporting in healthcare. From a theoretical perspective, we propose a conceptual
framework to guide future research on organizational learning from near misses.
Keywords: patient safety, near miss, organizational learning
THE CHALLENGE OF KNOWLEDGE TRANSFER IN A PUBLIC

HOSPITAL
Carswell, Peter; UNITEC New Zealand; pcarswell@unitec.ac.nz
The health reforms of the last twenty years have placed demands on Public Hospitals to be more cost
effective, improve quality, and be more accountable for decisions made. However, the hierarchical
structures and tribal nature of the various professional groups present problems for achieving these
goals. Recent reports and various scholarly papers have suggested that applying organizational learning
practices and principles in the Public Healthcare arena may help moderate some of the barriers to
achieving the goals of the health reforms. This paper explores organizational learning within a District
Health Board in New Zealand. One thousand six hundred and eighty respondents to an 80-item survey
indicated how typically they engaged in and experienced various organizational learning behaviors and
activities. MANOVA results indicated that there were significant differences between all professional
groups in their experiences of organizational learning behaviors. Subsequent discriminant analysis
indicated that 87% of this variance was on two functions one labeled organizational involvement and
the other access to formal learning systems. These results suggest that if knowledge transfer from
organizational learning is to aid in achieving the goals of the reforms then further structural reform may be
required. Such reform is in order to increase access to formal learning systems for all groups, increase
opportunity for groups to feel involved in the organization, and provide opportunity for the various
professional groups to work together more frequently.
Keywords: Knowledge transfer, Organizational learning, Public health
PERCEPTIONS OF CHANGE REGARDING NURSING

APPLICATIONS: A LONGITUDINAL STUDY
Atabay, Gulem; Izmir U of Economics; gulem.atabay@ieu.edu.tr
Gunay, Gonca; Izmir U of Economics; gonca.gunay@ieu.edu.tr
Halil, Basak; Ege U; basakhalil@hotmail.com
Organizational change is an emotional event, with the emotional reaction resulting from a cognitive
appraisal of the situation. These emotions predict how receptive employees will be towards organizational
change and how much they will actively resist an organizational change effort. Therefore, leaders of
change should perceive the cognitive appraisal of employees in order to manage change effectively.
Employees perceptions regarding the belief in the necessity of change and to approach the change with
shared goals along with the sensitivity of change leaders towards the issue will decrease the resistance
towards change, thereby increasing the possibility of success. On this basis, the aim of the research is to
observe the perceptions of nurses towards the changes executed in nursing service applications through
a longitudinal study. Results indicate a surprising unfavorable change in perceptions of constructs, which
are crucial for the successful implementation of change. This observation is important for researchers and
change leaders. It provides counterevidence regarding phases of acceptance of change and warns
change leaders to carefully and timely examine the perceptions during change process, which may signal
inappropriate utilization of policies adopted during this process.
Keywords: organizational change, perception, nurses
ONLINE CUSTOMER COMMUNITIES AND HMOS: A

KNOWLEDGE MANAGEMENT AND KNOWLEDGE
SOCIALIZATION PERSPECTIVE
Nambisan, Priya; Rensselaer Polytechnic Institute; nambip@rpi.edu
As the intensity of competition continue to increase in the health care industry, health maintenance
organizations (HMOs) as well as other health-care organizations are seeking innovative and costeffective ways to better serve their customers and to establish stronger relationships with them. Over the
past few years, several organizations including HMOs have realized the importance of online customer
community as a powerful tool to facilitate the interactions amongst their customers and to strengthen
customer-product ties. In this paper, I propose a model that would enable HMOs to utilize online customer
communities as a knowledge management (KM) and customer relationship management (CRM) tool, and
thereby, deliver a good overall experience to customers as well as impact their attitudes towards the HMO
and its services. I advance a new construct, online community experience (OCE), to enhance our
understanding of customers interaction experience in such online communities. I adopt a multidisciplinary approach and draw on theories in knowledge management, customer relationship
management, and communication to identify the critical antecedents or determinants of OCE. The paper
presents hypotheses that relate KM and CRM -based variables to the OCE construct as well as those that
relate the OCE construct to customer attitudes. The model will be validated using data collected from an
HMOs online customer community. I briefly describe the data collection method, variable
operationalization, and the study status. The study findings are expected to hold important implications for
HMOs customer relationship management strategies as well as the deployment of cost-effective
knowledge management practices.
Keywords: Online Customer Community, HMO, Knowledge Management
AN INTERVENTION MODEL OF SHIFTWORK TOLERANCE

Pisarski, Anne; U. of Queensland; a.pisarski@uq.edu.au
Lawrence, Sandra A.; U. of Queensland/Griffith U.; s.lawrence@business.uq.edu.au
Bohle, Philip; U of NSW; p.bohle@unsw.edu.au
Gallois, Cynthia; U of Queensland; c.gallois@uq.edu.au
Watson, Bernadette Maria; U of Queensland; b.watson@business.uq.edu.au
The present study contributes to both theory and practice through the development of a model of
shiftwork tolerance with the potential to indicate psychosocial and organizational interventions to reduce
nurses work life conflict and the health effects of shiftwork in hospital-based settings. This study forms
part of the first phase of a larger, longitudinal, research project being conducted across 3 large
metropolitan hospitals and reports the results from one of these hospitals. Survey data from 546 nurses
was used to conduct structural equation modeling examining the direct and indirect effects of supervisor
and colleague support, team identity, team cohesion and control over working environment on work life
conflict, psychological wellbeing and physical symptoms. The data revealed considerable evidence of
both direct effects on adjustment and complex indirect links between levels of adjustment and workrelated social supports, team identity, team cohesion and control. Nurses who perceived high levels of
supervisor support and appraised their work environments as increasingly controllable tended to have
increased levels of psychological well-being. In addition, nurses who perceived that they had high levels
of work team cohesion tended to increase their perceptions of control over their work environment, which
in turn lowered their appraisals of their work life conflict, which consequently increased their perceptions
of psychological wellbeing and reduced their perceptions of physical health symptoms. Work team
cohesion had indirect links on levels of psychological wellbeing via perceptions of control over the work
environment alone.
Keywords: Shiftwork, work life conflict, health
EMPOWERING NURSES FOR WORK ENGAGEMENT AND

HEALTH IN HOSPITAL SETTINGS.
Spence Laschinger, Heather K.; U. Western Ontario; hkl@uwo.ca
Finegan, Joan; U. Western Ontario; finegan@uwo.ca
Employee empowerment has become an increasingly important factor in determining employee health
and well-being in restructured health-care settings. We tested a theoretical model which specified the
relationships among structural empowerment, six areas of work life that promote employee engagement,
and staff nurses physical and mental health. A predictive, non-experimental design was used to test the
model in a random sample of 285 Canadian staff nurses. Structural equation modeling analyses revealed
a good fit of the hypothesized model to the data based on various fit indices. Staff nurses felt that
structural empowerment in their workplace resulted in higher levels of control over their work, more
manageable workloads, greater rewards and recognition for their contributions to meeting organizational
goals, fairer procedures across the organization, better working relationships among co-workers and
management, and greater congruence between personal and organizational values. These areas of work
life in turn were related to work engagement, burnout and nurses physical and mental health. This study
found support for the model linking Kanters theory of organizational empowerment to Maslach & Leiters
work engagement model.
Keywords: empowerment, work engagement, nursing
THE BENEFITS OF ORGANIZATIONAL ALIGNMENT: AN

EXPLORATORY INVESTIGATION IN HEALTHCARE
Dickson, Duncan; U of Central Florida; ddickson@mail.ucf.edu
Ford, Robert C; U. of Central Florida; rford@bus.ucf.edu
Fottler, Myron D; U. of Central Florida; Fottler@mail.ucf.edu
Bradley, Kenneth; Winter Park Memorial Hospital; ken_bradley@mail.fhmis.net
Johnson, Lee; Florida Hospital; lee.johnson@flhosp.org
In todays competitive healthcare environment service excellence is rapidly becoming a major
differentiating advantage between health care providers. Too often senior executives talk about their
commitment to a mission statement that extols the virtues of providing world class service to their patients
only to undermine those statements with their actions, policies, and systems. This paper presents an
exploratory investigation into the use of a new internal mission alignment instrument that seeks to assess
the extent to which an organizations internal processes are aligned with its service mission. This
instrument was sent to 250 randomly selected employees from all clinical departments of a large
southeastern hospital of whom 71 responded. The data reveal that this instrument holds considerable
promise as a diagnostic tool for identifying factors that when aligned with the mission lead to beneficial
employee outcomes such as organizational commitment and satisfaction with job and organization.
Keywords: service excellence, healthcare, organizational alignment
LOCALIZATION OF HEALTH IT: HOW USERS REPAIR

ELECTRONIC MEDICAL RECORD SYSTEMS
Bar Lev, Shirly; Bar Ilan U.; shirly.barlev@gmailcom
Harrison, Michael I; Agency for Healthcare Research and Quality;
mharriso@ahrq.gov
Implementation of Health Information Technologies (HIT) in hospitals encounters difficulties and leads to
unintended consequences when there is poor fit between the practices, standards, and assumptions of
clinical work and those embedded within HIT. This paper explores ways in which nurses and physicians
sought to repair an Electronic Medical Record (EMR) system and improve its fit with their everyday
practice. The paper is based on a case study of the introduction of an EMR in an academic hospital in
Israel. The research was guided by Orlikowskis work on the social construction of technology. We show
that repair work by clinical practitioners flowed from pragmatic efforts to incorporate HIT into their
practices, rather than from arbitrary resistance to HIT. By negotiating changes in the EMR, the
practitioners succeeded in overcoming gaps between the designers assumptions and realities of clinical
work. In this way the EMR became localized. This study supports Orlikowskis argument that the features
of a technology are not built in but emerge though negotiations among its stakeholders. Moreover, the
study supports previous research findings showing that localization is inherent to implementation of new
technologies. Moreover, we argue that localization of HIT implementation may actually contribute to its
capacity to improve clinical work. Recognition of gaps between assumptions built into HIT software and
the realities of clinical practice may help managers and designers learn to work more effectively with
practitioners to develop HIT systems that are flexible and well aligned with the needs and concerns of
users.
Keywords: health information technology, hospitals, innovation
CREATING A CULTURE OF SAFETY IN HOSPITALS

Singer, Sara J.; Harvard U.; ssinger@hbs.edu
Tucker, Anita L.; U. of Pennsylvania; tuckera@wharton.upenn.edu
Hospitals rely on a strong safety culture to minimize medical errors, yet existing research provides little
guidance for hospital leaders seeking to improve safety culture in their organizations. Drawing on relevant
findings from organizational, leadership, and high reliability organization literature, we provide a
framework for creating a strong safety culture. We claim that strong safety culture leadership requires five
actions: (1) setting and communicating a clear, compelling safety vision, (2) focusing on system issues,
(3) leading by example, (4) valuing and empowering personnel, and (5) being dissatisfied with the status
quo. We further suggest that leaders must apply these rules clearly and consistently. We illustrate this
framework using qualitative and quantitative data from two hospitals whose safety leadership differed
markedly. The case studies demonstrate that safety vision, a systems approach, and a willingness to act
in support of safety were necessary but insufficient for achieving a strong safety culture. Rather, strong
safety leadership also required consistently empowering others to act on behalf of safety and a constant
quest for process improvement. The cases highlight the benefits of storytelling as a means of engaging
personnel and relationship training for encouraging individuals to speak up. Implications and suggestions
for future research are discussed.
Keywords: Leadership, Safety Culture, Qualitative Methods
CONGRUENCE IN THE ASSESSMENT OF SERVICE QUALITY

BETWEEN ORGANIZATIONS' EMPLOYEES AND CUSTOMERS
Young, Gary J; Boston U.; health@bu.eu
Meterko, Mark; U.S. Department of Veterans Affairs; mark.meterko@med.va.gov
Mohr, David; U.S. Department of Veterans Affairs; david.mohr2@med.va.gov
This paper reports the results of a study that examined the congruence between employee and customer
assessments of the service quality that organizations provide. While research exists addressing whether
and to what degree individuals assess their own job performance in a manner consistent with external
judges, similar information is lacking about employee assessments of the performance of their
organizations relative to customers, an obviously important type of external judge for most organizations.
The social and cognitive processes that research suggests influences self-assessments of job
performance may not apply to employee assessments of their organizations performance. This study was
conducted from the perspective of social information processing theory. The study setting was a public
health care delivery system for which secondary data sets on employee and customer assessments of
service quality were available. As expected, study results indicated that employee tenure and the work
climate of an organization are positively associated with congruent employee-customer assessments of
service quality. Contrary to expectations, proximity to customers, as indicated by whether or not an
employee worked on the frontlines of an organization, was negatively associated with congruent
employee-customer assessments of service quality. Also, study results did not support the hypothesis
that professional training, as indicated by physician status, would be significantly associated with less
congruent employee-customer assessments of service quality. Study results have theoretical implications
regarding the concepts of leniency bias and the organizational identity of employees, and practical
implications regarding organizational effectiveness.
Keywords: service quality, social information processing theory, customer satisfaction
HEALTHCARE WORK LIFE IN CANADA

Steinke, Claudia; University of Victoria; steinke@uvic.ca
The purpose of this paper is to explore the issues and provide a perspective of the work environment in
health care and the impact this has on health care providers in their quest for meaningful work-personal
life integration. The Canadian Health Care System is fraught with changes that began in the 1990s.
Extensive changes and ideologies within the system in regard to the roles and responsibilities of
government, health care administrators, providers, and the public has been forced on the system due to
the conditions of the economic climate and the perceived need to control the escalation of costs within
health care. Redesigning, restructuring, re-engineering, and reforming activities have been touted as the
common way of life for health care providers and with this presents many work-life related challenges.
This paper offers no prescriptions for change about how to live and/or better integrate our work and
personal lives; it offers is a critical picture of the situation as it stands in Canada, a starting point to think
about the place of health care work given todays employment realities. The implications of this research
include priority issues that relate to improvements in the workplace and improvements in quality of work
life to facilitate meaningful work-personal life integration. A focus on the role and design of organizational
workplaces, structures and practices is recommended. It is through this that contributions to
organizational theory are made.
Keywords: Healthcare, Organizational Design, Management
HEALTH CARE STRATEGY: THE STATE OF RESEARCH 20002004

Weichold, Nelson C.; U. of Alabama at Birmingham; ncw@uab.edu
Abdolrasulnia, Maziar; U. of Alabama at Birmingham; maziabdo@uab.edu
This paper examines the health care strategic management literature and maps the streams of health
care strategy research over the past five years. We also propose new directions for future health care
strategy research. Using citation impact factors to identify a sample of 21 management and policy and
health oriented journals listed in the Institute for Scientific Information (ISI) Web of Science Citation Index
(SCI) for 2003, the study reviewed over 1,700 articles in order to identify the patterns of health care
strategy research. Content related papers dominated the health care strategy literature which was equally
divided between performance-focused and characteristic-focused research. Hospitals, biotechnical and
pharmaceutical firms were the most often used research settings with nursing homes and public health
agencies being the least frequently used settings. On the basis of the emergent streams as well as
current demands of management practitioners, we suggest some future directions for health care
strategic management research to further prepare practitioners to manage organizations in the complex
health care environment.
Keywords: Healthcare review, Research streams, Strategy literature
ORGANIZING VISION FOR IT HEALTHCARE: ANALYSIS OF

THE DISCOURSE SURROUNDING ELECTRONIC HEALTH
RECORDS
Reardon, John Lee; U. of Hawaii, Manoa; jr@hawaii.edu
Davidson, Elizabeth; U. of Hawaii, Manoa; Elizabeth.Davidson@hawaii.edu
Increasingly, heath care policy makers and industry leaders are looking to information technologies to
play a key role in addressing cost, quality and access issues. High expectations for the cures that
information technology might bring to healthcare, government mandates and increased funding for IT
initiatives and dramatic expansion of information technology capabilities are stimulating ambitious IT
projects in a variety of healthcare settings. Visions abound for applying IT in healthcare, but uncertainties
about their benefits and feasibility have also been raised. In this paper, we examine the evolving
discourse around electronic health records in the United States in academic journals, technical reports
and white papers, and the business and trade presses. Using the theoretic concept of an organizing
vision as an analytic lens, we identify key stakeholders who are shaping the EHR vision, assess how
stakeholders contribute to its interpretation, legitimization, and mobilization, and consider the implications
of the organizing vision for further development and diffusion of electronic health records. Our analysis
contributes to management theories on the diffusion of innovation by refining the organizing vision
concept and demonstrating its applicability to health care IT innovations. We also outline a systematic
methodology for analyzing organizing visions using archival information sources. Our analysis contributes
to management practice by highlighting the role public discourse plays in shaping organizational
decisions to adopt or to defer IT investments.
Keywords: EHR, Organizing Vision, Healthcare
HIGH INVOLVEMENT WORK PRACTICES IN NURSING HOMES:

DO THEY FACILITATE WORKPLACE CHANGE?
Rondeau, Kent; University of Alberta; kent.rondeau@ualberta.ca
In the past decade, health care organizations have adopted a variety of new approaches to the
management of their nursing workforce. Variously labeled as high involvement or high performance work
practices, these human resource innovations are aimed at increasing employee empowerment,
participation and accountability, while improving organizational performance and patient and employee
satisfaction. This paper reports on a study examining the relationship between the adoption of high
involvement practices by long-term care organizations and their likelihood of engaging in certain
organizational change initiatives. Nursing homes that adopted more high involvement work practices are
found to be more likely to have engaged in certain bottom-up (democratic) change initiatives. Top-down
(autocratic) change initiatives are not found to be associated with greater adoption of these practices. It
can be surmised that more high involvement practice adoption serves to facilitate bottom-up
organizational change, yet may be neutral or act as a barrier when top-down change is required.
Keywords: high involvement work practices, long-term care organizations, organizational change
IT TAKES TWO TO TANGO: TRUST AND INSTITUTIONAL

LOGICS AS ORGANIZING PRINCIPLES DURING CHANGE
Sonpar, Karan; U of Alberta; ksonpar@ualberta.ca
Handelman, Jay; Queen's U; JHandelman@business.queensu.ca
Dastmalchian, Ali; U. of Victoria; dastmal@business.uvic.ca
This study is about organizational change in healthcare. It draws upon 41 in-depth interviews of members
of a rural healthcare organization in Canada that was attempting to adopt an innovative medical model.
This innovation was driven by the entrepreneurship of new market-driven logics. However, these logics
are thwarted by some members who see this as a violation of the erstwhile logics of medical
professionalism. In addition to a clash on normative appropriateness of the two logics, a shift in logics
also alters power structures. It affects interests and creates conflicts where actors try to use favourable
impression management techniques to entrepreneur or resist logics. The complex interplay between
espoused values, self-interest, and shifts in status leads to conflicts within the organization. These are
evidenced through feelings of mistrust too. Using an emerging literature on organizing principles, the
paper explains how this interaction between trust and institutional logics occurs. A better understanding of
these interactions would address a long-standing gap in institutional theory on the micro dynamics of
change. The policy implication of the paper is to appreciate the role played by trust at an operational level
within organizations.
Keywords: Institutional Theory, Trust, Healthcare
ORGANIZATIONAL AND INSTITUTIONAL CHANGE IN HEALTH

CARE: LESSONS FROM THE FIELD
Goes, Jim; Walden U.; jim@cybernos.com
As healthcare industry environments grow more turbulent, researchers look for new ways to understand
industry change. We use institutional theory to develop a new conceptual understanding of turbulence
and organizational change in healthcare. Using the emergence of integrated health delivery systems as a
focus for this discussion, qualitative evidence from two highly competitive healthcare markets is used to
illustrate and explore this framework, and suggest avenues for further research and theoretical
development.
Keywords: turbulence, adaptation, integrated systems
DO NOT-FOR-PROFIT AND FOR-PROFIT NURSING HOMES

EMPLOY DIFFERENT MARKET STRATEGIES?
Davis, Jullet A.; U. of Alabama, Tuscaloosa; jdavis@cba.ua.edu
Marino, Louis; U. of Alabama; lmarino@cba.ua.edu
Aaron, Joshua Reece; U. of Alabama, Tuscaloosa; jaaron@cba.ua.edu
The nursing home industry is dominated by for-profit providers; yet, the not-for-profit nursing home
remains an essential industry component. However, little is known about how not-for-profits differ from for
profit nursing homes by factors other than quality of care and general economic indicators. This study
sought to expand the literature by examining differences by market strategies and entrepreneurial
orientation. The sample consists of 141 nursing homes located in the state of Florida. The survey
questions were grouped into four unique scales: external information gathering, remaining abreast of
changes, ranking the facilitys environment, and entrepreneurial orientation. The results show that, while
all facilities report they are engaging in some market strategies designed to generally acquire information
and meeting the demands of the external environment, there are few significant differences between forprofit and not-for-profit facilities along the various dimensions. Given the demands of the external market
and an increasingly informed consumer, not-for-profit nursing home administrators may find that
developing strategies to better compete with for-profit facilities is vital. These strategies may be more
consistent with the for-profit status than the not-for-profit status.
Keywords: nursing homes, profit status, market strategies
THE MODERATING EFFECT OF PROCEDURAL FAIRNESS

IN STANDARDIZING PROFESSIONAL WORK
Kwon, Seok Woo; U. of Kentucky; swkwon@uky.edu
This paper explores the role of procedural fairness in determining responses to bureaucratic
standardization. I examine this question in the context of drug formularies in hospitals. Drug formularies
are a list of drugs available to physicians in a healthcare organization, and represent a standardization of
the drug choices available to physicians. While some advocate the use of formularies as a cost-effective
means of managing drug benefits, critics see them as an infringement on physicians' clinical autonomy,
and as potentially harmful to patients, ultimately contributing to higher costs of providing care. Drawing on
organizational justice theory, I look at the role of procedural fairness in shaping the effectiveness of
bureaucratic standardization, and argue that the payoff from drug formularies depends on whether the
process of setting and implementing formulary policies is fair. To examine this, Inpatient Discharge Data
for 2002 from Florida, Illinois, New York, and Texas, combined with an original survey of 243 hospital
pharmacy directors, were analyzed using the hierarchical linear modeling technique. I found that the cost
effectiveness of drug standardization depends on the procedural fairness of the standardization process,
controlling for patient, hospital, and hospital market factors. Theoretically, this paper contributes to a
partial reconciliation of conflicting predictions from the standardization literature by considering procedural
fairness. Given the ubiquity of standardized rules in organizations, the findings also have practical
implications for how to manage bureaucratic standardization without alienating organizational members.
Keywords: standardization, procedural fairness, profession
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HEALTH CARE MANAGEMENT

Conference Paper Abstracts

VERTICAL INTEGRATION BETWEEN COMMUNITY HOSPITALS

Health Care Management Paper Abstracts -- 1

DOWNSTREAM INTEGRATION AND COMPETITIVE

A RESOURCE BASED VIEW OF PARTNERSHIP STRATEGIES

HUMAN RESOURCES MANAGEMENT, ORGANIZATIONAL

Health Care Management Paper Abstracts -- 2

STUDYING PATIENT SAFETY IN HEALTH CARE

THE EMERGENCE OF RADICALLY NEW HEALTH CARE

Health Care Management Paper Abstracts -- 3

MESO- AND MACRO-LEVEL BARRIERS AND FACILITATORS

JOB DEMANDS, BURNOUT, AND TURNOVER INTENT AMONG

Health Care Management Paper Abstracts -- 4

THE CHALLENGES FOR HRM AND PERFORMANCE IN THE

PATIENT TURNOVER AND NURSING STAFF ADEQUACY

Health Care Management Paper Abstracts -- 5

ORGANIZATIONAL TRUST IN HOSPITAL NURSING STAFFS

HR AND IT CAPABILITIES AND COMPLEMENTARITIES IN

Health Care Management Paper Abstracts -- 6

GAINING LEGITIMACY, KNOWLEDGE CREATION AND

VIRTUAL TEAMS: THINKING ABOUT HOW DISTANCE &

Health Care Management Paper Abstracts -- 7

BENEFITING FROM NETWORKS BY OCCUPYING CENTRAL

FACE-TO-FACE WITH AIDS IN THE WORKPLACE:CONCERN

Health Care Management Paper Abstracts -- 8

THE EFFECT OF EXPLORATION, EXPLOITATION, AND

WOMEN'S HEALTH ISSUES: A CASE STUDY IN SETTING

BOUNDARY OF AGENCY PREDICTIONS OF

Health Care Management Paper Abstracts -- 9

HOSPITALS ON THE ROAD TO COMPETITIVE

HAVING FUN WHILE GETTING HEALTH CARE WORK DONE:

Health Care Management Paper Abstracts -- 10

TECHNOLOGY ENABLERS: MANAGEMENT PRACTICES THAT

BARRIERS TO CEO SUCCESSION PLANNING: A

Health Care Management Paper Abstracts -- 11

CONTEXTUAL INFLUENCES OF LEARNING IN A HOSPITAL

COORDINATION IN A SYSTEM OF CARE: THE INITIAL STAGE

SENSE-MAKING IN DIFFICULT TIMES: EXPERIENCES OF

Health Care Management Paper Abstracts -- 12

WORK ENVIRONMENTS, PSYCHOLOGICAL SAFETY, AND

WORK ENVIRONMENT PERCEPTIONS AND ORGANIZATIONAL

Health Care Management Paper Abstracts -- 13

INFORMATION TECHNOLOGY STRATEGY-ENVIRONMENTAL

STRATEGY, ENVIRONMENTAL SCANNING, AND FIRM

Health Care Management Paper Abstracts -- 14

resources required for strategy-scanning activities (proper alignment notwithstanding) reduce

AN EXPLORATORY STUDY OF HEALTHCARE STRATEGIC

BOUNDED KNOWLEDGE AND SOCIAL IDENTITIES IN

Health Care Management Paper Abstracts -- 15

HUMAN RESOURCE MANAGEMENT PRACTICES AND

LET US WORK TOGETHER - THE CHALLENGES OF

PREVENTING BURNOUT: THE EFFECTS OF LMX AND

Health Care Management Paper Abstracts -- 16

ASSESSING THE DIFFERENTIAL IMPACT OF HOSPITAL

DOING BETTER TO DO WELL: DOES INNOVATION

Health Care Management Paper Abstracts -- 17

LEADERSHIP INCLUSIVENESS AND PROFESSIONAL STATUS

HEALTH CARE STRATEGIC PLANNING FOR TWENTY-FIRST

Health Care Management Paper Abstracts -- 18

IMPROVING CLINICAL PRACTICE THROUGH PAY-FORPERFORMANCE: BARRIERS, FACILITATORS, AND

DANGER IN THE GUISE OF SAFETY: NEAR MISS AS A

THE CHALLENGE OF KNOWLEDGE TRANSFER IN A PUBLIC