QUICK RECAP

Key Dimensions of Health Services Organizations

Differentiation Integration Centralization Change Innovation

Health Services Organizations as Systems

Closed

System

Maximize internal efficiency, predictability, and order

Open

System

Openness, adaptability, and innovation

Health Services Organizations as Systems

Production

Products or services at center of organizational activities

Boundary

Spanning

Interface between organization and external environment

Health Services Organizations as Systems

Maintenance

Physical and human infrastructure

Adaptation

Innovation as tool for change

Health Services Organizations as Systems

Management

Organizes, directs, and oversees

Governance

Provides strategic direction and imposes accountability

Areas of Managerial Activity

Organization

TheoryMacro Approach

Organization as social system Organizational design Interorganizational relationships Change and innovation Performance and strategy

Areas of Managerial Activity

Organizational

BehaviorMicro Approach

Examines individuals within organizations Motivation Leadership Conflict management

Ecology of Health Services Organizations

Are

Health Services Organizations Unique?

Professionalized providers Lack of managerial control over group generating work and expenditures Dual lines of authority

Ecology of Health Services Organizations

Are

Health Services Organizations Unique?

Work must be precise and errorless Services are interdependent and require coordination Require extreme degree of specialization

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Ecology of Health Services Organizations

Are

Health Services Organizations Unique?

Defining and measuring output are difficult Work is variable and complex Work is usually nondeferrable Work is often performed under emergency

conditions

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The External Control of Organizations

Ecology of Health Services Organizations

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The External Control of Organizations

Background

To understand the behavior of an organization you must understand the context of that behavior the ecology of the organization

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The External Control of Organizations

Relevant features of an organizations environment

Labor force, suppliers, customers & clients Competitors Other organizations Professional associations or bodies Government Communities in which the org operates Existing stock of knowledge and tech resources The broader social and cultural environment
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The External Control of Organizations

Open

systems theories

All theories point to some or all environmental features as important

Resource

dependency theory theory ecology

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Institutional

Organizational

The External Control of Organizations

Resource Dependency Theory

focuses on the consequences of power differences between organizations

Institutional Theory
examines the impact of the environment on organizations from a natural or social systems perspective

Organizational Theory
a macro perspective that uses sophisticated mathematical models to study the growth patterns of populations of organizations
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The External Control of Organizations

Resource Dependency Theory

The key to organizational survival is the ability to acquire and maintain resources

No organization is completely self-contained, they depend on other organizations and are linked by:
Federations Associations Customer-supplier relationships Competitive relationships Social-legal
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The External Control of Organizations

Resource

Dependency Theory cont All organizations must adhere to this

Public organizations Private organizations Small organizations Large organizations Bureaucratic organizations Organic organizations
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The External Control of Organizations

Resource

Dependency Theory in action

Convents and abbeys

Designed to be virtually self-sufficient Needs kept at a minimum Foods grown within Clothing made by abbeys labor Usually single gender Recruited new members
Prisons

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The External Control of Organizations

Resource

Dependency Theory How do we determine dependence?

The importance of the resource The extent to which the interest group has discretion over use and allocation of the resource Alternative resources

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The External Control of Organizations

Resource

Dependency Theory cont Resource exchange

Magnitude of the exchange
An organization that creates only one product or services is more dependent on its customers than an organization that has a variety of outs that are being disposed of in a variety of markets. Similarly, organizations which require one primary input for their operations will be more dependent on the sources of supply for that input than organizations that use multiple inputs, each in relatively small proportion.
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The External Control of Organizations

Resource

Dependency Theory More on Resource Exchange

Criticality of the resource
Criticality measures the ability of the organization to continue functioning in the absence of the resource or in the absence of the market for output

Problematic conditions of resources come from the environment.

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The External Control of Organizations

Organizational

vulnerability derives from the possibility of an environments changing so that the resource is no longer assured Discretion over resource allocation and use
Basis for control over a possession
Knowledge Ownership or ownership right Access Regulation
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The External Control of Organizations

Basis for control over a possession

Knowledge
Doctors Lawyers Engineers

Ownership or ownership right Access

Indirect discretion which depends upon a social-political conception and on enforceable social consensus Any process that affects the allocation of a resource provides some degree of control over it
Executive secretary

Regulation

The ability to make to make regulations and rules can determine the very existence and concentration of power

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The External Control of Organizations

Concentration of Resource Control

Dependence of one organization on another is dependent upon the concentration of resource control or the extent to which input or output transactions are made by a relatively few, or only one significant organization
Does the focal organization have access to the resource from additional resources An organization can have a monopoly position legally protected or legally established A group of firms can act together as one, constituting a cartel Unions, trade and professional associations
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The External Control of Organizations

Dependence

A resource that is not important to an organization cannot create a situation of dependence

When there are many sources of supply or potential customers, the power of any single one is correspondingly reduced

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THANK

YOU

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