Transitions in the Hierarchy of Authority in Hospitals: Implications for the Role of the Chief Executive Officer.

Hospitals are being transformed from a cottage industry in which each institution is relatively autonomous to a series of multihospital systems where a network of individual institutions are directed from corporate headquarters. The present paper examines the impact of adding a hierarchical level to the top of the hospital on the role of the hospital's chief executive officer (CEO). We report results of CEO functioning (201 from multihospital systems and 188 from traditional freestanding hospitals) relative to (1) division of labor, (2) need for coordination, and (3) managerial autonomy. We show that multisystem CEOs' activities are more standardized. but not more specialized, than those of freestanding hospital CEOs; however, we show only moderate support for the increased involvement in coordination activities for those in multihospital systems. Finally, while CEOs in multihospital systems exhibit less actual autonomy in their roles as managers, they perceive themselves as having more autonomy than CEOs in freestanding hospitals. These findings arc considered with respect to the administrator's credo of balancing the need of communities for healthcare with the organization's need to remain financially viable. [ABSTRACT FROM AUTHOR]