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Studying outcomes of organizational change in health services.
- Source :
-
Medical care [Med Care] 1997 Nov; Vol. 35 (11 Suppl), pp. NS6-18. - Publication Year :
- 1997
-
Abstract
- Objectives: The rapidly changing organizational context within which health care is delivered is altering provider-patient relations and processes of clinical decision-making, with significant implications for patient outcomes. Yet definitive research on such effects is lacking. The authors seek to underscore the contribution of organizational research to studies of clinical outcomes and demonstrates several approaches to further such efforts.<br />Methods: The authors present a theoretical framework of the operant mechanisms linking organizational attributes and patient outcomes. They use case examples from their ongoing research on hospitals to illustrate strategies for measuring these mechanisms and for overcoming some of the feasibility issues inherent in organizational research.<br />Results: Several methodological issues are explored: (1) exploiting "targets of opportunity" and "natural experiments" is a promising strategy for studying patient outcomes related to organizational reform; (2) indices of organizational traits, constructed from individual survey responses, can illuminate the operant mechanisms by which structure affects outcomes; and (3) secondary data sources and innovative statistical matching procedures provide a feasible strategy for constructing study comparison groups. Extending the organizational outcomes research strategy to new areas of inquiry offers an opportunity to enhance our understanding of how nursing organization affects outcomes.<br />Conclusions: Improving the effectiveness of medical care in a health-care system undergoing fundamental restructuring requires greater understanding of how organizational context affects clinical outcomes. A higher priority should be placed on organizational outcomes research by researchers and funding agencies.
- Subjects :
- Acquired Immunodeficiency Syndrome nursing
Attitude of Health Personnel
Burnout, Professional
Health Care Reform
Hospital Administration
Humans
Models, Theoretical
Nursing Service, Hospital organization & administration
Delivery of Health Care organization & administration
Health Services Research methods
Nursing Administration Research methods
Organizational Innovation
Outcome Assessment, Health Care methods
Subjects
Details
- Language :
- English
- ISSN :
- 0025-7079
- Volume :
- 35
- Issue :
- 11 Suppl
- Database :
- MEDLINE
- Journal :
- Medical care
- Publication Type :
- Academic Journal
- Accession number :
- 9366875
- Full Text :
- https://doi.org/10.1097/00005650-199711001-00002