Executive Control Strategies in Hospitals and Group Practice Hmos.

Abstract

Two kinds of organizations are investigated in this thesis: short-term general hospitals and prepaid group practice HMOs. Both organizations provide human services and in both cases the services are medical care. However, contrary to current notions about human service organizations, it is argued that: (1) human service technology and the preponderance of professionals are not the most significant features for underst and ing leadership and control in these organizations, (2) the bureaucratic model is a fruitful vehicle for underst and ing prepaid group practice health plans, and (3) short-term general hospitals are better understood in terms of the model of organized anarchy than simply as human service organizations. The focus of the thesis is executive control strategies. The central argument may be summarized as follows. Hospital organizations have two particularly unusual attributes: (1) the decision makers participate only intermittently in the organization, and (2) organizational goals are multiple, diffuse, and conflicting. These attributes significantly modify the bases of st and ard mechanisms of authority and control that are found in most organizations. As a consequence, unconventional strategies of control are employed by hospitals executives. The more traditionally bureaucratic features of prepaid health plans provide for the operation of st and ard mechanisms of authority and control. Hence health plan executives are less likely to employ unconventional strategies of control than hospital executives. The data support the research proposition that unconventional strategies of executive control (unobtrusiveness, facilitating opposition participation, and environmental adaptation) are more likely to be employed by hospital executives than health plan executives. The general findings include the following: (1) Technology and professionals are less promising explanatory variables than goals and participation. (2) Human service organizations are too diverse to be investigated as a group. (3) The bureaucracy and organized anarchy models show promise for analyzing human service organizations. Implications for leadership roles in hospitals and health plans and for public policy are also discussed.