Bazzoli G J, Shortell S M, Dubbs N, Chan C, Kralovec P
Research, Health Research and Educational Trust, Chicago, IL 60606, USA.
Health Serv Res. 1999 Feb;33(6):1683-717.
To use existing theory and data for empirical development of a taxonomy that identifies clusters of organizations sharing common strategic/structural features.
Data from the 1994 and 1995 American Hospital Association Annual Surveys, which provide extensive data on hospital involvement in hospital-led health networks and systems.
Theories of organization behavior and industrial organization economics were used to identify three strategic/structural dimensions: differentiation, which refers to the number of different products/services along a healthcare continuum; integration, which refers to mechanisms used to achieve unity of effort across organizational components; and centralization, which relates to the extent to which activities take place at centralized versus dispersed locations. These dimensions were applied to three components of the health service/product continuum: hospital services, physician arrangements, and provider-based insurance activities.
We identified 295 health systems and 274 health networks across the United States in 1994, and 297 health systems and 306 health networks in 1995 using AHA data. Empirical measures aggregated individual hospital data to the health network and system level.
We identified a reliable, internally valid, and stable four-cluster solution for health networks and a five-cluster solution for health systems. We found that differentiation and centralization were particularly important in distinguishing unique clusters of organizations. High differentiation typically occurred with low centralization, which suggests that a broader scope of activity is more difficult to centrally coordinate. Integration was also important, but we found that health networks and systems typically engaged in both ownership-based and contractual-based integration or they were not integrated at all.
Overall, we were able to classify approximately 70 percent of hospital-led health networks and 90 percent of hospital-led health systems into well-defined organizational clusters. Given the widespread perception that organizational change in healthcare has been chaotic, our research suggests that important and meaningful similarities exist across many evolving organizations. The resulting taxonomy provides a new lexicon for researchers, policymakers, and healthcare executives for characterizing key strategic and structural features of evolving organizations. The taxonomy also provides a framework for future inquiry about the relationships between organizational strategy, structure, and performance, and for assessing policy issues, such as Medicare Provider Sponsored Organizations, antitrust, and insurance regulation.
运用现有理论和数据，通过实证研究开发一种分类法，以识别具有共同战略/结构特征的组织集群。
1994年和1995年美国医院协会年度调查数据，这些数据提供了关于医院参与由医院主导的健康网络和系统的广泛信息。
运用组织行为理论和产业组织经济学来确定三个战略/结构维度：差异化，指医疗服务连续体上不同产品/服务的数量；整合，指用于在组织各组成部分之间实现协同努力的机制；集权化，指活动在集中地点与分散地点开展的程度。这些维度应用于健康服务/产品连续体的三个组成部分：医院服务、医师安排以及基于医疗服务提供者的保险活动。
我们利用美国医院协会的数据，在1994年识别出美国各地的295个健康系统和274个健康网络，在1995年识别出297个健康系统和306个健康网络。实证测量将各个医院的数据汇总到健康网络和系统层面。
我们为健康网络确定了一个可靠、内部有效且稳定的四类解决方案，为健康系统确定了一个五类解决方案。我们发现，差异化和集权化在区分独特的组织集群方面尤为重要。高差异化通常伴随着低集权化，这表明更广泛的活动范围更难进行集中协调。整合也很重要，但我们发现健康网络和系统通常同时采用基于所有权和基于合同的整合方式，或者根本没有整合。
总体而言，我们能够将约70%的由医院主导的健康网络和90%的由医院主导的健康系统归类到定义明确的组织集群中。鉴于人们普遍认为医疗保健领域的组织变革一直处于混乱状态，我们的研究表明，许多不断发展的组织之间存在重要且有意义的相似之处。由此产生的分类法为研究人员、政策制定者和医疗保健管理人员提供了一个新的词汇表，用于描述不断发展的组织的关键战略和结构特征。该分类法还为未来研究组织战略、结构和绩效之间的关系，以及评估诸如医疗保险提供者赞助组织、反垄断和保险监管等政策问题提供了一个框架。
