Lacey L M, Hynes D M, Kaluzny A D
University of North Carolina, Chapel Hill.
J Health Hum Resour Adm. 1992 Winter;14(3):307-26.
In this analysis, the authors examined the effects of different sets of process, structure, and environmental variables on the performance of the CCOP as a quasi-firm. Specifically, they distinguished between internal organizational processes, structural, and size characteristics of the CCOP and the organizational environment created by prior NCI program experience and the relationship within the quasi-firm. The analysis revealed that these sets of organizational and environmental characteristics have differential effects on treatment accrual. The strongest predictors are those associated with the quasi-firm relationship between the CCOP and its chosen research bases. Any definitive policy implications for the design of organizational network relationships--especially the CCOPs--will require further analysis. Particular attention needs to be given to the longitudinal nature of the relationships and the ability of these organizational and environmental factors to affect other aspects of performance. Several points have been made within this initial assessment. First, the structural character of the CCOP and its relationship to its organizational environment are important factors affecting accrual performance. The subtleties of this multivariate model are not as important as simply demonstrating that the various internal and external characteristics of these organizations as quasi-firms simultaneously affect their ability to accrue patients to clinical trials. Secondly, the importance of research base relations, and particularly the significant role of nurses, needs to be emphasized. While CCOPs were originally designed as a network of physicians and hospitals, it appears that an infrastructure of professionally active nurses working within a larger organizational environment is critical to success--at least as defined by accrual to treatment protocols. Finally, the failure of prior experience with other NCI community programs to affect CCOP accrual performance suggests that such experience does not assure "organizational learning" that may enhance performance. This suggests that CCOPs can be designated de novo to maximize performance without necessarily having to undergo a developmental or experiential phase involving community cancer programs to be effective. However, the authors suspect that another method of characterizing experience may produce different results. Further analyses of these data will test these results against other measures of CCOP performance. Specifically, attention will be given to whether this same set of characteristics is predictive of accrual to cancer control research protocols. Similarly, these same organizational characteristics may or may not be associated with other dimensions of CCOP performance such as changes in physician practice patterns and/or levels of institutionalization of the CCOP within its local community.(ABSTRACT TRUNCATED AT 400 WORDS)
在本分析中，作者研究了不同组别的流程、结构和环境变量对作为准企业的社区临床肿瘤项目（CCOP）绩效的影响。具体而言，他们区分了CCOP的内部组织流程、结构和规模特征，以及由美国国立癌症研究所（NCI）先前项目经验所营造的组织环境，还有准企业内部的关系。分析表明，这些组织和环境特征对治疗入组有不同影响。最强的预测因素是那些与CCOP及其选定研究基地之间的准企业关系相关的因素。对于组织网络关系设计——尤其是CCOP——的任何明确政策含义都需要进一步分析。需要特别关注这些关系的纵向性质，以及这些组织和环境因素影响绩效其他方面的能力。在这一初步评估中提出了几点。首先，CCOP的结构特征及其与组织环境的关系是影响入组绩效的重要因素。这个多变量模型的微妙之处不如简单地证明这些作为准企业的组织的各种内部和外部特征同时影响它们将患者纳入临床试验的能力那么重要。其次，需要强调研究基地关系的重要性，尤其是护士的重要作用。虽然CCOP最初被设计为医生和医院的网络，但在更大的组织环境中，一支积极开展专业工作的护士队伍的基础设施似乎对成功至关重要——至少按照治疗方案入组来定义是这样。最后，先前参与其他NCI社区项目的经验未能影响CCOP的入组绩效，这表明此类经验并不能确保能提升绩效的“组织学习”。这表明可以全新设立CCOP以实现绩效最大化，而不一定非要经历涉及社区癌症项目的发展或经验阶段才能有效。然而，作者怀疑另一种描述经验的方法可能会产生不同结果。对这些数据的进一步分析将用CCOP绩效的其他指标来检验这些结果。具体而言，将关注这同一组特征是否能预测癌症控制研究方案的入组情况。同样，这些相同的组织特征可能与CCOP绩效的其他维度相关，也可能不相关，比如医生执业模式的变化和/或CCOP在其当地社区的制度化水平。（摘要截选至400字）
