Accountable Care Organizations and Transaction Cost Economics

Using a Transaction Cost Economics (TCE) approach, this paper explores which organizational forms Accountable Care Organizations (ACOs) may take. A critical question about form is the amount of vertical integration that an ACO may have, a topic central to TCE. We posit that contextual factors outside and inside an ACO will produce variable transaction costs (the non-production costs of care) such that the decision to integrate vertically will derive from a comparison of these external versus internal costs, assuming reasonably rational management abilities. External costs include those arising from environmental uncertainty and complexity, small numbers bargaining, asset specificity, frequency of exchanges, and information impactedness. Internal costs include those arising from human resource activities including hiring and staffing, training, evaluating (i.e., disciplining, appraising, or promoting), and otherwise administering programs. At the extreme, these different costs may produce either total vertical integration or little to no vertical integration with most ACOs falling in between. This essay demonstrates how TCE can be applied to the ACO organization form issue, explains TCE, considers ACO activity from the TCE perspective, and reflects on research directions that may inform TCE and facilitate ACO development

Clustered and Distinct: A Taxonomy of Local Multihospital Systems

Despite their prevalence and power in markets throughout the United States, local multihospital systems (LMSs)—also referred to as hospital-based “clusters”—remain an understudied organizational form, with studies instead primarily focusing either upon individual hospitals or viewing hospital systems collectively without distinguishing the local “sub-systems” that comprise larger regional or national hospital chains. To better understand these organizational forms, we develop a taxonomy specifically devoted to LMSs, applying taxonomic analysis methods to a sample of LMSs in six U.S. states while accounting for LMSs’ geographic arrangements and non-hospital-based service locations. Our analysis identifies five distinct LMS categories, with forms clearly distinguished according to their varying degrees of differentiation and integration. The study’s results accentuate the importance of accounting for hospital systems’ activities and arrangements in local markets—including their non-hospital-based sites—and highlight differences in systems’ achievement of integration and coordination across services and locations, providing considerations in light of U.S. health system reform as well as international patterns of regional system formation

Synthesis and Convergence: The Maturation of Organization Theory

Readers will undoubtedly have been struck by the frequent use of terms and ideas drawn from a relatively small universe of macrolevel organization perspectives. All of the book\u27s chapters, except those the two of us wrote, were produced in total independence one to the next. That there is often a common parlance and appeal to a basic body of theoretical propositions is either a remarkable coincidence or the outcome of a convergence and maturation of our thinking about macrolevel organizational behavior. We lean toward the latter argument; what we see is neither accidental nor haphazard

Advances in Health Care Organization Theory, 2nd Edition

Advances in Health Care Organization Theory, 2nd Edition, introduces students in health administration to the fields of organization theory and organizational behavior and their application to the management of health care organizations. The book explores the major health care developments over the past decade and demonstrates the contribution of organization theory to a deeper understanding of the changes in the delivery system, including the historic passage of the Patient Protection and Affordable Care Act of 2010. Taking both a micro and macro view, editors Stephen S. Mick and Patrick D. Shay, collaborate with a roster of contributing experts to compile a comprehensive volume that covers the latest in organization theory. Topics include: Institutional and neo-institutional theory Patient-centered practices and organizational culture change Design and implementation of patient-centered care management teams Hospital-based clusters as new organizational structures Application of social network theory to health carehttps://digitalcommons.trinity.edu/mono/1035/thumbnail.jp

Introduction: Events, Themes, and Progress

The chapters in this second edition of Advances in Health Care Organization Theory are original essays in the broad realm of organization theory applied to health care organizations. In the first edition of this book, the authors explored what could be gleaned from the 1990s to inform and update organization theory in health care. The same pattern and goal applied to the Innovations in Health Care Organizations (Mick and Associates, 1990): chapter authors probed the events of the 1980s to determine what new might be written about organization theory as it was informed by the events of that time. We feel the need for a third in a series of books exploring the evolution of organization theory in the health care sector because organization theory in health care remains a work in progress. Although the field is highly developed outside health care and is routinely applied in business and commercial organizations, advances in organizational analysis in health care have lagged behind the general field. This situation exists for a complicated set of reasons

A Primer of Organization Theories in Health Care

This chapter provides a brief introduction to what can be referred to as the canon of basic macrolevel organization theory in health care. Until the late 1950s to the mid-1960s, the principal focus of organization theory has been on the interior of organizations. That is, the earliest writings on organizations, like Frederick Taylor\u27s scientific management, Max Weber\u27s bureaucratic theory, the human relations school with its contrast to scientific management, and other approaches to the study of organizations, addressed questions about the design of work, employee motivation, management skills and techniques, control systems, and the like. For the most part, the chapters in this book do not address these internal issues; in contemporary organization studies, these sorts of questions fall under the rubric of organization behavior, and they warrant a separate book on their own

Differentiated, Integrated, and Overlooked

Take a quick look at the competitive makeup of health care organizations in any single market in the United States, and you are likely to find at least one, if not several, hospital-based health care systems that serve as the primary and dominant health care providers within their local communities. Indeed, the existence of these entities, most of which are clusters of two or more acute care hospitals and other associated health care businesses, and the prominent role they play in the US health care system may seem obvious to the casual observer. Ironically, despite their importance as delivery modalities and their potential effects on competition and policy, these distinctive organizational forms—the clusters—are strikingly understudied. The gaps in knowledge appear even at the most basic levels of analysis, including their measurement and conceptualization. What are these systems? How did they come to exist? And how does their emergence and development speak to our understanding of organizations, organizational forms, and organization theory