Academic health centers (AHCs) have been concerned about their ability to cope with increasingly complex environments. The directors of many major teaching hospitals believe that state, university, and medical school officials have inordinate influence over their decisions, making them less timely and, perhaps at times, inappropriate. To study the structure of decision-making in AHCs, chief executive officers of 63 academic health center hospitals were surveyed about who in the academic health center had influence over hospital-related decision making, and about their hospitals' environments. The survey showed that CEOs and their staff had more influence than any other actor in the AHC. However, university presidents and vice presidents of health affairs had significant influence over financially- and strategically-related decisions. With respect to decisions related to clinical policy, medical school deans and clinical chiefs had the most influence. Deans and clinical chiefs had little or no influence over non-medical policy decisions. Multiple perspectives from organizational theory were used to suggest that formal authority, market uncertainty, financial performance, internal conflict, and societal norms might be factors related to the varying levels of centralization in decision-making. The primary result of multiple regression analysis showed that higher levels of centralization of formal authority had a substantial positive relationship with higher levels of centralization of influence. Other results suggested that higher levels of financial performance, market uncertainty, and hospital prestige were positively related to higher levels of decentralization, i.e. more hospital influence in decision-making. The results supported the view that non-medical center actors have substantial influence on hospital decision-making. However, the empirical measures used did not seem to adequately represent the influence of the medical school on overall decision-making; the relationship of physicians and hospital administrators in these major teaching hospitals needs much more explanation.Ph.D.Health Services Organization and PolicyUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/105478/1/9124147.pdfDescription of 9124147.pdf : Restricted to UM users only
