Professional participation in organizational decision making: Physicians in HMOs

Abstract

Although it has been suggested that participation by physicians in administrative and policy decisions is linked to outcomes in health care organizations, there is little research on this subject. Using Shortell's framework this paper considers relationships between perceived participation and three intermediate organizational outcomes: physician work satisfaction, perceived staff consensus about day-to-day activities, and attitudes toward patients. Also considered are situational, professional, and personal characteristics which may be related to participation. Data were collected from four staff model health maintenance organizations (HMOs) in 1978 and 1979 through physician questionnaires, administrator interviews, and documents. Physicians who reported greater participation were more satisfied with work, perceived greater staff consensus, and had more favorable attitudes toward patients. Greater participation was associated with full-time employment status and more years in the HMO (but not with the physicians' professional or personal characteristics). Implications of these findings are discussed, and it is proposed that the findings suggest mechanisms by which participation in organizational decision making may affect ultimate outcomes of the organization.

Evaluating Organizational Performance of Public Hospitals using the McKinsey 7-S Framework

“…There is a considerable discrepancy between the ‘as-is’ and the ‘should-be’ score of 5.3 concerning this aspect. J.K. Barr [ 57 ] described the relationship between perceived participation in decision-making and three indirect organizational outcomes: satisfaction with the work of a doctor, the staff’s perceived consensus on daily activities, and attitudes towards patients. Physicians who reported greater involvement in organizational decisions were more satisfied with their work, perceived a better consensus among employees, and had better attitudes towards patients.…”

Bringing the Physician Back In: Communication Predictors of Physicians' Satisfaction With Managed Care

“…Dissatisfaction with the referral process results when patients arrive at a specialist's office and neither the patient nor the specialist knows exactly why the primary care provider (PCP) sent the patient, or a patient returns to a PCP with insufficient notes from the specialist (Cybulska & Rucinski, 1989). Similarly, physicians who perceive themselves as having more participation in the decision making process of managed care organi-PHYSICIANS AND MANAGED CARE zations also tend to be more satisfied with their work (Barr & Steinberg, 1983;Deckard, Meterko, & Field, 1994;Silverstein & Kirkman-Liff, 1995).…”

Managing with Professionals in a Changing Health Care Environment

“…Delbecq and Gill (1985), for instance, analyze the appropriate goals for health care teams with physician members. Barr and Steinberg (1983) assess the impact that participation in Health Maintenance Organizations has on physicians' work satisfaction, attitudes toward patients, and perceived staff consensus. Examples of research in both the second and third areas are Schulz and Harrison's (1984) discussion of consensus management in the British National Health Service, which expounds the advantages of teams of clinical and administrative professionals for operational decision making, and an evaluation of hospital-based primary care group practices by Shortell et al (1984).…”