Two Decades of Organizational Change in Health Care: What Have we Learned?

Abstract

The 1980s and 1990s witnessed a substantial wave of organizational restructuring among hospitals and physicians, as health providers rethought their organizational roles given perceived market imperatives. Mergers, acquisitions, internal restructuring, and new interorganizational relationships occurred at a record pace. Matching this was a large wave of study and discourse among health services researchers, industry experts, and consultants to understand the causes and consequences of organizational change. In many cases, this literature provides mixed signals about what was accomplished through these organizational efforts. The purpose of this review is to synthesize this diverse literature. This review examines studies of horizontal consolidation and integration of hospitals, horizontal consolidation and integration of physician organizations, and integration and relationship development between physicians and hospitals. In all, around 100 studies were examined to assess what was learned through two decades of research on organizational change in health care.

Pursuing Enterprise Risk Management: A Local Road Map for Canadian Healthcare Leaders

“…Healthcare-based ERM must J a m e s H a n e y 201 2 5 | P a g e look beyond program silos and not only provide a snapshot of the current challenges, but rather a portrait of emerging trends, likely pressure points, and strategic opportunities. Common sense, supported by leading research (Jardine et al, 2003;Ackermann et al, 2003;Bazzoli et al, 2004), prescribes that truly comprehensive risk management practice needs to be built-up from within the organization based on tested methodology that (in a practical way) contemplates the common barriers that often derail efforts at organizational risk management. Overall, it cannot be overstated that the most effective risk management processes acknowledge the unique idiosyncrasies of the organization, tap into existing programs and techniques, understand and address key management challenges to risk program success, and most of all, build on the strengths of its own people.…”

Helsefeltets strateger

“…For example, Bazzoli et al (2004) find that stated merger motives are: improving organizational efficiency, financial performance, long-term survival, community accountability, and patient outcomes. Fulop et al (2002Fulop et al ( , 2005 mention economic gains, reduction of excess capacity to treat patients and increased effectiveness in certain clinical specialties (as the amount of activity increases) as typical merger arguments.…”

“…A general assessment of the literature shows that hospitals typically justify mergers by promising dramatic increase in financial and operational efficiency (Bazzoli et al, 2004;Goddard & Ferguson, 1997). For example, Bazzoli et al (2004) find that stated merger motives are: improving organizational efficiency, financial performance, long-term survival, community accountability, and patient outcomes.…”

“…In the 1980s, the merger trend hit the health care sector typically justified by promising dramatic financial and operational improvements (Bazzoli et al, 2004;Goddard & Ferguson, 1997). Starting in the US, extensive merger waves occurred at a record pace.…”

“…Yet several efforts have been made to identify patterns of consistency and inconsistency in the health care restructuring literature (see e.g. Bazzoli et al, 2004;Goddard & Ferguson, 1997). Among these, Bazzoli et al's (2004) comprehensive review deserves extra attention because it focuses simultaneously on motives, context, process and the outcomes of mergers that coincide with the aspects of special interest to this study.…”