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At least 19 recordsLinked to original sources
PubMed1991

Organizational affiliation and effectiveness: the case of rape crisis centers.

Many rape crisis centers (RCCs) that were founded as autonomous organizations have affiliated with other organizations. The relationship of affiliation type and effectiveness is examined in a sample of 25 RCCs in Florida. Effectiveness is defined in terms of range of services for rape victims and involvement in rape prevention (social change) activities. The data show that 23 RCCs are affiliated with six types of organizations and two are free-standing. Each affiliation type has advantages and disadvantages but, overall, free-standing RCCs appear to be most effective and RCCs affiliated with community mental health centers, least effective. Of the seven types, free-standing agencies are most involved in rape prevention activities aimed at social change.

Ambulatory Care Facilities↗
PubMed2007

Factors affecting primary care physicians' perceptions of health system reform in Israel: professional autonomy versus organizational affiliation.

This paper examines primary care physicians' perceptions of a National Health Insurance Law that introduced managed competition into Israel's health care system, and the factors affecting their perceptions. Between April and July 1997, we conducted a mail survey of primary care physicians employed by Israel's four health plans (which are managed care organizations). Eight hundred questionnaires were returned, representing a response rate of 86%. The findings indicate that, overall most physicians support the components of the National Health Insurance Law with statistically significant differences among physicians by health plan. Multivariate analysis revealed that, contrary to theoretical expectations, a perceived decrease in professional autonomy and in the status of the profession following reform did not significantly affect attitudes toward national health insurance. These findings highlight the need for additional empirical studies to further examine theoretical contentions about the implications of infringing on the professional autonomy and the dominant status of physicians. The principal and most interesting finding of this study was the independent effect of health plan affiliation on physicians' attitudes toward each of the five components of the National Health Insurance Law, after controlling for background characteristics, for the reform's perceived effect on the physicians' autonomy and status in the health plan, and for the reform's perceived effect on the level of health plan services and the health plan's financial situation. We found that physicians' perceptions tended to conform to the formal position of their health plan, suggesting the need to analyze the attitudes of physicians in their organizational context, rather than treating them as members of a uniform professional community.

Adult↗
PubMed1988

The epidemiology of medical care utilization by severely-disabled independently-living adults.

A prospective study of the medical care utilization experience of 205 severely-disabled independently-living adults in Eastern Massachusetts shows that there was a mean of 0.83 +/- 1.26 hospital admissions, 9.9 +/- 22.7 hospital days, 1.5 +/- 2.31 emergency room (ER) visits, and 26.88 +/- 44.4 outpatient contacts per person per year. Among those hospitalized, the mean experience was 16.2 +/- 27.1 days per person per year; mean length-of-stay was 9.3 +/- 14.7 days per admission. Regression analysis indicates that those with spinal cord injuries as major disabling conditions were significantly more likely to be hospitalized. So were those with lower self-assessments of health, higher levels of depressions, and more baseline ER visits. Self-assessment of health is a significant predictor of hospital days for the total cohort (including those with no admissions); so are age at onset of disability (greater age; higher risk), and bed disability days in the month before the baseline survey (more disability days; higher risk). Among those hospitalized, the total number of days hospitalized is significantly related to both age at onset of disability (later onset; more days) and baseline days hospitalized (greater number; more days). Lengths-of-stay are significantly related to two factors; age and age at onset of disability (in both cases, greater age associated with longer stays). Prior ER visits are a significant predictor of subsequent ER visits (more baseline; more subsequent); so are respondents' reported satisfaction with their participation in their medical care (lower reported satisfaction; more ER visits), organizational affiliations, and frequencies of contacts with friends or relatives. Higher levels of social interaction (i.e. organizational affiliation and more frequent social contacts) were associated with more ER visits. Prior contacts with physicians, nurse-practitioners, or physician-assistants was the most powerful predictor of subsequent outpatient contacts (more baseline; more subsequent). There were also significant relationships between subsequent contacts and respondents' assessments of their health relative to others with similar disabilities (relatively worse health; more contacts), age (greater age; more contacts), and baseline ER visits (more visits; more contacts).

Activities of Daily Living↗
PubMed1998

An investigation of workplace AIDS training with implications for occupational health promotion efforts.

Workplace AIDS training is a recent addition to many corporations' occupational health agenda. However, little is known about the objectives, content, and practices of AIDS training programs. A survey of 126 workplace AIDS trainers was conducted to determine the impact of the trainer's organizational affiliation (in-house, consultant, union, etc.) and personal motives on training program objectives, content, and practices. Results indicate that the organizational affiliation of trainers is significantly related to training objectives, topics, and practices, whereas strong personal motives for becoming an AIDS trainer is significantly associated with an emphasis on more controversial content areas and training practices. Findings are discussed in terms of applicability to other values-oriented training topics, applications to practice, and future research needs.

Acquired Immunodeficiency Syndrome↗
PubMed2004

A national study of job satisfaction and burnout among perfusionists.

A national qualitative survey of perfusionists to assess their level of job stress, career satisfaction, and burnout in various organizational settings was performed. The hypothesis for this study is incorporated into the following research questions. First, is there an association between job satisfaction and burnout among perfusionists? Second, is there an association between level of burnout and intention to leave their job or profession among perfusionists? Third, is there a difference in job satisfaction and burnout across different organizational affiliations of perfusionists? Invitations to participate in the survey were sent by electronic mail to the 1478 AmSECT members with an e-mail address. To categorize perfusionists, the Phase Model of the Maslach Burnout Inventory (MBI) was used. It is based on the Maslach Model, but extends it by suggesting the order of severity in which persons experience burnout. Two hundred eighty-three responses were received, with the following results. As burnout increases, job satisfaction decreases. As burnout pressure increases from low to high, it is associated with a greater intention of perfusionists to leave their jobs for a lateral move or demotion within 6 months. There is insufficient evidence to show a difference between employee satisfaction and burnout based on organizational affiliation. The perfusionists who answered the inquiry seem to be clear about their role at work, to have adequate resources, and to feel they are treated fairly by supervisors. Organizational climate, communication, training, participation, trust, and culture are evaluated positively. Although the respondents considered interdepartmental communication adequate, higher management or corporate communication is portrayed as needing improvement. When the MBI scores are divided into the eight phases and then compressed into the three subphases, 42% of the perfusionists surveyed are categorized as low burnouts, 20% of the perfusionists as moderately burned out, and 38% were in the high burnout group. It will be important to use this information as a benchmark and follow the profession as it changes over the next few years.

Adult↗
PubMedDate not supplied

Medical group affiliations: interorganizational relationships and organizational performance.

The hyperturbulent health care environment is causing health care organizations to create interorganizational relationships (IORs). This article reports on a study of 686 medical groups that assessed how 11 types of IORs affected 7 dimensions of organizational performance. Organizational performance was ascertained through self-reported questions about performance relative to local market competitors. Respondents believed that, to varying degrees, all IORs lead to a competitive advantage over local competitors in all seven performance categories. There was no consistent pattern for either loose or tight linkages to be associated with superior performance. Consequently, loose linkages may be preferable to tighter linkages (i.e., membership in a fully integrated delivery system) that require higher levels of resource commitment.

Economic Competition↗
PubMed1997

AIDS services in Florida: who's doing what, and who's paying for it?

The rapid growth of AIDS in the 1980s was paralleled by a rapid growth in AIDS Service Organizations (ASOs) throughout the United States. This article examines one state, Florida, and the 52 ASOs to determine each ASOs organizational affiliation, major types of service offered, sources of funding, and geographic dispersion in the state. Based on the results of this examination, several research and policy implications are discussed.

AIDS Serodiagnosis↗
PubMed1989

Financing and home health agencies.

Home health agencies are examined with reference to changes that have occurred in their financing as a result of DRGs. Comparisons are made based on organizational affiliation and findings indicate agencies that become affiliated with larger and more complex organizations are more frequently proprietary agencies. In other ways, however, nonprofit and proprietary agencies are becoming more similar. Both types of agencies are increasingly interested in reducing reliance on government funding.

Budgets↗
PubMed1991

An assessment of the needs of mutual-help groups.

Assessed the needs of mutual-help groups in relation to how self-help clearinghouses can best assist. Most important problems centered on member involvement, attendance and recruitment, lack of public awareness, and finances. Most important needs were for greater public education and more referrals to groups. Significant differences were found across different types of organizational affiliation for the problems of recruitment of members, lack of public awareness, and problem members. The dynamic nature of mutual-help groups may naturally produce many of the turnover, attendance, and involvement problems which in turn generates the ongoing need to recruit new members in part through greater public awareness. Many of the goals and needs of mutual-help groups, coupled with the large number of group members, may lead to significant social and policy change in health and mental health services.

Goals↗
PubMed2000

Opinion leaders' support for tobacco control policies and participation in tobacco control activities.

OBJECTIVES: Because opinion leaders hold positions from which they may influence tobacco control efforts, this study examined their support for tobacco control policies and their involvement in tobacco control activities. METHODS: A telephone survey was administered to 712 California opinion leaders who were randomly selected from constructed lists representing 8 types of organizations: health, education, law enforcement, media, government, business, ethnic, and youth. Hierarchical regression analysis was used to identify predictors of support for and participation in tobacco control activities. RESULTS: Approximately one half to two thirds of opinion leaders supported the tobacco control policies queried; 60% reported involvement in tobacco control-related activities during the previous year. Organizational affiliation was a strong predictor of support and involvement, with leaders from health and educational organizations reporting the highest levels and business and media leaders reporting the lowest. Tobacco issue involvement variables (e.g., having a friend or family member with a smoking-related illness) were significantly associated with the outcomes, while sociodemographics, for the most part, were not. CONCLUSIONS: Study results can be used to mobilize opinion leaders' support for tobacco control more effectively.

Analysis of Variance↗
PubMed2005

Factors associated with interorganizational relationships among outpatient drug treatment organizations 1990-2000.

OBJECTIVE: To identify the factors associated with drug abuse treatment center participation in interorganizational relationships (IORs). DATA SOURCES: Three nationally representative samples of outpatient drug abuse treatment units surveyed in 1990, 1995, and 1999/2000 as part of the National Drug Abuse Treatment System Survey (NDATSS), stratified by public/private status, treatment modality (methadone or nonmethadone), and organizational affiliation. STUDY DESIGN: Probit analyses on 647 lagged treatment center-year observations from the years 1990 to 1995 with outcomes in 1995 and 2000, respectively. Standard errors were adjusted for clustering of center-year observations within centers. PRINCIPAL FINDINGS: Centers with greater motivation to form IORs (e.g., as a result of client diversity or government revenue) were more likely to do so, as were centers with greater opportunities to form IORs (e.g., centers whose directors participated in policy making). CONCLUSIONS: Both motivating and enabling factors promoted the formation of IORs by drug abuse treatment centers. Managed care also played a distinct role, in this case appearing to undermine interorganizational cooperation. Because IORs can improve access to care and quality, policy makers should consider using both incentives and support such as management training to promote IOR formation.

Cooperative Behavior↗
PubMedDate not supplied

Coordinated agency versus autonomous consumers in health services markets.

Despite widespread acceptance of the competitive market model in the U.S. health care system, debate continues regarding the optimal form of competition and the patient-professional relationship. The managed care model envisions organizations that act as the consumer's agent, addressing the challenges that consumers face in the market for health care services. The consumer-directed health plan model envisions autonomous, well-informed, price-conscious consumers shopping among providers unconstrained by organizational affiliations. Although advocates of these two approaches stress their philosophical differences, the realities of the market suggest that both models, as well as hybrids, might be valued by consumers.

Community Participation↗
PubMed1997

Control and prevention of serogroup C meningococcal disease: evaluation and management of suspected outbreaks: recommendations of the Advisory Committee on Immunization Practices (ACIP).

Outbreaks of serogroup C meningococcal disease (SCMD) have been occurring more frequently in the United States since the early 1990s, and the use of vaccine to control these outbreaks has increased. These outbreaks are characterized by increased rates of disease among persons who may have a common organizational affiliation or who live in the same community. By using surveillance for SCMD and calculation of attack rates, public health officials can identify SCMD outbreaks and determine whether use of meningococcal vaccine is warranted. This report describes 10 steps for evaluation and management of suspected SCMD outbreaks. The principles described also apply to suspected outbreaks caused by meningococcal serogroups A, Y, and W-135. The effectiveness of mass chemoprophylaxis (administration of antibiotics to large populations) has not been demonstrated in most settings in which community and organizational outbreaks occur. However, in outbreaks involving small populations, administration of chemoprophylaxis to all persons within this group may be considered. The ability to validate some aspects of these recommendations is currently limited by incomplete reporting of serogroup information in most systems for meningococcal disease surveillance in the United States and by the relative rarity of SCMD and SCMD outbreaks.

Antibiotic Prophylaxis↗
PubMed2007

Racial and ethnic disparities in SSRI availability in substance abuse treatment.

OBJECTIVE: The high rate of co-occurrence of psychiatric and substance use disorders suggests that specialty substance abuse treatment facilities may be an important site for the delivery of psychotropic medications. However, the literature suggests there may be associations between the percentage of racial and ethnic minority clients and the availability of selective serotonin reuptake inhibitors (SSRIs) in these facilities. METHODS: Survey data from the National Treatment Center Study, comprising nationally representative samples of 326 publicly funded and 339 privately funded substance abuse treatment centers, were used to measure the availability of SSRI medications from 2002 to 2004. Independent variables included the percentages of African-American and Hispanic clients, center type, organizational affiliation, region, size, accreditation status, presence of an integrated care program, and physician availability. RESULTS: SSRIs were available in 48% of the centers. Logistic regression analysis indicated that greater minority representation in centers' caseloads was negatively associated with the availability of SSRIs. The association between the percentage of African-American clients and SSRI availability was fully mediated by the addition of factors related to treatment inputs, such as the presence of a physician on staff or contract and the presence of an integrated care program. With organizational and treatment characteristics factored out, there was a negative association between the percentage of Hispanic clients and the availability of SSRIs. CONCLUSIONS: Although SSRIs were available in nearly half of these substance abuse treatment settings, racial and ethnic disparities exist in the availability of these medications.

Black or African American↗
PubMed1991

The creation and early implementation of a high speed fiber optic network for a university health sciences center.

In late 1989 the University of Missouri Health Sciences Center began the process of creating an extensive fiber optic network throughout its facilities, with the intent to provide networked computer access to anyone in the Center desiring such access, regardless of geographic location or organizational affiliation. A committee representing all disciplines within the Center produced and, in conjunction with independent consultants, approved a comprehensive design for the network. Installation of network backbone components commenced in the second half of 1990 and was completed in early 1991. As the network entered its initial phases of operation, the first realities of this important new resource began to manifest themselves as enhanced functional capacity in the Health Sciences Center. This paper describes the development of the network, with emphasis on its design criteria, installation, early operation, and management. Also included are discussions on its organizational impact and its evolving significance as a medical community resource.

Academic Medical Centers↗
PubMedDate not supplied

Public sector hospitals and organizational change: an agenda for policy analysis.

An important feature of health care systems in recent years is the change in the organizational position and relations of public sector hospitals. Health sector reforms have led to increasing heterogeneity in the organizational location and status of public sector hospitals and new organizational forms of public-private relations are being developed by and for hospitals. These changes can have important implications for health and health care. They raise issues around equity, control, accountability and performance of health care. Yet the policy process in practice may be failing to develop and implement appropriate forms of policy formulation on health sector reform. This paper focuses on the organizational position and relations of hospitals within public sector health services. It firstly outlines key elements of health sector reform and relates these to two dimensions of organizational change for hospitals: increasing heterogeneity and forms of public-private relations. The paper provides a descriptive format for classifying forms of hospital organizational change and proposes a framework of six questions for analysing these organizational forms. This may be used to assess the appropriateness of specific policies to particular country situations and to develop more open debate around hospital organizational forms.

Decision Making, Organizational↗
PubMed1989

Dynamics of the marketplace: key issues, new linkages, and successful organizational models in academic CME.

Following an initial description of the marketplace for CME, the article identifies and explores six key issues for the future of academic CME: evolution of the academic health center; practice changes and reimbursement; impact of technology; regulatory influences; proliferation of CME providers; and medical school leadership. The author then turns to a discussion of new ways to link CME with practitioners--through academic health centers, within various practice environments, through technology, in the regulatory arena, and by developing relationships with competing groups and organizations. Finally, the article suggests several organizational models with potential for expanding these linkages.

Academic Medical Centers↗