POLICY ANALYSIS AND MANAGEMENT
Non Technical Summary
This research will attempt to determine how and why health services organizations change and why some effect successful change while others either do not change, or change unsuccessfully. Specifically, the research will examine the characteristics of health services organizations that might predispose them toward successful or unsuccessful change and the processes or factors that might enable or impede change.
Animal Health Component
Research Effort Categories
Goals / Objectives
The overarching objective of my research is to answer the question: How and why do health services organizations change? In answering this question, the research will attempt to characterize and define the nature and mechanisms of organizational change in health services organizations; to identify mechanisms (enabling processes or factors) by which successful organizational change may be accomplished in health services organizations; to contrast these mechanisms with those found in unsuccessful health services organizations; to track over time the organizational characteristics that may facilitate successful (and unsuccessful) organizational change; to define and characterize the decision-making and leadership processes that contribute to change in health services organizations, both successful and unsuccessful; to establish the nature of the relationships between leadership, organizational change, and success in health services organizations; to describe how
appropriate (facilitative of success) leadership behaviors might best be imparted to health services managers. My dissertation research established that there appear to be 5 configurations into which successful health services organizations may be grouped based on 20 organizational characteristics. Less successful health services organizations may, likewise, be grouped into 5 configurations. These configurations were shown to be statistically significantly different than the configuration that might be expected due to chance. The present studies will look at organizations at different time periods. Although it is expected that any given organization may change, or move from one configuration to another, over time, it is also expected that the characteristics describing the configurations will remain stable over time. Based on theory, it is also expected that organizations in any one configuration will only be influenced to change by one or two processes or factors and will only change
to one or two other configurations. Examining units within health services organizations, it is expected that units whose managers are perceived as and who behave as transformational leaders will outperform and will more readily change in response to environmental stimuli than units whose managers are perceived as and who act as managers or transactional leaders.
Re-examining the health services organizations used earlier, and using the same 21 characteristics, all organizations will be re-rated three years after the initial rating. Obverse, or Q-factor analysis will again be used to group the organizations. However, cluster analysis will also be used as a corroborative grouping technique. As the data do not meet the assumptions appropriate for factor analysis, independent confirmation of statistical significance is needed, so binomial tests will be run comparing the total Cartesian space occupied by organizations in a suggested configuration to those spatial profiles expected by chance. If it is found that configurations are stable and significant and that many individual organizations fall into configurations different than those they occupied 3 years ago, case studies of all changed organizations will determine what processes or factors contributed to change from one configuration to another. Finally, hierarchical linear
modeling techniques will be used to examine the change patterns as a function of both configurational (the level 2 group) and organizational (the level 1 group) characteristics and across time where the each period's observations represent the level-1 (within unit) stage, and the various change patterns from one configuration to another represent the level 2 (between units) stage. To examine leadership, two groups of first-line managers, e.g., nurse managers, will be randomly chosen from participating health services organizations. The Multifactor Leadership Questionnaire (MLQ) assessing perceptions of managerial, leadership, and motivational capabilities will be administered to participating managers' subordinates and to the managers, themselves. Also, because organizations or units with certain working environments are more likely to change successfully, subordinates and managers will be asked to rate their working environment in the Organizational Description Questionnaire (ODQ).
The units' performance will be assessed before the study based on readily available financial measurements, e.g., cost per procedure, waiting times, total revenues, and/or total expenses and on available human resources indicators, e.g., turnover, absenteeism, tardiness, and/or grievances filed. Then, during a 12 or 15 week session, the experimental managers' group will be trained to exhibit transformational leaders' behaviors while the control group will be trained in management tools, i.e., budgeting. Following the training, 4 to 6 months will elapse during which the training's impact can be fully realized and participating units can be analyzed using case studies. Then the MLQ and the ODQ will be repeated for both subordinates and managers, and units will be reassessed on the same financial and human resource measurements. Hopefully, the participating organizations will agree to yearly reassessments thereafter to include 1 or 2 hour refresher training sessions, re-administration of
both the MLQ and the ODQ, and continuation of the case study analyses of the units to determine what changes occurred within and among units, and what the impact of any unit level changes had on the organization.