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Decision making, goal consensus, and effectiveness in university hospitals
T D'Aunno1, R Hooijberg, F C Munson
1School of Public Health, University of Michigan, Ann Arbor 48109.
Hospital & Health Services Administration
|January 1, 1991
Summary
External actor influence decreased in university hospital (UH) decision-making, with internal academic health center (AHC) actors gaining influence. This shift showed a link to improved UH effectiveness, though internal consensus had mixed results.
Area of Science:
- Health Services Management
- Organizational Behavior in Healthcare
- Academic Health Center Administration
Background:
- University hospitals (UHs) face complex governance structures.
- Shifting influence among stakeholders impacts UH decision-making and performance.
- Understanding these dynamics is crucial for optimizing UH operations.
Purpose of the Study:
- To analyze changes in the influence of key actors in UH management and policy decisions.
- To investigate the relationship between actor influence, goal consensus, and UH performance.
- To identify factors contributing to improved UH effectiveness.
Main Methods:
- Longitudinal analysis of data from a national sample of 52 UHs.
- Comparison of decision-making influence in 1981 and 1985.
- Regression analyses to assess the impact of influence and consensus on UH effectiveness.
Main Results:
- External actors (state, university officials) decreased influence in UH policy and management decisions.
- Internal actors (UH, medical school administrators) increased influence.
- Decreased external influence correlated with higher UH effectiveness, while internal influence and goal consensus showed weak or inconsistent relationships.
Conclusions:
- A trend towards internalizing decision-making within academic health centers (AHCs) is evident in UHs.
- Reducing external stakeholder influence may enhance UH performance.
- Further research is needed to clarify the role of internal consensus in UH effectiveness.