Community orientation in hospitals: an institutional and resource dependence perspective

Area of Science:

• Health Services Research
• Organizational Behavior
• Strategic Management

Background:

• Hospitals face increasing environmental pressures requiring strategic adaptation.
• Community orientation, defined as generating, disseminating, and using community health-need intelligence, is a strategic response.
• Understanding the predictors of community orientation is crucial for hospital strategy.

Purpose of the Study:

• To conceptualize community orientation as a strategic response to environmental pressures.
• To test a theoretically justified model of the predictors of community orientation in hospitals.
• To identify factors influencing hospitals' adoption of community health-need intelligence.

Main Methods:

• Analysis of data from 4,578 hospitals using the American Hospital Association Annual Survey and Medicare Hospital Cost Report.
• Market-level data sourced from the Area Resource File.
• Multiple regression analysis to examine predictors including hospital size, managed care dependence, ownership, and network/system/alliance memberships.

Main Results:

• Hospital size, ownership, dependence on managed care, and network/system/alliance membership significantly predict community orientation.
• The diffusion of community-orientation practices in the local area also positively influences a hospital's degree of community orientation.
• These findings support a model of organizational responsiveness to environmental pressures.

Conclusions:

• Community orientation is influenced by environmental pressures and hospital-specific interests.
• Larger, nonprofit hospitals, and those in networks/systems/alliances exhibit higher community orientation.
• Hospitals more dependent on managed care and operating in areas with greater community-orientation diffusion are also more community-oriented.