The first two articles in this issue complement each other well. The first is by Robert Weech-Maldonado, Gerald Neff, and Vincent Mor, and was the winner of the "Best Theory to Practice Award" at the 2002 Academy of Management meetings. It considers whether quality of care in the nursing home industry leads to better financial performance. The authors use three different measures for quality-outcomes, process, and structural-and found the first two to have a positive impact on financial performance. This is an important finding, and one that requires continued exploration not only in the context of nursing homes but in other health care settings as well. The tension between quality and financial performance has plagued policymakers and managers for decades. Many of the "savior recipes" such as total quality management (TQM) have promised to resolve the conflict but have had little documented impact. This article suggests looking within health care organizations to learn how they can have both rather than looking outside to determine how they should resolve this conflict.
The second article, by Nicholas Castle, links strategic responses (using the Miles and Snow typology) to nursing facilities' quality outcomes. Prospector nursing facilities had the highest quality outcomes. These are the organizations that seek out new market opportunities, and the author posits that facilities with a reputation for quality may be better able to pursue new opportunities. We will look forward to future articles that consider the implications of these two articles and address the relationships among different strategic groups, financial performance, and various measures of quality.
The next article provides unexpected results. In a study of health systems and health networks, Jeffrey Alexander, Shoou-Yih Lee, and Gloria Bazzoli found that despite theoretical arguments that network governance would be more informal, both types maintained incorporated governing boards. This research stands out for two reasons. First, governance is a critical implementation variable, yet one that does not receive much attention. As the authors point out, it has largely been ignored in discussions of health systems versus health networks. Second, too often expectations are shaped by what the theoretical literature predicts, and contrary results are seen as a failure. This research makes clear the value of contrary results. As we have long argued, these are often the results that are the richest in terms of advancing not only our knowledge of practice but also of theory.
Diversity management has become increasingly important in all organizations, and perhaps especially so in health care organizations. Not only is the workforce diverse but so too are the patients and communities they serve. Yet as Kathryn Dansky, Robert Weech-Maldonado, Gita De Souza, and Janice Dreachslin point out, health care organizations have been slow to embrace diversity management. The authors study the relationships among organizational strategy, organizational sensitivity to diversity, and diversity practices. Their findings reflect the importance of permeable organizational boundaries. Hospitals that have an external focus are more involved in diversity management.
The fifth paper in this issue has a very different level of analysis. John Swan, Lynne Richardson, and James Hutton look at the impact of appealing hospital rooms on patient evaluation of hospital services-another facet of quality. Patients in these rooms experienced their hospital stay more favorably than those in typical rooms. If we relate this back to the findings of Weech-Maldonado et al., it raises the question of what impact this has on financial performance. Is this an instance in which the improvement in quality (which may raise costs) enhances revenue?
Considering the articles as a whole, two general observations may be made. The first is the importance of considering implementation variables. What do health care organizations actually do and with what impact? The second is how interrelated the technical core, the strategic level, and the external environment are. This is seen, for example, in the article on diversity, where the hospitals whose strategies are most responsive to the environment are the most engaged in diversity management practices.
This issue concludes with a very special FORUM featuring an article by Reuben McDaniel, Michelle Jordan, and Brigitte Fleeman with commentaries by Benjamin Crabtree and Kathleen Montgomery.
-Barbara Bigelow, Ph.D., Co-editor
-Margarete Arndt, D.B.A., Co-editor