The articles in this issue demonstrate the diverse interests of the journal's audience: strategy, quality of care, and human resources management. In addition, we offer a FORUM that explores the complex interactions between working in both academia and practice.
The lead article is by Short, Palmer, and Ketchen. This article, which won a best paper award at the 2001 Southern Management Association meeting, explores the effect of membership in a strategic group and of organizational resources on organizational performance. It is followed by the work of Marlin, Huonker, and Sun, who also studied the effect of strategic group membership on organizational performance. The two articles use different concepts of strategic group, and both raise interesting questions about deliberate choice of strategy, about response to environmental demands on hospitals, and about the difficulties associated with relocating from one strategic group to another. These two articles add valuable knowledge for managers and researchers.
Strategy research usually relies on realized strategy. Inherently, this reflects the rational assumption that the intended will become the actual. In health care, perhaps more so than in other industries, there is significant influence from many important stakeholders on an organization's conduct. There are regulators and community leaders who have something to say about addition or closure of services; there is public opinion about the appropriate domain of a health care organization; there are third party payers who make clinical services more or less attractive through their reimbursement policies; and there are physicians who want to expand services in keeping with their own clinical interests, or who do not want the hospital to compete with them for patients. How much power these various influences exert on an organization's initial strategic intent, and to what extent they reshape strategy during its implementation are still not completely understood.
The article by Havlovic, Lau, and Pinfield offers us a glimpse of the effect of today's health care system on a particularly important group of care takers: nurses. Not surprisingly, the study found that nurses who worked both their preferred shift and their preferred work week reported more positive work outcomes and less interference with their nonwork activities. Other findings are perhaps not quite so obvious: for example, compressed work weeks aggravate the negative effects of shift rotation, and contingent nurses reported lower quality patient care. This article offers important insights into an aspect of human resources management that is increasing in importance as fewer and fewer nurses are available.
One of the important functions of health care managers is to balance the needs of different stakeholders, e.g., patients, caregivers, third party payers, public opinion, and the organization itself. The task is made more difficult because their demands frequently conflict. A longer length of stay may increase a patient's comfort or lessen the caretaking burden on the family but is in conflict with payers' demand for shorter stays. Similarly, the organization may identify opportunities for cost reductions through increased use of contingent staff or overtime on demand in lieu of permanent staff; yet such policies may be perceived by nurses as diminishing their ability to provide excellent patient care or to sustain a meaningful balance in their lives.
Diane Irvine Doran and her colleagues add to the field's knowledge of continuous quality improvement. Focusing on both process and outcome they found that training in CQI techniques led to improvements in CQI knowledge and in team members' interactions, although not all teams were able to effect improvements in patient outcomes. Another important point raised by this study is that over time teams stopped engaging in their improvement work, and the authors identify ongoing organizational support as important for continued CQI success.
CQI is one management practice from the private sector that has become well established in health care organizations. No doubt, the requirements of the Joint Commission contributed to that. At the same time the early institutionalization of CQI may have contributed to the dearth of empirical research into its effectiveness. Health care providers are under constant pressure to adopt new management practices that are thought to improve efficiency, making it difficult for organizations to give any one technique the sustained attention that may be necessary to secure beneficial results.
Linda Roemer's article focuses on CEOs and on the role mentors played in their achievement. In interviews with women who were heading hospitals she found that most identified people who had been significant influences in their lives and that the majority reported that they had been mentored. It is interesting to note how large a role serendipity played in these women's lives and that most of them did not see mentoring as a prerequisite to their success. The author offers an interesting discussion of why that may be so.
Women have traditionally played a large role in the delivery of health care, be it as nurses, social workers, dietitians, therapists, technicians, or as family caregivers. It is less well known that historically they also were the dominant force in hospital administration. Up to the second half of the 20th century the typical hospital administrator was a woman, often a nurse. The occupation became overwhelmingly male during the second half of the century. Since then women have tried to gain entry into the occupation, usually without an awareness that they were trying to reenter an occupation that used to be female. It remains an interesting research question how this change in the occupation's gender composition occurred.
The FORUM focuses on the experiences of health care researchers and practitioners who have been active in both areas. Their contributions explore how their activities in one area influence what they do in the other. The separate introduction to the FORUM provides a context for this feature.
-Margarete Arndt, D.B.A.
Coeditor
-Barbara Bigelow, Ph.D.
Coeditor