1. Issel, L. Michele PhD, RN

Article Content

Health care organizations can be viewed and understood as being embedded in various environments, both physical and sociocultural, and as being contextualized by various forces acting on it. The embeddedness and contextualized aspects of health care organizations have received scholarly attention. Embeddedness often is considered in terms of control or descriptive variables, such as urban/rural, region of country, and national health policy. Contextual forces tend to be studied as independent variables, such as provider supply, local health conditions, isomorphic pressures, and reimbursement rates. These approaches, although empirically and theoretically sound, hide or implicitly diminish the role of the patient in the health care organization.

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The patient, as an individual, tends to be viewed as internal to the health care organization, as exemplified by the hosting of individual patient EHRs on the organization's servers. Yet, the reality is that individual persons who may become patients are part of the environment in which the health care organization is embedded. Patients, furthermore, are an element of the contextualizing forces as well as subject to many of the same contextualizing forces. Recognizing and acting on this reality can have important strategy, management, and performance implications. This is not to say that patients have been ignored in health care management scholarship but that a refreshed and updated consideration is overdue.


The need for an updated approach to "patients" accelerated, one could argue, with the Affordable Care Act's emphasis on community benefits that encompass community assessment, population health, and preventive care. The community benefits and assessment portions of the Affordable Care Act, in particular, pose new challenges for some health care organizations. Mattessich and Rausch (2014) studied cross-sector collaborations for improving community health, but not from the point of view of health care organizations. Their perspective was that of the community, leaving open a plethora of health care management questions.


To achieve community benefits, local interorganizational and social network development might be initial considerations, raising questions of who within a health care organization is doing this and how is the networking process managed as a strategy. Similarly, questions arise as to how health care administrators manage perceptions, values, and definitions of populations that balance the patient panel as population with the community as population. These nuances become important in extending conceptualization of the patient from an intraorganizational element to be managed to an external organizational embedding and contextualizing force to be leveraged and assisted toward greater health. Investigations and inquiry from the external perspective might yield new insights for health care management and administration.


L. Michele Issel, PhD, RN






Mattessich P. W., & Rausch E. J. (2014). Cross-sector collaboration to improve community health: A view of the current landscape. Health Affairs (Millwood), 33(11), 1968-1974. doi: 10.1377/hlthaff.2014.0645 [Context Link]