Studying outcomes of organizational change in health services.
OBJECTIVE
The rapidly changing organizational context within which health care is delivered is altering provider-patient relations and processes of clinical decision-making, with significant implications for patient outcomes. Yet definitive research on such effects is lacking. The authors seek to underscore the contribution of organizational research to studies of clinical outcomes and demonstrates several approaches to further such efforts.


METHODS
The authors present a theoretical framework of the operant mechanisms linking organizational attributes and patient outcomes. They use case examples from their ongoing research on hospitals to illustrate strategies for measuring these mechanisms and for overcoming some of the feasibility issues inherent in organizational research.


RESULTS
Several methodological issues are explored: (1) exploiting "targets of opportunity" and "natural experiments" is a promising strategy for studying patient outcomes related to organizational reform; (2) indices of organizational traits, constructed from individual survey responses, can illuminate the operant mechanisms by which structure affects outcomes; and (3) secondary data sources and innovative statistical matching procedures provide a feasible strategy for constructing study comparison groups. Extending the organizational outcomes research strategy to new areas of inquiry offers an opportunity to enhance our understanding of how nursing organization affects outcomes.


CONCLUSIONS
Improving the effectiveness of medical care in a health-care system undergoing fundamental restructuring requires greater understanding of how organizational context affects clinical outcomes. A higher priority should be placed on organizational outcomes research by researchers and funding agencies.
Aiken
L H
LH
Center for Health Services and Policy Research, School of Nursing, University of Pennsylvania, Philadelphia 19104-6096, USA.
Sochalski
J
J
Lake
E T
ET
D000163:Acquired Immunodeficiency Syndrome / Q000451:nursing; D001291:Attitude of Health Personnel; D002055:Burnout, Professional; D003695:Delivery of Health Care / Q000458:organization & administration*; D018166:Health Care Reform; D006302:Health Services Research / Q000379:methods*; D006739:Hospital Administration; D006801:Humans; D008962:Models, Theoretical; D015401:Nursing Administration Research / Q000379:methods*; D009738:Nursing Service, Hospital / Q000458:organization & administration; D009936:Organizational Innovation; D017063:Outcome Assessment, Health Care / Q000379:methods*