Community orientation in hospitals: an institutional and resource dependence perspective.
OBJECTIVE
To conceptualize community orientation-defined as the generation, dissemination, and use of community health-need intelligence-as a strategic response to environmental pressures, and to test a theoretically justified model of the predictors of community orientation in hospitals.


METHODS
The analysis used data for 4,578 hospitals obtained from the 1994 and 1995 American Hospital Association (AHA) Annual Survey and the 1994 Medicare Hospital Cost Report data sets. Market-level data came from the Area Resource File.


METHODS
Multiple regression analysis was used to examine the effects of hospital size, dependence on managed care, ownership, network, system and alliance memberships, and level of diffusion of community-orientation practices in the area on the degree of community orientation in hospitals. The model, based on Oliver's (1991) framework of organizational responsiveness to environmental pressures, controlled for the effects of industry concentration and lagged profitability.


RESULTS
Degree of community orientation is significantly related to hospital size; ownership; dependence on managed care; and membership in a network, system, or alliance. It is also significantly related to the diffusion of community-orientation practices among other area hospitals.


CONCLUSIONS
Degree of community orientation is influenced by the nature of environmental pressures and by hospital interests. It is higher in hospitals that are large, nonprofit, or members of a network, system, or alliance; in hospitals that are more dependent on managed care; and in hospitals that operate in areas with higher diffusion of community-orientation activities.
Proenca
E J
EJ
Department of Health and Medical Services Administration, School of Business Administration, Widener University, Chester, PA 19013, USA.
Rosko
M D
MD
Zinn
J S
JS
D000573:American Hospital Association; D018672:Community Health Planning / Q000458:organization & administration*; D003159:Community-Institutional Relations; D003625:Data Collection; D004059:Diffusion of Innovation; D005163:Factor Analysis, Statistical; D006276:Health Facility Size / Q000706:statistics & numerical data; D006302:Health Services Research; D006739:Hospital Administration / Q000145:classification / Q000706:statistics & numerical data*; D006801:Humans; D008329:Managed Care Programs / Q000458:organization & administration; D006278:Medicare; D020380:Needs Assessment / Q000458:organization & administration*; D009935:Organizational Affiliation / Q000706:statistics & numerical data; D016134:Organizational Policy; D010067:Ownership / Q000706:statistics & numerical data; D012044:Regression Analysis; D014481:United States