Debora Goetz Goldberg
Departments of Family Medicine and Health Administration
Virginia Commonwealth University
June 29, 2009
Research Questions
1. Are environmental factors and organizational
characteristics related to the existence of quality
infrastructure in family medicine practices in
Virginia?
2. Are current organizational theories sufficient
to understand and explain organizational
behaviors of family medicine practices?
Organizational Theory –
Environmental Influences on Organizational Change
Environment
Influences
Organizational
Response
Institutional Theory
Incorporation of business
strategies
High Complexity
High
Uncertainty
Coercive
Normative, &
Mimetic Forces
High Rate of
Change
Implementation of new
technologies and clinical
processes
Imitation of similar
organizations
Resource Dependency
Theory
Scarcity of
Valued Resources
Resource
Dependence
Competition &
Organizational
Relationships
Organizational Slack
Establishment of
favorable linkages and
strategies to secure
resources
Hypotheses
Institutional Theory
Coercive
Coercive Forces
from Third Party Payers
Mimetic
Environmental
Uncertainty
Normative
Pressure from External
Groups/Organizations
Resource Dependency
Theory
Competition
Organizational
Relationships
Organizational Slack
Located in Areas with a
High Density of
Competitors
Affiliation with
Larger Health Care
Systems
Organizational Size
Quality
Infrastructure
Study Design Characteristics
 Cross-Sectional Research Design
 Primary data source
 2007 Virginia Family Practice Survey
 Secondary data sources
 VA Board of Medicine Practitioner Database
 HRSA Area Resource File
 Primary Care Service Area
 Unit of Analysis = Practice
 Market = Primary Care Service Area
 Descriptive/Multivariate Statistics
Results - Hypothesis Testing
 Hypotheses Supported
 Organizational Slack/size - strongest predictor of
quality infrastructure in practices
 Organizational Relationships – ownership, contractual
 Normative Forces - Stakeholder/patient expectations
 Hypotheses Not Supported
 Coercive Forces - Degree of HMO/Medicare beneficiary
penetration
 Mimetic Forces - Difficulty and lack of knowledge of
HMO/Medicare rules and regulations
 Competition - significant, but in the opposite direction
Potential explanations for findings
 Institutional Theory  Incorrect assumption of institutional forces on family
medicine practices
 Appropriateness of Theories
 Measurement error
 Resource Dependency  Small practices don’t have the financial or knowledge
resources to innovate
 Organizational relationships provide access to more
resources
 Intense lack of resources results in less innovation