Organization Theory Research and the Future of U.S. Health Care
Photos: Hoag Levins
Convened at the University of Pennsylvania this year, the national Organization Theory in Health Conference (OTHC) was founded twenty one years ago by Wharton School Health Care Management Professor and LDI Senior Fellow Lawton Burns, PhD, MBA; University of California, Berkeley School of Public Health Professor Stephen Shortell, PhD, MPH, MBA; and the late University of Minnesota School of Public Health Professor of Organizations and Management Douglas Wholey, PhD. That move was a recognition that the rapidly emerging field of health services research was largely dominated by the discipline of health economics. "Back then, the health economists were holding annual conferences and presenting papers and networking and the three of us thought there was a need for the same kind of thing in health care management," explained Burns. "We held the first OTHC event at Berkeley with Steve, the second at Minnesota with Doug, and the third at Wharton with me. After that, various other universities have hosted it. We're really glad to have it back at Wharton this year."
|OTHC co-hosts Ingrid Nembhard and Lawton Burns (above, left) welcomed the arriving researchers. Above, right, Wharton School Deputy Dean and Professor of Investment Banking Michael Gibbons, PhD, noted that Wharton has changed as much as health care itself over the last twenty years. "Wharton's health care-related curriculum has evolved and expanded and our degree students are taught a number of topics that were simply unknown two decades ago," he said. "In addition to our undergraduate, MBA and PhD programs, Wharton now offers an executive education program aptly titled "The New Era of Health Care Leadership," which focuses on individual leadership skills in managing health care, improving patient care, investing in technology, understanding quality issues and developing effective teams."|
Twenty five years ago, some of the then-small group of Organization Theory In Health Care academicians collaborated on writing and editing Health Care Management: Organization Design and Behavior. A textbook for students of health care administration now in its 7th edition (above, left), the work covers a wide range of topics from organizational design and government regulations to conflict resolution and personnel motivation. Threaded throughout this year's OTHC were reminiscences and memorials for OTHC co-founder Douglas Wholey, who died in February. Above, right, University of Iowa Associate Professor of Health Management and Policy Xi Zhu, PhD, speaks of Wholey's accomplishments in the field.
The three-day conference included three panel plenaries, five paper presentations, a poster session, interest group meetings and social events. Above, left, Paola Roberta Boscolo, PhD, of Bocconi University in Milan, Italy, presents her paper entitled "How Overlapping Innovations Challenge Organizations." Above, right, engaging in the Q&A session, are Peter Martelli, PhD, an Associate Professor of Healthcare Administration at Suffolk University in Boston, and Meghan Lane-Fall, MD, MSHP, Assistant Professor of Anesthesiology and Critical Care, Perelman School and LDI Senior Fellow. "Organization theory is important to me as a researcher because it sheds light on the inner workings of healthcare delivery settings," said Lane-Fall. "Secondary data analysis, often used in health services research, is helpful for answering 'what' questions, as in 'what is the association between x and y?' Organization theory research often involves qualitative and mixed methods primary data collection, which is more suited to answering 'why' questions."
On the opening panel focused on moving organizational theory in health care forward were five of its earliest pioneers and most experienced practitioners: John Kimberly, PhD, Emeritus Professor of Health Care Management at The Wharton School and LDI Senior Fellow; Ann Barry Flood, PhD, Emeritus Professor of Radiology, Community and Family Medicine at the Dartmouth Institute; Stephen Shortell, PhD, MPH, MBA, Professor and Dean Emeritus of the UC Berkeley School of Public Health; Anthony Kovner, Professor Emeritus of Public and Health Management at New York University; and Jacqueline Zinn, Professor Emeritus of Risk, Insurance, and Healthcare Management at the Temple University Fox School of Business and Editor Emeritus of HSR, the health services research journal; and Ingrid Nembhard, moderator.
Wharton professor John Kimberly (above, left) recommended that organization theory researchers take note of the new peer-reviewed journal Behavioral Science & Policy that has just published its sixth issue. It features "short, accessible articles describing actionable policy applications of behavioral scientific research that serve the public interest." Kimberly, who is an Associate Health Policy Editor at the journal, said one of its goals is to be "an interesting counterweight to the hegemony of economists and economics in health care research." Above, right, UC Berkeley's Stephen Shortell said that since his career started in the 1970s, "the changes have been huge, particularly in the area of data. Back then, we had to collect our own primary data. Today, with all the available data sets, almost no one collects data anymore," he said. Shortell originally expected to become a hospital administrator but was "bitten by the research bug in the health services research field."
As a Wharton School Associate Professor during the years 1970 to 1974, Anthony Kovner (above, left) was both a friend of Colonial Penn insurance CEO Leonard Davis and a colleague of the late Robert Eilers, PhD, the Wharton School Professor of Insurance and founding Director of Penn's Leonard Davis Institute of Health Economics. Kovner recounted how he worked with Eilers and the late Wharton Professor William Kissick, MD, PhD, MPH, to help organize the first academic research center of its kind focused on the organization, financing, and management of health care delivery. "Eilers told me the secret to success was to 'choose a narrow topic and know more about it than anybody else,'" Kovner recounted, "and I chose the governance of hospitals." Above, right, Ann Barry Flood has continued to study the advances, uses and issues raised by medical device breakthroughs in recent decades. She noted that implementation science research as it relates to new kinds of medical devices is an area organizational theorists should pay more attention to.
"We expect physicians to practice evidence-based medicine, but what about hospital executives practicing evidence-based management?" Wharton's Lawton Burns (above, left) asked as he spoke of academia's health care management role in the world of health services research. "Twenty-one years later, we have more people doing organization theory research than ever before," Burns continued. "A testimony to that is the Wharton School Dean's recent comments that we should be devoting more resources to health care management. You know, for a while, we all thought that fixing health care was just about economic incentives provided to doctors and patients, but now we've realized that's not enough. That's why there is so much interest in behavioral economics today -- not just the 'economics' part but the structuring and influencing of the decisions that people make." Above, right, also taking part in the discussions were Kathryn McDonald, PhD, MM, of Stanford University; Yaminette Diaz-Linhart, PhD of Brandeis University; Amber Stephenson, PhD, MPH of Clarkson University; Cheryl Rathert, PhD, of Virginia Commonwealth University; and Hector Rodriguez, PhD, MPH of the University of California, Berkeley.