Social Organization and Control in Medical Work

Goss, Mary E. W.; Battistella, Roger M.; Colombotos, John; Freidson, Eliot; Riedel, Donald C.

doi:10.1097/00005650-197705001-00003

Cited by 10 publications

(4 citation statements)

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“…Our knowledge of medical staff organization and functioning is extremely scanty (Freidson, 1979;Georgopoulos, 1975;Goss et al 1977). Perhaps stimulated by the works of Parsons (1947), Merton (1949) and Huntingdon (1 956), sociologists and organization theorists raised the question of how physicians (who were viewed as individual entrepreneurs) could function within some form of hierarchy in hospitals.…”

Section: Interdependence: Practical Importance In Teaching Hospitalsmentioning

confidence: 99%

Probing Into Task Interdependencies: The Case of Physicians in a Teaching Hospital [1]

Gosselin¹

1985

J Management Studies

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IK'IRODUCTION TRADITIONALLY, hospital-based physicians group themselves into services (or divisions) and services into departments. Following recent advances in medical technologies these physicians now interact across departmental boundaries for sharing knowledge, information, resources and clientele. Two questions are thus examined here (1) what is the nature of those interdependencies (2) which of those activities are so critical that a new basis for grouping -namely workflow -should be considered.This study was conducted in a 600 bed teaching hospital. It focused on interactions among specialists involved in diagnosing and treating heart diseases. Three indicators are used to assess the nature, frequency and direction of communications. Findings reveal the existence of three groupings of services belonging to distinct departments, with some services belonging to more than one grouping. A more in-depth analysis of the critical aspects of those relationships suggest that in these organizations process interdependency is valued as a pervasive source of professionals' knowledge renewal and career advancement, hence predominates over workflow interdependency as the basic criterion for grouping physicians.Since the important book by Chaple and Sayles (1961), followed a few years later by that of Thompson (1967), few studies have been published which further examine the nature and impact of task interdependencies on the grouping of positions or of work units. Yet interdependence is constantly referred to as one of the most pervasive characteristics of organizations, and unit grouping as one of the most powerful of the design parameters (Mintzberg, 1979). In an attempt to stimulate such research, this article reports on the results of a study of task interdependencies among hospitalbased medical specialists.

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Section: Interdependence: Practical Importance In Teaching Hospitalsmentioning

confidence: 99%

Probing Into Task Interdependencies: The Case of Physicians in a Teaching Hospital [1]

Gosselin¹

1985

J Management Studies

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“…Through the grievance system in HMOs, physician behavior that might not be subject to challenge by patients in a solo, fee-for-service practice is potentially subject to review. Members have contractual rights with the organization for a set of services, and they can be expected to make demands which may represent a challenge to physicians (Goss, et al, 1977;Freidson, 1975).…”

Section: Discussionmentioning

confidence: 99%

“…These observations suggest that while medical knowledge may become more rationalized and physician accountability more systematized, medical care remains the responsibility of physicians and the medical profession. It has been suggested that in the face of policies intended to alter practice patterns, physicians may maintain dominance while becoming more routinely accountable (Goss, et al, 1977).…”

Section: Implications and Conclusionmentioning

confidence: 99%

Organizational Structure and Professional Norms in an Alternative Health Care Setting: Physicians in Health Maintenance Organizations

Barr¹,

Steinberg

2019

Challenges and Innovations in U.S. Health Care

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In the 1976 amendments (P.L. 94-460) to the law, three organizational models are delineated, all operating under the prepayment mechanism but differentiated by practice site and mode of physician reimbursement (U.S. Department of Health, Education, and Welfare, 1977). These three models are: (1) Staff: central facility; physicians are salaried employees of the HMO. (2) Group: central facility; physicians are part of a medica group, partnership, or corporation reimbursed

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“…After all, the equity issue discussed above is only one of many areas where precise knowledge of the health care utilization pattems is important. For instance, accurate information about the demand for particular medical facilities (e.g., emergency rooms) has also been cited as valuable for the organization and administration of quality health care (11). Rather obviously, the extent to which persons choose one type of provider setting (e.g., an emergency room) over another (e.g., a doctor's office) is an important dimension of the demand for therapeutic services.…”

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confidence: 99%

Emergency room use and access to alternative sources of care

Kleiman

1979

Sociology Health & Illness

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In recent years a great deal of attention has been called to the extent to which emergency rooms (ERs) in the United States are being used for routine -rather than emergency -care. In attempting to explain this extensive routine use, many scholars have surmised that much of this use occurs among people for whom the emergency room is the onlyor is the most convenient -health care facility available. That is, many researchers have posited that the emergency room serves to extend health services to medically disadvantaged persons who might otherwise have no convenient access to care. Of course, such a claim has profound implications for the role of the emergency room in bringing about an equitable distribution of medical resources. Yet in spite of the importance of this issue, few studies have provided empirical evidence useful for assessing the claimed relationship between emergency room utilization and access to altemative sources of care. The present study seeks to close this research gap by employing national survey data to examine emergency room visits in light of the accessibility of more traditional provider settings. Multiple Classification Analysis is used to analyze the data, and comparisons are made for the sample as a whole as well as for three critical explanatory variables: income, age, and residence. In addition, four indicators of illness are used as controls. Findings suggest that, contrary to what has previously been surmised, emergency room visitation often occurs independently of, rather than as a substitute for, access to non-ER health care settings. Finally, implications of these findings and directions for future research are discussed.As a number of health services scholars (1,2) have recently pointed out, the growing use of the hospital emergency room (ER) for the treatment of elective -rather than urgent or emergent -medical conditions has become a major issue in US emergency room care. In point of fact, there is a substantial body of evidence (3) that hospital emergency departments now see primarily non-urgent health problems which might more traditionally be treated at a doctor's office. In Roth's (4) words, 'Hospital emergency services handle largely routine "walk-in" cases ... "urgent" (cases) ... range from six to (only) ten percent of the total emergency department census. ' And Roskies et al. (5) agree that

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Social Organization and Control in Medical Work

Cited by 10 publications

References 0 publications

Probing Into Task Interdependencies: The Case of Physicians in a Teaching Hospital [1]

Probing Into Task Interdependencies: The Case of Physicians in a Teaching Hospital [1]

Organizational Structure and Professional Norms in an Alternative Health Care Setting: Physicians in Health Maintenance Organizations

Emergency room use and access to alternative sources of care

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