Traditionally, physicians enjoyed autonomy and independence of practice. During the managed care era, as professional autonomy declined, the importance of organizations as decision making entities grew and the management techniques of the MCOs alienated physicians. Now, partnership and alliance between organizations and physicians are widely considered to be the most effective approach to improve the quality and efficiency of health care (Conrad and Shortell 1996; Gillies et al. 2001).
In light of these developments, the current research evaluates the organizational strategies that generate sustainable alignment between substance abuse (SA) treatment centers and their physicians using the organizational theory of governance, namely, theories evolved from the Human Relation Movement (HRM). HRM, a body of sociological research and management theories, implies that improving employer-employee relations can have a positive impact on work environment and productivity (Trist 1951) and suggests that an enabling governance style will be more effective.
Specifically, this dissertation examines which organizational strategies align physicians in prescribing buprenorphine when their organization adopts it. Despite its well-established advantages, buprenorphine - a new medication to treat addiction, introduced in outpatient settings in 2002 - has not been incorporated into the common practice of addiction treatment providers. A study using physicians’ survey data (Thomas CP 2008) found that when an organization recommends the use of buprenorphine, 26% of its physicians still do not prescribe it. Another study using survey data of organizations that employ many of these physicians (Wallack S. 2008) found that an organization’s internal technical, political, and cultural systems are important determinants of buprenorphine adoption, with cultural systems being dominant.
Combining the physician and organizational responses, this study uses logistic regression models to identify factors associated with physicians’ alignment. The findings show that two structural variables (availability of buprenorphine and encouraging physicians to receive buprenorphine training), two operational variables (involvement of the whole team in clinical decision-making and a low organizational hierarchy) and one cultural attribute (general agreement on opiate treatment methods) are significantly associated with alignment. To account for the clustering of physicians, the units of analysis, within treatment centers, the technique of generalized estimating equations (GEE) was employed to estimate logistic regression models using discrete response survey data.
These results are cross-validated by performing logistic regression on the physicians’ survey data to examine physicians’ alignment with their perception of their centers’ support for prescribing buprenorphine. The results corroborate the findings from the combined data that all three strategies - structural, operational and cultural -- are important predictors of alignment.
The significance of the various strategies in predicting physicians’ alignment suggests that organizations will be able to align their employees better by adopting an approach that motivates them to work towards the organizational goals instead of requiring them to comply. Policy makers seeking to implement quality improvement strategies in health care delivery may use the results of this study to persuade health care organizations to adopt the non-financial strategies that will most effectively align their physicians.
|Advisor:||Wallack, Stanley S.|
|Commitee:||Chilingerian, Jon A., Hodgkin, Dominic, Landon, Bruce E., Thomas, Cindy P., Wallack, Stanley S.|
|School:||Brandeis University, The Heller School for Social Policy and Management|
|Department:||The Heller School for Social Policy and Management|
|School Location:||United States -- Massachusetts|
|Source:||DAI-B 72/04, Dissertation Abstracts International|
|Subjects:||Mental health, Organization Theory, Health care management|
|Keywords:||Organizational culture, Physicians' alignment, Physicians' practice pattern, Quality of care, Research to practice, Substance abuse|
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