Stephen Shortell - Academia.edu (original) (raw)

Papers by Stephen Shortell

Research paper thumbnail of Toward a 21st-Century Health Care System: Recommendations for Health Care Reform

Annals of Internal Medicine, 2009

Research paper thumbnail of The Evolving Role of Third Parties in the Hospital Physician Relationship

American Journal of Medical Quality, 2007

Hospital-physician relationships (HPRs) are a key concern for both parties. Hospital interest has... more Hospital-physician relationships (HPRs) are a key concern for both parties. Hospital interest has been driven historically by the desire for the physician's clinical business, the need to combat managed care, and now the threats posed by single specialty hospitals, medical device vendors, and consumerism. Physician interest has been driven by fears of managed care and desires for new sources of revenue. The dyadic relationships between hospitals and physicians are thus motivated and influenced by the role of third parties. This article analyzes the history of HPRs and the succession of third parties. The analysis illustrates that the role of third parties has shifted from a unifying one to one that divides hospitals and physicians. This shift presents both opportunities and problems.

Research paper thumbnail of The Impact of Hospital Ownership Conversions: Review of the Literature and Results From a Comparative Field Study

Advances in Health …, 2009

Page 1. THE IMPACT OF HOSPITAL OWNERSHIP CONVERSIONS: REVIEW OF THE LITERATURE AND RESULTS FROM A... more Page 1. THE IMPACT OF HOSPITAL OWNERSHIP CONVERSIONS: REVIEW OF THE LITERATURE AND RESULTS FROM A COMPARATIVE FIELD STUDY Lawton R. Burns, Rajiv J. Shah, Frank A. Sloan and Adam C. Powell ABSTRACT ...

Research paper thumbnail of Convenience and Independence: Do Physicians Strike a Balance in Admitting Decisions?

Journal of Health and Social Behavior, 1991

This paper contrasts economic and professional models of physician admitting behavior. Economic m... more This paper contrasts economic and professional models of physician admitting behavior. Economic models emphasize physician convenience and income maximization, while professional models emphasize physician autonomy and independence. The paper examines the relative power of these models to explain two types of admitting decisions made by physicians: which hospitals to begin admitting patients to, and how many patients to admit to a hospital. Analyses of physician admitting patterns over a three-year period suggest that economic considerations outweigh professional considerations in both decisions. Results are interpreted in light of recent changes in the profession of medicine and physician-hospital relationships.

Research paper thumbnail of (Forthcoming, Administrative Science Quarterly) Beauty is in the Eye of the Beholder: The Impact of Organizational Identification, Identity, and Image on Physician Cooperative Behaviors

Research paper thumbnail of Review of Medicare, Medicaid, and Commercial Quality of Care Measures: Considerations for Assessing Accountable Care Organizations

Journal of health politics, policy and law, Jan 29, 2015

Accountable Care Organizations (ACOs) have proliferated under the Affordable Care Act (ACA). If A... more Accountable Care Organizations (ACOs) have proliferated under the Affordable Care Act (ACA). If ACOs are to improve health care quality and lower costs, quality measures will be increasingly important in determining if provider consolidations associated with the development of ACOs are achieving their intended purpose. This paper assesses quality measurement across public and private sectors. We reviewed available quality measures for a subset of programs in six organizations and assessed the number and domain of measures (structure, process, outcomes, and patient experience). Two-thirds of all quality measures were categorized as process measures. Outcome measures comprised nearly 20 percent of measures. Patient experience and structure measures comprised approximately 8 percent and 7 percent, respectively. We propose further improvements to quality measurement initiatives. For example, programs that reward providers should consider reward size and distribution within the organizat...

Research paper thumbnail of Accountable Care Organizations and Population Health Organizations

Journal of health politics, policy and law, Jan 29, 2015

Accountable care organizations (ACOs) and hospitals are investing in improving "population h... more Accountable care organizations (ACOs) and hospitals are investing in improving "population health," by which they nearly always mean the health of the "population" of patients "attributed" by Medicare, Medicaid, or private health insurers to their organizations. But population health can and should also mean "the health of the entire population in a geographic area." We present arguments for and against ACOs and hospitals investing in affecting the socioeconomic determinants of health to improve the health of the population in their geographic area, and we provide examples of ACOs and hospitals that are doing so in a limited way. These examples suggest that ACOs and hospitals can work with other organizations in their community to improve population health. We briefly present recent proposals for such coalitions and for how they could be financed to be sustainable.

Research paper thumbnail of Improving the value of healthcare delivery using publicly available performance data in Wisconsin and California

Research paper thumbnail of An Early Assessment of Accountable Care Organizations' Efforts to Engage Patients and Their Families

Medical care research and review : MCRR, Jan 2, 2015

Accountable care organizations (ACOs) have incentives to meet quality and cost targets to share i... more Accountable care organizations (ACOs) have incentives to meet quality and cost targets to share in any resulting savings. Achieving these goals will require ACOs to engage more actively with patients and their families. The extent to which ACOs do so is currently unknown. Using mixed methods, including a national survey, phone interviews, and site-visits, we examine the extent to which ACOs actively engage patients and their families, explore challenges involved, and consider approaches for dealing with those challenges. Results indicate that greater ACO use of patient activation and engagement (PAE) activities at the point-of-care may be related to positive perceptions among ACO leaders of the impact of PAE investments on ACO costs, quality, and outcomes of care. We identify a number of important practices associated with greater PAE, including high-level leadership commitment, goal-setting supported by adequate resources, extensive provider training, use of interdisciplinary care ...

Research paper thumbnail of Accountable Care Organizations: The National Landscape

Journal of health politics, policy and law, Jan 29, 2015

There are now more than seven hundred accountable care organizations (ACOs) in the United States.... more There are now more than seven hundred accountable care organizations (ACOs) in the United States. This article describes some of their most salient characteristics including the number and types of contracts involved, organizational structures, the scope of services offered, care management capabilities, and the development of a three-category taxonomy that can be used to target technical assistance efforts and to examine performance. The current evidence on the performance of ACOs is reviewed. Since California has the largest number of ACOs (N=67) and a history of providing care under risk-bearing contracts, some additional assessments of quality and patient experience are made between California ACOs and non-ACO provider organizations. Six key issues likely to affect future ACO growth and development are discussed and some potential "diagnostic" indicators for assessing the likelihood of potential antitrust violations are presented.

Research paper thumbnail of Improving ऀð Chronic ऀð Illness ऀð Care: ऀð Findings ऀð from ऀð a ऀð National ऀð Study ऀð of ऀð Care ऀð Management ऀð Processes ऀð in ऀð ऀð Large ऀð Physician ऀð Practices ऀð

Research paper thumbnail of PREPAID GROUPS AND ORGANIZED DELIVERY SYSTEMS

Research paper thumbnail of First national survey of ACOs finds that physicians are playing strong leadership and ownership roles

Health affairs (Project Hope), 2014

The extent to which physicians lead, own, and govern accountable care organizations (ACOs) is unk... more The extent to which physicians lead, own, and govern accountable care organizations (ACOs) is unknown. However, physicians' involvement in ACOs will influence how clinicians and patients perceive the ACO model, how effective these organizations are at improving quality and costs, and how future ACOs will be organized. From October 2012 to May 2013 we fielded the National Survey of Accountable Care Organizations, the first such survey of public and private ACOs. We found that 51 percent of ACOs were physician-led, with another 33 percent jointly led by physicians and hospitals. In 78 percent of ACOs, physicians constituted a majority of the governing board, and physicians owned 40 percent of ACOs. The broad reach of physician leadership has important implications for the future evolution of ACOs. It seems likely that the challenge of fundamentally changing care delivery as the country moves away from fee-for-service payment will not be accomplished without strong, effective leade...

Research paper thumbnail of Innovation in the safety net: integrating community health centers through accountable care

Journal of general internal medicine, 2014

Safety net primary care providers, including as community health centers, have long been isolated... more Safety net primary care providers, including as community health centers, have long been isolated from mainstream health care providers. Current delivery system reforms such as Accountable Care Organizations (ACOs) may either reinforce the isolation of these providers or may spur new integration of safety net providers. This study examines the extent of community health center involvement in ACOs, as well as how and why ACOs are partnering with these safety net primary care providers. Mixed methods study pairing the cross-sectional National Survey of ACOs (conducted 2012 to 2013), followed by in-depth, qualitative interviews with a subset of ACOs that include community health centers (conducted 2013). One hundred and seventy-three ACOs completed the National Survey of ACOs. Executives from 18 ACOs that include health centers participated in in-depth interviews, along with leadership at eight community health centers participating in ACOs. Key survey measures include ACO organization...

Research paper thumbnail of The ties that bind: interorganizational linkages and physician-system alignment

Medical care, 2001

To examine the association between the degree of alignment between physicians and health care sys... more To examine the association between the degree of alignment between physicians and health care systems, and interorganizational linkages between physician groups and health care systems. The study used a cross sectional, comparative analysis using a sample of 1,279 physicians practicing in loosely affiliated arrangements and 1,781 physicians in 61 groups closely affiliated with 14 vertically integrated health systems. Measures of physician alignment were based on multiitem scales validated in previous studies and derived from surveys sent to individual physicians. Measures of interorganizational linkages were specified at the institutional, administrative, and technical core levels of the physician group and were developed from surveys sent to the administrator of each of the 61 physician groups in the sample. Two stage Heckman models with fixed effects adjustments in the second stage were used to correct for sample selection and clustering respectively. After accounting for sample s...

Research paper thumbnail of Physicians as double agents: maintaining trust in an era of multiple accountabilities

JAMA

JAMA is a highly cited weekly medical journal that publishes peer-reviewed original medical resea... more JAMA is a highly cited weekly medical journal that publishes peer-reviewed original medical research findings and editorial opinion.

Research paper thumbnail of The structural configuration of U.S. hospital medical staffs

Medical care, 1981

Using data from the 1973 American Hospital Association national survey of hospital medical staff ... more Using data from the 1973 American Hospital Association national survey of hospital medical staff organization, six factors of medical staff organization structure are examined in relation to each other and to hospital ownership, size, teaching status, geographic region and size of Standard Metropolitan Statistical Area (SMSA). The six factors include 1) Resource Capability; 2) Generalist Physician Contractual Orientation; 3) Communication and Control; 4) Local Staff Orientation; 5) Physician Participation in Decision Making; and 6) Hospital-Based Contractual Orientation. Several relatively distinct patterns emerged related to hospital ownership, size, teaching activity and region of the country, as well as interrelationships among the factors themselves. Differences between smaller and larger hospitals clearly emerged as well as a distinctive pattern for for-profit hospitals. All of the factors are subject to manipulation through administrative and/or public policy interventions and...

Research paper thumbnail of The Role of Perceived Team Effectiveness in Improving Chronic Illness Care

Medical Care, 2004

The importance of teams for improving quality of care has received increased attention. We examin... more The importance of teams for improving quality of care has received increased attention. We examine both the correlates of self-assessed or perceived team effectiveness and its consequences for actually making changes to improve care for people with chronic illness. STUDY SETTING AND METHODS: Data were obtained from 40 teams participating in the national evaluation of the Improving Chronic Illness Care Program. Based on current theory and literature, measures were derived of organizational culture, a focus on patient satisfaction, presence of a team champion, team composition, perceived team effectiveness, and the actual number and depth of changes made to improve chronic illness care. A focus on patient satisfaction, the presence of a team champion, and the involvement of the physicians on the team were each consistently and positively associated with greater perceived team effectiveness. Maintaining a balance among culture values of participation, achievement, openness to innovation, and adherence to rules and accountability also appeared to be important. Perceived team effectiveness, in turn, was consistently associated with both a greater number and depth of changes made to improve chronic illness care. The variables examined explain between 24 and 40% of the variance in different dimensions of perceived team effectiveness; between 13% and 26% in number of changes made; and between 20% and 42% in depth of changes made. The data suggest the importance of developing effective teams for improving the quality of care for patients with chronic illness.

Research paper thumbnail of A SOCIAL CAPITAL INDEX FOR COMMUNITY PARTNERSHIPS

The International Quarterly of Community Health Education, 2001

Research paper thumbnail of Risk Assumption and Physician Alignment With Health Care Organizations

Medical Care, 2001

To examine the association between risk assumption by individual physicians and physician groups ... more To examine the association between risk assumption by individual physicians and physician groups and the degree of alignment between physicians and health care systems. A cross sectional comparative analysis using a sample of 1,279 physicians practicing in loosely affiliated arrangements and 1,781 physicians in 61 groups closely affiliated with 14 vertically integrated health systems. Measures of physician alignment were based on multiitem scales validated in previous studies and derived from surveys sent to individual physicians. Measures of risk assumption were developed from surveys sent to the administrator of each of the 61 physician groups in the sample and to physicians affiliated with these groups. Two stage Heckman models with fixed effects adjustments in the second stage were used to correct for sample selection and clustering respectively. After accounting for selection, fixed effects, and group and individual controls, physicians in groups with larger proportional revenue from managed care displayed greater normative commitment and system loyalty than physicians in groups with lower proportional managed care revenue. Individual-level managed care risk was also positively related to both normative commitment and group behavioral commitment to the system. Physicians in groups with larger physician equity positions expressed lower levels of normative commitment to the system. Physician productivity compensation was negatively related to all measures of alignment. Finally, group emphasis on individually-based incentives for staff physicians was negatively related to system identification. Our findings suggest that organizations must balance individually-based risk schemes with those that emphasize the performance of the group and the system to achieve long-term goals of loyalty, identification, and commitment to the system.

Research paper thumbnail of Toward a 21st-Century Health Care System: Recommendations for Health Care Reform

Annals of Internal Medicine, 2009

Research paper thumbnail of The Evolving Role of Third Parties in the Hospital Physician Relationship

American Journal of Medical Quality, 2007

Hospital-physician relationships (HPRs) are a key concern for both parties. Hospital interest has... more Hospital-physician relationships (HPRs) are a key concern for both parties. Hospital interest has been driven historically by the desire for the physician's clinical business, the need to combat managed care, and now the threats posed by single specialty hospitals, medical device vendors, and consumerism. Physician interest has been driven by fears of managed care and desires for new sources of revenue. The dyadic relationships between hospitals and physicians are thus motivated and influenced by the role of third parties. This article analyzes the history of HPRs and the succession of third parties. The analysis illustrates that the role of third parties has shifted from a unifying one to one that divides hospitals and physicians. This shift presents both opportunities and problems.

Research paper thumbnail of The Impact of Hospital Ownership Conversions: Review of the Literature and Results From a Comparative Field Study

Advances in Health …, 2009

Page 1. THE IMPACT OF HOSPITAL OWNERSHIP CONVERSIONS: REVIEW OF THE LITERATURE AND RESULTS FROM A... more Page 1. THE IMPACT OF HOSPITAL OWNERSHIP CONVERSIONS: REVIEW OF THE LITERATURE AND RESULTS FROM A COMPARATIVE FIELD STUDY Lawton R. Burns, Rajiv J. Shah, Frank A. Sloan and Adam C. Powell ABSTRACT ...

Research paper thumbnail of Convenience and Independence: Do Physicians Strike a Balance in Admitting Decisions?

Journal of Health and Social Behavior, 1991

This paper contrasts economic and professional models of physician admitting behavior. Economic m... more This paper contrasts economic and professional models of physician admitting behavior. Economic models emphasize physician convenience and income maximization, while professional models emphasize physician autonomy and independence. The paper examines the relative power of these models to explain two types of admitting decisions made by physicians: which hospitals to begin admitting patients to, and how many patients to admit to a hospital. Analyses of physician admitting patterns over a three-year period suggest that economic considerations outweigh professional considerations in both decisions. Results are interpreted in light of recent changes in the profession of medicine and physician-hospital relationships.

Research paper thumbnail of (Forthcoming, Administrative Science Quarterly) Beauty is in the Eye of the Beholder: The Impact of Organizational Identification, Identity, and Image on Physician Cooperative Behaviors

Research paper thumbnail of Review of Medicare, Medicaid, and Commercial Quality of Care Measures: Considerations for Assessing Accountable Care Organizations

Journal of health politics, policy and law, Jan 29, 2015

Accountable Care Organizations (ACOs) have proliferated under the Affordable Care Act (ACA). If A... more Accountable Care Organizations (ACOs) have proliferated under the Affordable Care Act (ACA). If ACOs are to improve health care quality and lower costs, quality measures will be increasingly important in determining if provider consolidations associated with the development of ACOs are achieving their intended purpose. This paper assesses quality measurement across public and private sectors. We reviewed available quality measures for a subset of programs in six organizations and assessed the number and domain of measures (structure, process, outcomes, and patient experience). Two-thirds of all quality measures were categorized as process measures. Outcome measures comprised nearly 20 percent of measures. Patient experience and structure measures comprised approximately 8 percent and 7 percent, respectively. We propose further improvements to quality measurement initiatives. For example, programs that reward providers should consider reward size and distribution within the organizat...

Research paper thumbnail of Accountable Care Organizations and Population Health Organizations

Journal of health politics, policy and law, Jan 29, 2015

Accountable care organizations (ACOs) and hospitals are investing in improving "population h... more Accountable care organizations (ACOs) and hospitals are investing in improving "population health," by which they nearly always mean the health of the "population" of patients "attributed" by Medicare, Medicaid, or private health insurers to their organizations. But population health can and should also mean "the health of the entire population in a geographic area." We present arguments for and against ACOs and hospitals investing in affecting the socioeconomic determinants of health to improve the health of the population in their geographic area, and we provide examples of ACOs and hospitals that are doing so in a limited way. These examples suggest that ACOs and hospitals can work with other organizations in their community to improve population health. We briefly present recent proposals for such coalitions and for how they could be financed to be sustainable.

Research paper thumbnail of Improving the value of healthcare delivery using publicly available performance data in Wisconsin and California

Research paper thumbnail of An Early Assessment of Accountable Care Organizations' Efforts to Engage Patients and Their Families

Medical care research and review : MCRR, Jan 2, 2015

Accountable care organizations (ACOs) have incentives to meet quality and cost targets to share i... more Accountable care organizations (ACOs) have incentives to meet quality and cost targets to share in any resulting savings. Achieving these goals will require ACOs to engage more actively with patients and their families. The extent to which ACOs do so is currently unknown. Using mixed methods, including a national survey, phone interviews, and site-visits, we examine the extent to which ACOs actively engage patients and their families, explore challenges involved, and consider approaches for dealing with those challenges. Results indicate that greater ACO use of patient activation and engagement (PAE) activities at the point-of-care may be related to positive perceptions among ACO leaders of the impact of PAE investments on ACO costs, quality, and outcomes of care. We identify a number of important practices associated with greater PAE, including high-level leadership commitment, goal-setting supported by adequate resources, extensive provider training, use of interdisciplinary care ...

Research paper thumbnail of Accountable Care Organizations: The National Landscape

Journal of health politics, policy and law, Jan 29, 2015

There are now more than seven hundred accountable care organizations (ACOs) in the United States.... more There are now more than seven hundred accountable care organizations (ACOs) in the United States. This article describes some of their most salient characteristics including the number and types of contracts involved, organizational structures, the scope of services offered, care management capabilities, and the development of a three-category taxonomy that can be used to target technical assistance efforts and to examine performance. The current evidence on the performance of ACOs is reviewed. Since California has the largest number of ACOs (N=67) and a history of providing care under risk-bearing contracts, some additional assessments of quality and patient experience are made between California ACOs and non-ACO provider organizations. Six key issues likely to affect future ACO growth and development are discussed and some potential "diagnostic" indicators for assessing the likelihood of potential antitrust violations are presented.

Research paper thumbnail of Improving ऀð Chronic ऀð Illness ऀð Care: ऀð Findings ऀð from ऀð a ऀð National ऀð Study ऀð of ऀð Care ऀð Management ऀð Processes ऀð in ऀð ऀð Large ऀð Physician ऀð Practices ऀð

Research paper thumbnail of PREPAID GROUPS AND ORGANIZED DELIVERY SYSTEMS

Research paper thumbnail of First national survey of ACOs finds that physicians are playing strong leadership and ownership roles

Health affairs (Project Hope), 2014

The extent to which physicians lead, own, and govern accountable care organizations (ACOs) is unk... more The extent to which physicians lead, own, and govern accountable care organizations (ACOs) is unknown. However, physicians' involvement in ACOs will influence how clinicians and patients perceive the ACO model, how effective these organizations are at improving quality and costs, and how future ACOs will be organized. From October 2012 to May 2013 we fielded the National Survey of Accountable Care Organizations, the first such survey of public and private ACOs. We found that 51 percent of ACOs were physician-led, with another 33 percent jointly led by physicians and hospitals. In 78 percent of ACOs, physicians constituted a majority of the governing board, and physicians owned 40 percent of ACOs. The broad reach of physician leadership has important implications for the future evolution of ACOs. It seems likely that the challenge of fundamentally changing care delivery as the country moves away from fee-for-service payment will not be accomplished without strong, effective leade...

Research paper thumbnail of Innovation in the safety net: integrating community health centers through accountable care

Journal of general internal medicine, 2014

Safety net primary care providers, including as community health centers, have long been isolated... more Safety net primary care providers, including as community health centers, have long been isolated from mainstream health care providers. Current delivery system reforms such as Accountable Care Organizations (ACOs) may either reinforce the isolation of these providers or may spur new integration of safety net providers. This study examines the extent of community health center involvement in ACOs, as well as how and why ACOs are partnering with these safety net primary care providers. Mixed methods study pairing the cross-sectional National Survey of ACOs (conducted 2012 to 2013), followed by in-depth, qualitative interviews with a subset of ACOs that include community health centers (conducted 2013). One hundred and seventy-three ACOs completed the National Survey of ACOs. Executives from 18 ACOs that include health centers participated in in-depth interviews, along with leadership at eight community health centers participating in ACOs. Key survey measures include ACO organization...

Research paper thumbnail of The ties that bind: interorganizational linkages and physician-system alignment

Medical care, 2001

To examine the association between the degree of alignment between physicians and health care sys... more To examine the association between the degree of alignment between physicians and health care systems, and interorganizational linkages between physician groups and health care systems. The study used a cross sectional, comparative analysis using a sample of 1,279 physicians practicing in loosely affiliated arrangements and 1,781 physicians in 61 groups closely affiliated with 14 vertically integrated health systems. Measures of physician alignment were based on multiitem scales validated in previous studies and derived from surveys sent to individual physicians. Measures of interorganizational linkages were specified at the institutional, administrative, and technical core levels of the physician group and were developed from surveys sent to the administrator of each of the 61 physician groups in the sample. Two stage Heckman models with fixed effects adjustments in the second stage were used to correct for sample selection and clustering respectively. After accounting for sample s...

Research paper thumbnail of Physicians as double agents: maintaining trust in an era of multiple accountabilities

JAMA

JAMA is a highly cited weekly medical journal that publishes peer-reviewed original medical resea... more JAMA is a highly cited weekly medical journal that publishes peer-reviewed original medical research findings and editorial opinion.

Research paper thumbnail of The structural configuration of U.S. hospital medical staffs

Medical care, 1981

Using data from the 1973 American Hospital Association national survey of hospital medical staff ... more Using data from the 1973 American Hospital Association national survey of hospital medical staff organization, six factors of medical staff organization structure are examined in relation to each other and to hospital ownership, size, teaching status, geographic region and size of Standard Metropolitan Statistical Area (SMSA). The six factors include 1) Resource Capability; 2) Generalist Physician Contractual Orientation; 3) Communication and Control; 4) Local Staff Orientation; 5) Physician Participation in Decision Making; and 6) Hospital-Based Contractual Orientation. Several relatively distinct patterns emerged related to hospital ownership, size, teaching activity and region of the country, as well as interrelationships among the factors themselves. Differences between smaller and larger hospitals clearly emerged as well as a distinctive pattern for for-profit hospitals. All of the factors are subject to manipulation through administrative and/or public policy interventions and...

Research paper thumbnail of The Role of Perceived Team Effectiveness in Improving Chronic Illness Care

Medical Care, 2004

The importance of teams for improving quality of care has received increased attention. We examin... more The importance of teams for improving quality of care has received increased attention. We examine both the correlates of self-assessed or perceived team effectiveness and its consequences for actually making changes to improve care for people with chronic illness. STUDY SETTING AND METHODS: Data were obtained from 40 teams participating in the national evaluation of the Improving Chronic Illness Care Program. Based on current theory and literature, measures were derived of organizational culture, a focus on patient satisfaction, presence of a team champion, team composition, perceived team effectiveness, and the actual number and depth of changes made to improve chronic illness care. A focus on patient satisfaction, the presence of a team champion, and the involvement of the physicians on the team were each consistently and positively associated with greater perceived team effectiveness. Maintaining a balance among culture values of participation, achievement, openness to innovation, and adherence to rules and accountability also appeared to be important. Perceived team effectiveness, in turn, was consistently associated with both a greater number and depth of changes made to improve chronic illness care. The variables examined explain between 24 and 40% of the variance in different dimensions of perceived team effectiveness; between 13% and 26% in number of changes made; and between 20% and 42% in depth of changes made. The data suggest the importance of developing effective teams for improving the quality of care for patients with chronic illness.

Research paper thumbnail of A SOCIAL CAPITAL INDEX FOR COMMUNITY PARTNERSHIPS

The International Quarterly of Community Health Education, 2001

Research paper thumbnail of Risk Assumption and Physician Alignment With Health Care Organizations

Medical Care, 2001

To examine the association between risk assumption by individual physicians and physician groups ... more To examine the association between risk assumption by individual physicians and physician groups and the degree of alignment between physicians and health care systems. A cross sectional comparative analysis using a sample of 1,279 physicians practicing in loosely affiliated arrangements and 1,781 physicians in 61 groups closely affiliated with 14 vertically integrated health systems. Measures of physician alignment were based on multiitem scales validated in previous studies and derived from surveys sent to individual physicians. Measures of risk assumption were developed from surveys sent to the administrator of each of the 61 physician groups in the sample and to physicians affiliated with these groups. Two stage Heckman models with fixed effects adjustments in the second stage were used to correct for sample selection and clustering respectively. After accounting for selection, fixed effects, and group and individual controls, physicians in groups with larger proportional revenue from managed care displayed greater normative commitment and system loyalty than physicians in groups with lower proportional managed care revenue. Individual-level managed care risk was also positively related to both normative commitment and group behavioral commitment to the system. Physicians in groups with larger physician equity positions expressed lower levels of normative commitment to the system. Physician productivity compensation was negatively related to all measures of alignment. Finally, group emphasis on individually-based incentives for staff physicians was negatively related to system identification. Our findings suggest that organizations must balance individually-based risk schemes with those that emphasize the performance of the group and the system to achieve long-term goals of loyalty, identification, and commitment to the system.