Years ago it was typical for a physician to serve as a hospital's Chief Executive Officer (CEO). However, with the development of Master of Health Administration, Master of Public Health, and Master of Business Administration programs, hospitals began to move away from this model. Today however, as hospitals search for innovative ideas to reduce healthcare costs and improve the quality of care, the idea of the physician hospital CEO has returned. Little empirical research is available in the health services literature on the physician hospital CEO. The study aims to examine the relationship between organizational and environmental factors and physician CEOs, and whether or not physician CEOs are associated with improved hospital performance.The conceptual framework is adapted from Donabedian's structure, process, and outcome perspective, which when applied to the organizational level becomes context design-performance. The theoretical perspective applied to the conceptual framework to guide the development of hypotheses is contingency theory, which suggests that organizations are most successful when they can adapt their structures to fit their environment.Data for this study were obtained from multiple sources: American Hospital Association Annual Survey, the Centers for Medicare and Medicaid Services Hospital Cost Reports, SK&A, Area Resource File, and the Centers for Medicare and Medicaid Services Hospital Quality Alliance.Besides descriptive analyses, logistic regression was used in this study to evaluate the relationship between the organizational and environmental hospital characteristics. Ordinary least squares regression was used to explore the relationship between physician CEOs and hospital performance.Results indicate that hospitals in markets with greater physician competition are more likely to have physician CEOs. Hospitals that are affiliated with a system are also more likely to have physician CEOs. The study found that while teaching hospitals and specialty hospitals were associated with placement of physician CEOs, it was in the opposite direction of what was hypothesized. This may be a result of the small sample size of both teaching and specialty hospitals in the study sample. The study concludedthat having a physician CEOs is associated with hospital financial outcomes but not associated with its quality of care outcomes.

Titel: Morotens väg till motivation – En flerfallsstudie om belöningssystem i IT-företag Författare: Alexandra Gustafsson, Minda Langmoen & Amanda Tamme Examinator: Elin Funck Handledare: Anders Jerreling  Bakgrund & Problem: IT-branschen är en ung bransch som präglas av snabb förändring och utveckling. Utifrån Contingency-teorin kommer företags ekonomistyrning att skilja sig beroende på aspekter gällande storlek, strategi och miljö. Belöningssystem som en del av ekonomistyrningen, kan vid rätt utformning användas som ett effektivt styrmedel, men problemet ligger i att hitta lämplig utformning som sedan skapar motivation hos anställda. Syfte: Syftet med uppsatsen är att beskriva, förklara samt jämföra hur belöningssystem är utformade inom tre olika IT-företag. Vidare syftar arbetet till att utreda hur denna del av ekonomisystemet motiverar företagets medarbetare. Metod: Studien är av kvalitativ karaktär och vid insamling av empiriskt material har semistrukturerade intervjuer på IBM, NAB Solutions och Atea genomförts. Utifrån uppsatsens syfte valdes flerfallsstudie som forskningsstrategi. Det insamlade materialet presenteras först på företagsnivå sedan görs en jämförelse mellan de tre företagen. Slutsats: Samtliga företag har ett belöningssystem bestående av både monetära och icke- monetära belöningar, där de intervjuade har uppgett att det generellt sett är de icke-monetära belöningarna som bidrar till att skapa motivation. De avgörande faktorerna för företagens utformning av belöningsssystem antas vara storleken, strategin och dess ålder. Att IT- branschen är så pass ung kan leda till att företagen snabbt kan bli tvungna att göra om sina belöningssystem. Beroende på contingency-aspekterna storlek, strategi och miljö förväntas utformningen mellan företagen att skilja åt.

Nessa pesquisa busca-se identificar se, em empresas em que as variáveis contextuais são mais favoráveis à mudança na contabilidade gerencial, é maior o nível de sofisticação do BSC implementado. Para tanto realizou-se estudos de casos em quatro empresas que implementaram essa ferramenta. Nelas são analisadas as características do BSC implementado e como essas estão associadas a determinadas variáveis contextuais: as características organizacionais e os fatores que aceleram ou desaceleram o processo de mudança na contabilidade gerencial, ambos analisados sob a perspectiva da abordagem contingencial. Embora não seja possível generalizar os resultados, o desenvolvimento do estudo dos casos permitiu confirmar a relação entre tais variáveis contextuais e o nível de sofisticação do BSC implementado nas empresas pesquisadas. Quanto às características organizacionais, observa-se que, de modo geral, conforme crescem o nível de pressão competitiva e o tamanho da empresa, mais sofisticado é o BSC implementado, havendo apenas uma exceção, onde o BSC mais desenvolvido foi explicado por outros fatores. Quanto aos fatores de estímulos para mudanças, três fatores se destacaram, possibilitando relevantes comparações quanto aos tipos de BSC implementados nas empresas: os objetivos específicos para mudança, as necessidades externas e o envolvimento da alta gestão. A análise do grau de comunicação incorporada ao estudo dos casos mostrou que, em empresas onde o BSC é mais desenvolvido, há maior grau de comunicação da estratégia. / This study aims to identify if, in companies where the variable contextual are more favorable to the change in the managerial accounting is higher the level of sophistication of the implemented BSC. Therefore, the studies of cases were done in four companies of which had implemented this tool. In these companies the characteristics of the implemented BSC are analyzed and how these are linked and established to the changeable contextual ones: the organizational characteristics and the factors that speed up or decelerate the process of management accounting change, were both analyzed under the perspective of the contingency approach. Although it is not possible to generalize the results, the development of the study of cases allowed to confirm the relation between such contextual variables and the level of sophistication of the BSC implemented in the studied companies. For the organizational characteristics, it is observed that, in general, as the level of competition and the growth of the company increases, more sophisticated are the implemented BSC. However there is only one exception; the BSC that is more developed was obtained by other factors. In the factors of stimulating changes, three factors stood out, allowing excellent comparisons to the types of BSC implemented in the companies: the specific objectives for change, the external necessities and the engagement of the high level management. The analysis of the degree of communication incorporated to the study of the cases showed that, in companies where the BSC is more developed, it has greater degree of communication of the strategy.

Nessa pesquisa busca-se identificar se, em empresas em que as variáveis contextuais são mais favoráveis à mudança na contabilidade gerencial, é maior o nível de sofisticação do BSC implementado. Para tanto realizou-se estudos de casos em quatro empresas que implementaram essa ferramenta. Nelas são analisadas as características do BSC implementado e como essas estão associadas a determinadas variáveis contextuais: as características organizacionais e os fatores que aceleram ou desaceleram o processo de mudança na contabilidade gerencial, ambos analisados sob a perspectiva da abordagem contingencial. Embora não seja possível generalizar os resultados, o desenvolvimento do estudo dos casos permitiu confirmar a relação entre tais variáveis contextuais e o nível de sofisticação do BSC implementado nas empresas pesquisadas. Quanto às características organizacionais, observa-se que, de modo geral, conforme crescem o nível de pressão competitiva e o tamanho da empresa, mais sofisticado é o BSC implementado, havendo apenas uma exceção, onde o BSC mais desenvolvido foi explicado por outros fatores. Quanto aos fatores de estímulos para mudanças, três fatores se destacaram, possibilitando relevantes comparações quanto aos tipos de BSC implementados nas empresas: os objetivos específicos para mudança, as necessidades externas e o envolvimento da alta gestão. A análise do grau de comunicação incorporada ao estudo dos casos mostrou que, em empresas onde o BSC é mais desenvolvido, há maior grau de comunicação da estratégia. / This study aims to identify if, in companies where the variable contextual are more favorable to the change in the managerial accounting is higher the level of sophistication of the implemented BSC. Therefore, the studies of cases were done in four companies of which had implemented this tool. In these companies the characteristics of the implemented BSC are analyzed and how these are linked and established to the changeable contextual ones: the organizational characteristics and the factors that speed up or decelerate the process of management accounting change, were both analyzed under the perspective of the contingency approach. Although it is not possible to generalize the results, the development of the study of cases allowed to confirm the relation between such contextual variables and the level of sophistication of the BSC implemented in the studied companies. For the organizational characteristics, it is observed that, in general, as the level of competition and the growth of the company increases, more sophisticated are the implemented BSC. However there is only one exception; the BSC that is more developed was obtained by other factors. In the factors of stimulating changes, three factors stood out, allowing excellent comparisons to the types of BSC implemented in the companies: the specific objectives for change, the external necessities and the engagement of the high level management. The analysis of the degree of communication incorporated to the study of the cases showed that, in companies where the BSC is more developed, it has greater degree of communication of the strategy.

Made available in DSpace on 2015-04-23T12:42:31Z (GMT). No. of bitstreams: 1 Dissetacao-Manuel Filho.pdf: 429783 bytes, checksum: f77156ce50ffcff6793d5544747ef1fc (MD5) Previous issue date: 2003-11-12 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Esta pesquisa teve como principal meta analisar as estruturas orgânicas de duas prefeituras de universidades que possuem seus próprios Campi . Com base na Teoria da Contingência, que fundamentou a pesquisa, variáveis do contexto foram relacionadas, definidas e operacionalizadas para funcionarem como variáveis independentes e influenciadoras das variáveis de estrutura, as quais foram aqui também determinadas, definidas e operacionalizadas. O universo da pesquisa constituiu-se de duas Prefeituras de Universidades, sendo uma Federal, a Universidade do Amazonas e outra, particular, a Universidade Luterana de Manaus que possuem seus próprios Campi‟. A técnica de coleta de dados utilizada na pesquisa principal foi a de entrevista pessoal e de levantamento empírico de dados em cada divisão funcional das prefeituras. Os dados foram tratados a analisados utilizando a técnica de estatística descritiva. As conclusões finais a que se chegou através da análise das informações coletadas estão anunciadas no Capitulo VI desta dissertação.

Contrariando o caráter universalista das abordagens clássicas anteriores, a Teoria da Contingência defende que não há uma melhor forma de se organizar. Conforme o contexto ambiental apresentado, a organização deve se estruturar de uma maneira diferente. No âmbito da contabilidade gerencial, os estudiosos desta teoria argumentam que não há como desenvolver um Sistema de Contabilidade Gerencial (SCG) que tenha a mesma eficiência em todas as situações. Diferentes ambientes requerem diferentes modelos de estratégia e estrutura organizacional, o que termina por impactar a forma como o SCG é organizado. Amparada então pela teoria contingencial, a presente pesquisa tem por objetivo identificar e analisar os arranjos promovidos pelo encaixe existente entre os fatores ambientais e organizacionais nas maiores empresas atuantes no mercado brasileiro. Os fatores empregados são: ambiente, tecnologia, estratégia, estrutura organizacional, atributos do SCG e desempenho organizacional. Para cada fator, há uma ou mais variável que procura mensurar o quanto as características tratadas estão presentes. A coleta dos dados se deu por meio de questionários enviado às empresas constantes no projeto Melhores & Maiores, edição 2006. A amostra final é composta por 104 participantes, a partir da qual se empregou estatística descritiva e Análise de Cluster. Os resultados revelaram três arranjos. O primeiro é composto por empresas com ambiente competitivo, tecnologias modernas e não-padronizadas, estratégia de diferenciação, estrutura orgânica e atributos do SCG sofisticados (instrumentos e práticas modernas, informações tempestivas, agregadas, integradas, não-financeiras, focadas no ambiente externo e no futuro). O segundo é composto por empresas com ambiente estável e protegido, tecnologias pouco padronizadas e pouco desenvolvidas, estratégia de liderança em custos, estrutura mecanicista e atributos do SCG menos sofisticadas (instrumentos e práticas tradicionais, informações não-tempestivas, não-agregadas, não-integradas, financeiras, focadas no ambiente interno e no passado). O terceiro arranjo é composto por empresas com ambiente e atributos do SCG semelhantes ao primeiro, e com estratégia e estrutura similar ao segundo. Nos dois arranjos iniciais o desempenho mostra-se superior e considerando ainda que a disposição das variáveis convergem com os resultados empíricos de outras investigações, conclui-se que nestes arranjos há um maior encaixe entre os fatores situacionais do que no terceiro. O estudo ainda conclui que ajustar os atributos do Sistema de Contabilidade Gerencial a cada contexto ambiental e organizacional resulta na utilização mais eficiente dos recursos aplicados neste sistema. / Unlike the universal character of previous classical approaches, the Contingency Theory claims that there is not one best way for organization. Thus, companies should structure themselves differently, in accordance with the environmental context they find themselves in. In the field of managerial accounting, researchers of this theory argue that it is not possible to develop a Managerial Accounting System (MAS) that presents the same effectiveness in all situations. Different environments require different strategies and organizational structures, which end up impacting the form in which the MAS is organized. Therefore, based on the Contingency Theory, the purpose of this research is to identify and analyze the arrangements that are made by the adjustment of environmental and organizational factors in the largest companies in the Brazilian market. The factors that are utilized are the following: environment, technology, strategy, organizational structure, MAS attributes, and organizational performance. For each factor there are one or more variables which seek to measure the extent of the presence of the characteristic being considered. Data was collected by means of questionnaires which were sent to the companies listed in the Melhores & Maiores project, 2006. The final sample consists of 104 participants, and this sample was subjected to descriptive statistics and Cluster Analysis. The results revealed the existence of three arrangements. The first consists of companies with a competitive environment, modern and non standardized technology, differentiation strategies, organic structure and sophisticated MAS attributes (advanced management accounting practices, and timely, aggregated, integrated, and non financial information focused on the external environmental and in the future). The second consists of companies in a stable and protected environment, with technology without much standardization and development, low price strategy, mechanistic structure, and less sophisticated MAS attributes (traditional management accounting practices, and untimely, non aggregate, non integrated, non financial information focusing on the internal environment and in the past). The third arrangement consists of companies in an environment and with MAS attributes which are similar to the first arrangement, and with strategies and structure similar to the second. The first two arrangements presented superior performance, and considering that the dispositions of the variable converge with the empirical results of other investigations, it is concluded that these arrangements achieve greater fit between situational factors than in the third. The study also concludes that the fit of the MAS attributes to each different environmental and organizational context results in more efficient utilization of the resources applied in such system.

Contrariando o caráter universalista das abordagens clássicas anteriores, a Teoria da Contingência defende que não há uma melhor forma de se organizar. Conforme o contexto ambiental apresentado, a organização deve se estruturar de uma maneira diferente. No âmbito da contabilidade gerencial, os estudiosos desta teoria argumentam que não há como desenvolver um Sistema de Contabilidade Gerencial (SCG) que tenha a mesma eficiência em todas as situações. Diferentes ambientes requerem diferentes modelos de estratégia e estrutura organizacional, o que termina por impactar a forma como o SCG é organizado. Amparada então pela teoria contingencial, a presente pesquisa tem por objetivo identificar e analisar os arranjos promovidos pelo encaixe existente entre os fatores ambientais e organizacionais nas maiores empresas atuantes no mercado brasileiro. Os fatores empregados são: ambiente, tecnologia, estratégia, estrutura organizacional, atributos do SCG e desempenho organizacional. Para cada fator, há uma ou mais variável que procura mensurar o quanto as características tratadas estão presentes. A coleta dos dados se deu por meio de questionários enviado às empresas constantes no projeto Melhores & Maiores, edição 2006. A amostra final é composta por 104 participantes, a partir da qual se empregou estatística descritiva e Análise de Cluster. Os resultados revelaram três arranjos. O primeiro é composto por empresas com ambiente competitivo, tecnologias modernas e não-padronizadas, estratégia de diferenciação, estrutura orgânica e atributos do SCG sofisticados (instrumentos e práticas modernas, informações tempestivas, agregadas, integradas, não-financeiras, focadas no ambiente externo e no futuro). O segundo é composto por empresas com ambiente estável e protegido, tecnologias pouco padronizadas e pouco desenvolvidas, estratégia de liderança em custos, estrutura mecanicista e atributos do SCG menos sofisticadas (instrumentos e práticas tradicionais, informações não-tempestivas, não-agregadas, não-integradas, financeiras, focadas no ambiente interno e no passado). O terceiro arranjo é composto por empresas com ambiente e atributos do SCG semelhantes ao primeiro, e com estratégia e estrutura similar ao segundo. Nos dois arranjos iniciais o desempenho mostra-se superior e considerando ainda que a disposição das variáveis convergem com os resultados empíricos de outras investigações, conclui-se que nestes arranjos há um maior encaixe entre os fatores situacionais do que no terceiro. O estudo ainda conclui que ajustar os atributos do Sistema de Contabilidade Gerencial a cada contexto ambiental e organizacional resulta na utilização mais eficiente dos recursos aplicados neste sistema. / Unlike the universal character of previous classical approaches, the Contingency Theory claims that there is not one best way for organization. Thus, companies should structure themselves differently, in accordance with the environmental context they find themselves in. In the field of managerial accounting, researchers of this theory argue that it is not possible to develop a Managerial Accounting System (MAS) that presents the same effectiveness in all situations. Different environments require different strategies and organizational structures, which end up impacting the form in which the MAS is organized. Therefore, based on the Contingency Theory, the purpose of this research is to identify and analyze the arrangements that are made by the adjustment of environmental and organizational factors in the largest companies in the Brazilian market. The factors that are utilized are the following: environment, technology, strategy, organizational structure, MAS attributes, and organizational performance. For each factor there are one or more variables which seek to measure the extent of the presence of the characteristic being considered. Data was collected by means of questionnaires which were sent to the companies listed in the Melhores & Maiores project, 2006. The final sample consists of 104 participants, and this sample was subjected to descriptive statistics and Cluster Analysis. The results revealed the existence of three arrangements. The first consists of companies with a competitive environment, modern and non standardized technology, differentiation strategies, organic structure and sophisticated MAS attributes (advanced management accounting practices, and timely, aggregated, integrated, and non financial information focused on the external environmental and in the future). The second consists of companies in a stable and protected environment, with technology without much standardization and development, low price strategy, mechanistic structure, and less sophisticated MAS attributes (traditional management accounting practices, and untimely, non aggregate, non integrated, non financial information focusing on the internal environment and in the past). The third arrangement consists of companies in an environment and with MAS attributes which are similar to the first arrangement, and with strategies and structure similar to the second. The first two arrangements presented superior performance, and considering that the dispositions of the variable converge with the empirical results of other investigations, it is concluded that these arrangements achieve greater fit between situational factors than in the third. The study also concludes that the fit of the MAS attributes to each different environmental and organizational context results in more efficient utilization of the resources applied in such system.

The prolonged wars in Iraq and Afghanistan have taken a toll on the United States as a whole and the United States military in particular. The primary aim of this research is to determine what impact the wars in Iraq and Afghanistan have had on the performance of military hospitals over the fiscal years 2001-2006. Specifically, what direct effect has the war in Iraq and Afghanistan had on the productivity and quality of military hospitals, and, do productivity and quality trends differ based on hospital characteristics? Since observations over multiple time periods are nested within hospitals, multilevel mixed effects regression and Poisson regression models are used to evaluate changes in productivity and quality while accounting for differences within hospitals. Using a contingency theory framework, this study fills the gap in looking at the impact of war on permanent military hospitals’ productivity and quality using nationally developed and implemented quality indicators (Agency for Healthcare Quality and Research Inpatient Quality Indicators and Patient Safety Indicators). Structural characteristics of the hospital, teaching status and branch of Armed Service influenced productivity and certain quality indicators. The structural components were not able to reliably predict differences in productivity and all quality indicators, but overseas hospitals and non-teaching hospitals were most likely to differ from major teaching hospitals. The wars in Iraq and Afghanistan, denoted by the variables for wounded discharges and deployed staff, were only partially related to the productivity of military hospitals. Only an increase in the percentage of wounded discharges was related to productivity of military hospitals, and none were related to the quality indicators. In essence, the war affected the workload and productivity of military hospitals, but it did not affect the quality provided in the hospitals, as measured by AHRQ inpatient and patient safety quality indicators. Structural characteristics account for more of the variation in quality among military hospitals than the impact of war within the timeframe studied.

Academic Health Centers (AHCs) hold a unique place in today’s health care environment. They service their communities through a tripartite mission of education, research, and provision of complex care to disadvantaged populations. To achieve this mission, AHCs face challenges in funding and cost containment compared to non-AHCs. Additionally, the implementation of government programs like the Hospital Readmission Rate Program (HRRP) and Value Based Purchasing (VBP) have the potential to affect AHCs differently from non-AHCs. While AHC’s unique features are known and there has been research to date on HRRP and VBP, literature has yet to statistically explore the financial differences between AHCs and non-AHCs and how HRRP and VBP may have differentially affected AHCs compared to non-AHCs. The objectives of this study are to explore financial differences between AHCs and non-AHCs and the impact that HRRP and VBP has had on these two types of organizations through the use of a contingency theory framework. Contingency theory is an organizational theory that seeks to explain variations in organizational performance over time by studying internal and external environmental influences. Guided by Contingency Theory, the study used a non-randomized, quasi-experimental, retrospective study design to evaluate two hypotheses. The study sample consisted of a total of 10,157 (991 AHCs) US non-rural hospital years from 2011 through 2015. The study used operating margin and total margin as the key measures of hospital financial performance for the dependent variables. HRRP and VBP were combined into a single independent variable along with hospital type differentiating AHCs from non-AHCs. Covariates of Herfindahl-Hirschman Index, Medicaid expansion, health system affiliation, and ownership structure were used to control for other environmental influences. A repeated measure analysis of variance was employed to test the difference between the two hospital groups in isolation of HRRP, VBP, and covariates and a repeated measure analysis of variance with covariance was used to test the full model, which incorporated HRRP, VBP, and covariates. The results of the analysis support the significance of HRRP and VBP on hospital operating margin, but the results did not support a differential effect of these programs on AHCs as compared to non-AHCs. While the results did not support the two main hypotheses, it did provide valuable insight into the financial differences between AHCs and non-AHCs and the importance of VBP and HRRP on hospital financial performance. The results also provide important policy implications and thoughts on potential managerial actions given the HRRP and VBP programs.

Agency theory proposes that the role of the board of directors is to control management (Fama & Jensen 1983). A structurally independent board, one with a high percentage of non-executive directors and a chairperson who is not the CEO, has been used as a proxy for the control role. Therefore, agency theory predicts a positive relationship between independent board structure and firm performance. These predictions have not been confirmed by meta-analytic reviews (Dalton, Daily, Ellstrand, & Johnson 1998; Rhoades, Rechner, & Sundaramurthy 2000). This thesis applies structural contingency theory to provide an alternative explanation for the relationship between board structure and firm performance. Structural contingency theory (Donaldson 2001) proposes that the relationship between an organization???s structure and its performance is moderated by contingencies. In this study the contingency is the salience of the board???s control role. I argue that structural independence of the board has a beneficial effect on performance only if it is in fit with control salience. For example, a firm with an independently structured board that gives high prominence to the control role will perform well. On the other hand, another firm with a less independently structured board that does not see its main role as controlling management will also prosper. Survey data were analyzed to measure the control salience for 98 Australian listed companies. Archival data provided measures of board structure and firm performance. Consistent with the meta-analytic reviews, there was no association between independent board structure and firm performance. There was some evidence that high control salience resulted in high performance, but this effect was evident chiefly when performance was measured by total shareholder returns. This may indicate that the share market was responding to the symbolism of high control salience. In contrast to the symbolic main effect of control salience, the fit between the control salience and the independent structure of the board caused increased return on equity. This reflects the board???s objective effect on profit when its structure is in fit with control salience.