THE IMPACT OF ORGANIZATIONAL ENVIRONMENTS AND BELIEFS ON STAFFING AND SERVICE PATTERNS IN HOME HEALTH CARE.
Contributors: University of Michigan.
Published: 1990
Number of pages: 225
Subjects: Health Sciences, Nursing.; Health Sciences, Public Health.
Description: The purposes of this study were to describe the organizational environments, beliefs, and structure of home health care agencies, and to investigate the relationships among environments, beliefs, and structure. The study was based on institutional theory of organizations. A national sample of visiting nurse associations (VNAs) and hospital-based home health care agencies (HBHHAs) was obtained using a stratified disproportionate sampling technique based on type and region of agency. Two hundred seventy-six administrators from VNAs and HBHHAs responded to the mailed survey for a return rate of 73%.

Differences were found between the environments of the VNAs and HBHHAs using regression analyses. HBHHAs had a higher percent of funding from Medicare, were more likely to be accredited, and had a higher percent of referrals from physicians and hospitals than VNAs. VNAs had a greater number of funding sources, a higher percent of funding from other governmental sources, were more likely to be involved in professional organizations, perceived more competition, and received a higher percent of referrals from families and clients than HBHHAs. HBHHAs were more likely than VNAs to subscribe to a medical model of home health care that emphasizes acute illness and treatment. In terms of agency structure, HBHHAs provided a higher number of high-tech services. HBHHAs were more likely to employ nursing staff with associate degrees or nursing diplomas, while VNAs were more likely to employ nurses with bachelor's or master's degrees.

There were several key findings in relation to the relationships among environments, beliefs and structure. Specific key actors, such as providers of fiscal resources, clients and complementary services, and competing organizations in the environment were related to agency services and staffing. Technical and institutional demands from key actors were not related to services, although institutional demands were related to agency staffing. Technical demands were positively related to acknowledgement of the business belief system of home health care.

Beginning support was found for the relationships among organizational environments, beliefs and structure. An important implication of this study is the need to consider the context of nursing practice.
Notes: Source: Dissertation Abstracts International, Volume: 51-07, Section: B, page: 3319.

Thesis (PH.D.)--THE UNIVERSITY OF MICHIGAN, 1990.

School code: 0127.