Interorganizational Relations Among Hospitals: A Strategy, Structure, and Performance Model

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Abstract
Contrasting theories of organization-environment relationships are used to consider current trends in relations among health care organizations in the United States. Chandler's well-known thesis is used to bridge the contrasting organization-environment theories. Revising and extending Chandler's thesis results in a recursive model of strategy, structure, and performance. Interviews, organizational documents, and administratively collected data were examined to determine the extent to which strategy, structure, and performance are linked in four different types of interorganizational structures known as multi-hospital systems: a consortium, a joint venture, a merger, and a corporate management system. Using Kendall's W measure of concordance, strategy and structure are found to be closely related; and strategy, structure, and performance are found to be generally interrelated in the four multi-hospital systems considered. While the relationship of strategy and structure is not one-to-one as in the industrial organizations considered by Chandler, the significant association found between one measure of strategy, structure, and performance indicates that the multi-hospital systems examined are able to link their strategy and structure effectively to performance. By systematically exploring the interrelationship of strategy, structure, and performance in a variety of organizational contexts, organizational researchers will very likely increase their undestanding of how organizations are interrelated with their environments.

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