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PhD 3743: Creation of Institutional Logic for Management of Hospitals:…
PhD 3743: Creation of Institutional Logic for Management of Hospitals: Efficiency, 11/11/2017
Three Assumptions
hospitals act like businesses
large hospitals are models for other providers
hospitals introduce new tech while containing costs
Hospital growth
Hospitals grew from 149 in 1873 to 6,665 by 1913
Move care from home to hospital
Efficiency used to promote desirability of hospitals
New Contributions
creation of institutional logic for hospitals
focus on AHA
history of hospital management
Theoretical Framework
Institutions and their logic
Institutions and their logics change
Efficiency is the logic for hospitals which led to standardization and business practices
Method
Data Source- Modern Hospital
Data Supplement- American Journal of Nursing, Trained Nurse and Hospital Review, and Journal of the American Medical Association
Time Period- 1913 to 1920
Analysis
read every issue of MH from 1913 to 1920
36 categories created
total immersion in text for "practical understanding"
Hospitals in the Early 1900s
small, did everything on their own
new tech included refrigerators, sterilization equipment, electricity, operating lights, vacuum cleaners, kitchen utensils, new flooring materials, medical records
large hospitals led by physician
small hospitals led by nurse
supervisors had broad responsibilities
vision for important societal role in overall health
depended on patient revenue, developed sliding fee schedule to accommodate middle class
Emerging Organizing Principle: Efficiency
Efficiency defined broadly, encompassing all hospital operations
Standardize facilities and services
Adopt management practices from the business sector
Standardization of facilities and services
MH extensive material on planning and construction
Maintenance, housekeeping, infection control, laundry, essential to modern scientific facility
Nursing services critical
emerging field of American Dietetic Association
Social work promoted to aid in efficiency
Business practices as guide for administration
internal control systems- cost accounting and bookkeeping
budgeting and cash control
purchasing and inventory policies
formal admissions and billing procedures
business models of department and committee structures