How Structural Design Relates To Decision-Maker Attention in Three Health Systems

Abstract

Background: Some scholars have suggested that the design of organizations can play an important role in determining how attention and effort are distributed within firms. However, our understanding of how existing organizational structures focus attention in health care is limited. Purpose/Methodology: We view breast cancer care delivery efforts through the lens of organization design and the attention-based view of the firm. More specifically, we use exploratory evidence from comparative case studies of three health systems to help us understand how the placement of organizational boundaries relates to where organizations focus their attention. Non-probability discriminative snowball sampling was used to identify the final sample of key informants and we employed a grounded approach to analyzing and interpreting the interview data. Findings: We found variation across the three health systems in terms of where organizational attention was primarily focused. More specifically, each organization was categorized as having one of three dominant foci of attention types (tactical-focused attention, patient-focused attention, and provider relationship-focused attention) that manifested themselves via the specific issues most frequently discussed by key informants from each health system. Conclusions: Study findings suggest that the placement of organizational boundaries (i.e., physician contracting paradigm used, the extent of inter- organizational coordination, clinical structure, and location of breast cancer services) can create situations where an organization’s structural design distributes the focus of attention across different types of issues. Moreover, having a “one-stop shop,” where all services are provided in a single location doesn’t appear to be a necessary, or even sufficient, means to having a patient-centered orientation.