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This paper adopts a view of organizations as complex adaptive systems and makes a case for making organizations more complex internally through the use of a fairly simple managerial rule-using participative decision making. Participation in decision making enhances connectivity in organizations, which in turn, gives the organization the opportunity to(More)
One way hospitals complicate themselves is by increasing the participation of clinical professionals and middle managers in making strategic decisions. Using a survey methodology this article investigates the relationships between the participation of clinical professionals (MDs and RNs) and middle managers with hospital costs, as well as the possible(More)
An exploratory study examined variation in the participation of physicians in hospital strategic decision making as a function of (1) strategic decision content or (2) hospital strategy, or both. The findings revealed that who participates is a function of decision content while how physicians participate is a function of decision content and the(More)
When hospitals are viewed as complex adaptive systems, simple rules can lead to behavior that emerges as complex and that enables creative, adaptive organizational responses. Based on empirical findings from a decade of research on hospital strategic decision making this article offers the simple rule of letting physicians help decide strategic issues.(More)
A conceptual design of an organizational decision support system (ODSS) is proposed for the limited domain of hospital-based clinical decisionmaking (H-CDM). The design is a first step in the research program to evaluate the viability of an ODSS for H-CDM. The design is also used as a basis for evaluating two other issues. First, the adequacy of broader(More)
This study examines the participation of six internal stakeholder groups in hospital strategic decision-making. Results show that internal stakeholder group participation is affected by strategic decision content and by the nature of the hospital's strategy. Results show that the participation of internal stakeholdergroups is associated with lower cost per(More)
Theory suggests that organizations should respond to external complexity with internal complexity. We examine whether "environmentally sensitive" hospitals are more internally complex than "environmentally insensitive" hospitals. Results show that environmentally sensitive and insensitive hospitals differed on three of the measures of internal complexity:(More)
Organizational design is presented as a decision process, with specific structures seen as providing alternative choices. To illustrate this, the authors present the case of a major metropolitan hospital that used the process to coordinate service delivery (nursing care versus patient care) and service focus (product oriented versus function oriented).(More)