Ultural and mission differences impact on physician practices integration into existing hospital-based systems.

Document Preparation:
1. Journal Article Reviews:
The narrative of journal article reviews must be:
· Double spaced
· Standard 1 inch margins on all four sides of the paper
· Size 12 font for the narrative
· Page numbers
· Headings that stand out to break up the content.
· Your Name and Date
· Name of the topic of the paper (Example: Nurse Staffing in a Hospital)
· Article Reviewed and Source (journal, authors, month and year)
· Key Points of the Article (this is a practice in summarizing, interpreting and paraphrasing reading material in your own words (no cutting and pasting or bullet points); be concise but brief (limit this section to one half page)
· Critique of the Article (make this part the bulk of the paper since it carries the most grading weight) including:
-why the article is important/relevant to management in health care
-management issues related to key points made by the author(s); examples: cultural, political, legal, ethical or global issues
-conclusion(s) drawn from the article as a way to close the paper; answers the So, what were the lessons learned in the article?
· Bibliography (see instructions below about learning and using APA style)
· Caution: No Title Page
Length Requirement:
The length of each journal review assignment should be at least 4 pages and no more than 5 pages (at about 300 words per page, double spaced). The length of the case preparation summaries is at least 2 pages. The length specifications do not include bibliography or attachments.since each writing assignment is relative short in terms of length requirement, express your ideas as concisely as possible.

Below is the journal article to be reviewed:

Understanding organizational designs of primary care practices / Practitioner applicationAlfred F Tallia, Kurt C Stange, Reuben R McDaniel Jr, Virginia A Aita, et al. Journal of Healthcare Management. Chicago: Jan/Feb 2003. Vol. 48, Iss. 1; pg. 45, 17 pgs
Abstract (Summary)
During the past decade, many hospitals experienced difficulty integrating primary care practices into their health systems. A hypothesis that this difficulty may be, in part, a result of limited understanding of practice organizational designs was studied. Eighteen family practices, including nine affiliated with five separate hospital systems, were studied using an in-depth comparative case study design. A content analysis of the rich descriptive data from these cases indicates that a great variety exists in the organizational design of primary care practices, and this variety appears to be influenced by the initial conditions under which the practice was organized. Hospital system design in and of itself did not predict the design of affiliated practices. In fact, both affiliated and independent practices exhibited a range of design characteristics, some of which did not fit traditional models. Hospital systems that allowed greater flexibility of practice organizational designs were more effective at integrating and managing practices. Practice response to environmental change was greater when practice autonomy was highest.
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Copyright Health Administration Press Jan/Feb 2003
[Headnote]
EXECUTIVE SUMMARY

[Headnote]
During the past decade, many hospitals experienced difficulty integrating primary care practices into their health systems. We hypothesized that this difficulty may be, in part, a result of limited understanding of practice organizational designs. The structure and function of practices have not been well studied. In this article, we answer the following questions: Are practices all the same, or do variations in their organizational design exist? Do hospital designs predict the designs of affiliated practices? If variation exists, what are the management implications?
Eighteen family practices, including nine affiliated with five separate hospital systems, were studied using an in-depth comparative case study design. A content analysis of the rich descriptive data from these cases indicates that a great variety exists in the organizational design of primary care practices, and this variety appears to be influenced by the initial conditions under which the practice was organized. Hospital system design in and of itself did not predict the design of affiliated practices. In fact, both affiliated and independent practices exhibited a range of design characteristics, some of which did not fit traditional models. Hospital systems that allowed greater flexibility of practice organizational designs were more effective at integrating and managing practices. Practice response to environmental change was greater when practice autonomy was highest.
These findings suggest that a science of practice organizational design separate from that of hospitals is needed to help explain the success and failure of practices within health systems and to provide information for planning practice change.

During the last decade, health systems engaged in mergers and acquisitions of physician practices to integrate primary care networks into existing hospital-based systems. Although some ventures were successful, many were not. The spectacular failure of some networks (e.g., the Allegheny Health System) led to a wholesale retreat from the strategy of practice ownership and management by hospital health systems (Atkinson 1998; Bums et al. 2000). For a succinct view of the rise and fall of physician practice acquisition, see Aymond and Hariton (2000). What went wrong? How do we account for these failures and learn from the lessons presented?
Organizational design theory has produced many models to describe the structure and functioning of human organizations. Models of organizational design include classical design theories of Taylor (1947), Weber (1964), and others (Gulick and Urwick 1937; Mooney 1947; Gouldner 1954); the human relations theory of Likert (1967); and the contingency theory of Lawrence and Lorsch (1967) and others. More recent models include matrix, resource dependency, population ecology, strategic management, and institutional design (Shortell and Kaluzny 2000).
Models of organizational design can be applied to the analysis of hospitalbased systems. Are these theories useful for understanding outpatient practices in community settings? Aside from the cultural and mission differences between hospitals and primary care practices, little is known about the intricacies of primary care practices or their organization (Stange et al. 1998). Although some may argue that practices intuitively must be diverse, many hospitals organize management structures and functional oversight in a way that treats all practices the same. Additionally, standards of external oversight agencies tend to foster a management approach that is notable for its singularity of design. In this article, we seek to answer the following questions: Are there variations in the organizational designs of practices? Can we assume that hospital system organizational designs predict the designs of affiliated practices? If variations exist, what are the management implications?
METHODS
This study analyzed data from the Prevention & Competing Demands in Primary Care(P&CD) study, a cross-sectional, multimethod case study that examined preventive services and organizational contexts of 18 family practices (Crabtree, Miller, and Stange 2001). In the P&CD study, practices were sampled from 91 Midwestern practices randomly selected to participate in an earlier study on tobacco prevention and cessation (McIlvain et al. 2000). Practices were purposefully selected (Kuzel 1999; Patton 1990)
to obtain maximum variation in size (small and large); geographic location (urban, suburban, and rural); and intensity of prevention. Among the five hospital systems in this Midwestern region, two practices each were selected from four of the hospital systems and one practice was selected from the fifth-a university-based system.
Primary data for the P&CD s