Defense Date


Document Type


Degree Name

Doctor of Philosophy


Health Administration

First Advisor

Roice D. Luke


This research investigated market and organizational factors that influence the strategic decisions of teaching hospitals to participate in strategic hospital alliances (SHAs). It described the characteristics of both teaching hospitals and the health care environment in which they operate. This research also examines the association of these factors with the strategic position of teaching hospitals in terms of their dominance in the market or within their organizations.

The theoretical model used two concepts from institutional theory--coercive and normative pressures. It was argued that coercive pressures in the market facilitated the decision to participate in SHAs and gain market and Organizational dominant positions. Alternatively, normative organizational pressures were argued to hinder the process of participating in SRAs and gaining market and organizational dominance.

An important finding of this research was that high levels of SRA penetration had a negative influence on all three dependent variables , SRA participation, market dominance, and organizational dominance. This finding suggests that as market consolidation advances, teaching hospitals may find it difficult to participate in SRAs or gain positions of dominance. In addition to the SRA penetration measure there were a number of other relationships of interest. SRA participation was related to the percent of large employers in the market and the teaching hospital's net revenue . Market dominance was related to the percent of large group practices and the percent of primary care physicians in the market as well as the profit status of the teaching hospital. Organizational dominance was related to the profit status and the administrative structure of the teaching hospital.


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