Defense Date


Document Type


Degree Name

Doctor of Philosophy


Health Services Organization and Research

First Advisor

James W. Begun


Hospitals are joining multihospital systems (MHSs) with growing frequency. About 80% of MHSs are small, composed of 2-7 hospitals. An important management issue in MHSs is the extent to which member hospitals retain control over their own strategic directions.

Using a contingency framework, this study uses both system and hospital—level determinants to explain the extent to which hospital members of MHSs control their own strategies. Survey and secondary data from 272 member hospitals of 62 small multi hospital systems (size 2-7 hospitals) are analyzed. System dispersion, size, ownership, strategic type, and age along with hospital occupancy, size, relationship to the MRS, and market factors are determinants of hospital control of strategy.

Two types of hospital strategic decisions were revealed by factor analysis: tactical and periodic. For tactical decisions, such as those relating to hospital budgets, service additions, and formulation of strategies, Catholic system ownership is a significant predictor of greater hospital control. Prospector system strategy and older system age are significant predictors of reduced hospital control. For periodic decisions, such as appointment of hospital board members, sale of hospital assets, and changes in bylaws, older system age is negatively associated with hospital control, and a hospital which is owned by the system has significantly less control.

The results are analyzed using the framework of the Hickson, Butler, Cray, Mallory, & Wilson (1986) typology of strategic decisions. Thus the results of this work can be useful to managers in identifying the nature of a decision and understanding its associated decision process.


Scanned, with permission from the author, from the original print version, which resides in University Archives.


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