Determinants of performance failure in the nursing home industry☆
Section snippets
Change and organizational failure
According to structural inertia theory (Hannan and Freeman, 1984, Hannan and Freeman, 1989) where in the organization change occurs determines whether it is disruptive, contributing to performance failure or adaptive, contributing to reliable and accountable performance. Changes in core structure are often disruptive and destabilizing, and as a result, inertia, resistance to change, is thought to be strongest in core structure (Hannan & Freeman, 1989). The underlying logic of this argument is
Data and sample
The primary data for this study come from the longitudinal Online Survey Certification and Reporting (OSCAR) system. An administrative database maintained by the Centers for Medicare and Medicaid Services (CMS), OSCAR includes organizational characteristics for all Medicare/Medicaid certified nursing homes in the U.S. and aggregate resident data routinely collected as part of the licensure and certification process. CMS contracts with each state to conduct onsite inspections, which occur, on
Results
Table 1 presents summary statistics for the variables included in our model, aggregated from OSCAR data (1996–2005). 73.7% of sample facilities were for-profit and 56.1% were chain-affiliated. Average Medicare census was 10.8%. 62.8% were located in states that had introduced Medicaid case mix reimbursement during the study time period.
Table 2 presents the logistic regression model results of the determinants of performance failure. As predicted by hypothesis 1, a facility experiencing one
Discussion
Our results support the contention, derived from structural inertia theory, that where in the organization change occurs determines whether it is disruptive and thus contributes to performance failure or adaptive, protecting against failure. Our results indicate that change of ownership, particularly when it occurred with greater frequency over the study period, increases the likelihood of termination from public program participation. This suggests that major reorganization required by change
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This research was supported in part by National Institute for Aging grants (AG#11624 and AG023622) and a Robert Wood Johnson Foundation Health Policy Investigator Award.