Decision making, goal consensus, and effectiveness in university hospitals

This article examines changes in the influence of several key actors (state and university officials, board members, and hospital and medical school administrators) in management and policy decisions for university hospitals (UHs). We propose that the decreasing influence of external actors in UH decision making and the increasing influence of UH and medical school actors as well as UH-medical school goal consensus will be related to higher levels of UH performance. Data are drawn from a national sample of 52 UHs that participated in a study of UH decision making in 1981 and 1985. Results indicate that state and university actors lost influence in UH policy decisions between 1981 and 1985, while actors internal to academic health centers (AHCs) gained influence in such decisions. The data indicate a similar trend, although not as strong, regarding influence in UH management decisions. Results from regression analyses indicate that decreasing levels of external influence on UH decision making are related to UH effectiveness, but increasing levels of AHC influence and goal consensus have weak or inconsistent relationships with UH effectiveness. Implications for improving the performance of UHs are discussed.