J. Zajac and Thomas D'Aunno Health Care Management: Organizaiton
Design and Behavior, 3rd Edition, Shortell, Stephen M.
and Kaluzny, Arnold D. 1994
There is no doubt
that the U.S. health care environment is undergoing major
changes that could be characterized as turbulent. The word
was originally used to depict highly complex and rapidly changing
environments; "turbulence" has been somewhat vaguely
used to describe many industry contexts.2 However, a closer
inspection of the Emery and Trist definition reveals that
the term applies when two general conditions are met: (1)
organizations are highly interconnected with one another,
and (2) organizations are highly interdependent with the society
in which organizations find themselves. This emphasis on connectedness
and interdependence is an important basis for viewing a specific
organization's environment not as some amorphous external
force but rather as the set of other organizations that are
interconnected or interdependent
with it. This organization, in turn, is part of the environment
for the other organizations. In other words, when an organization
looks out with concern or anticipation at its turbulent environment,
what it sees is other organizations looking out at that organization.
This conceptualization of organizational environments suggests
the need to focus more attention on how specific organizations
interact with one another. This chapter emphasizes one such
type of interaction; namely, cooperative interorganizational
relations. Longest, in discussing what he terms "interorganizational
linkages in health care," distinguishes between market
transactions. voluntary relationships, and involuntary relationships.
We focus most of our attention on those interorganizational
relations that are noncoercive and entered into primarily
for strategic purposes, that is, that are important to an
organizations mission and expected to enhance organizational
performance. Such relationships we term strategic alliances.
which are defined as any formal arrangements between two or
more organizations for purposes of mutual gain.
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