Organizational Influences on Patient Health Behaviors

  • James R. Greenley
  • Robert E. Davidson


Modern technological and scientific medicine is a relatively new phenomenon (Anderson, 1985). The modern profession of medicine has developed in the past 100 years. The delivery of medical care in formal organizations and bureaucratic settings has accelerated rapidly in the last few decades (Mechanic, 1976). Practitioners and health services researchers have come to increasingly appreciate the extent to which these organizational settings influence patient behaviors. These influences are difficult to study because they usually involve comparing different kinds of patients across a variety of organizations. Nevertheless, there has appeared a small but significant body of theory and research guiding our understanding of these organizational influences on patient health behaviors. This chapter will describe a particular theoretical perspective to explain organizational behaviors vis-à-vis patients and to interpret data about patient behavior in different organizational contexts.


Health Care Organization Community Mental Health Center Patient Behavior Health Service Researcher Bureaucratic Organization 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Anderson, J. G., & Bartkus, D. E. (1973). Choice of medical care: A behavioral model of health and illness behavior. Journal of Health and Social Behavior, 14, 348–362.PubMedCrossRefGoogle Scholar
  2. Anderson, O. (1985). Health services in the United States. Ann Arbor: Health Administration Press.Google Scholar
  3. Anderson, O. W., & Sheatsley, P. B. (1959). Comprehensive medical insurance—A study of costs, use, and attitude under two plans. Chicago: Health Information Foundation, Research Service 9.Google Scholar
  4. Baekeland, F., & Lundwall, L. (1975). Dropping out of treatment: A critical review. Psychological Bulletin, 82(5), 738–783.PubMedCrossRefGoogle Scholar
  5. Barth, E. A. (1963). The causes and consequences of interagency conflict. Sociological Inquiry, 33, 51–57.CrossRefGoogle Scholar
  6. Bashshur, R. L., Metzner, C. A., & Warden, C. (1967). Consumer satisfaction with group practice, the CHA case. American Journal of Public Health, 57, 1991–1999.PubMedCrossRefGoogle Scholar
  7. Becker, M., Drachman, R., & Kirscht, J. (1974). A field experiment to evaluate various outcomes of continuity of physician care. American Journal of Public Health, 64, 1062–1070.PubMedCrossRefGoogle Scholar
  8. Black, B. J., & Krause, H. M. (1963). Inter-agency cooperation in rehabilitation and mental health. Social Service Review, 37, 26–32.CrossRefGoogle Scholar
  9. Brooks, A. D. (1974). Law, psychiatry, and the mental health system. Boston: Little, Brown & Co.Google Scholar
  10. Brown, P. (1985). The transfer of care. London: Routledge & Kegan Paul.Google Scholar
  11. Cahal, M. F. (1962). What the public thinks of the family doctor: Folklore and facts. General Practice, 25, 146–157.Google Scholar
  12. Cartwright, A. (1967). Patients and their doctors: A study of general practice. London: Routledge & Kegan Paul.Google Scholar
  13. Comstock, L. N., & Sloan, D. (1973). A health survey of students. II. Satisfaction, attitudes, and knowledge. Journal of the American College of Health Association, 22, 156–159.Google Scholar
  14. Connery, R. H. (1968). The politics of mental health. New York: Columbia University Press.Google Scholar
  15. Cumming, E. (1967). Allocation of care to the mentally ill. In M. N. Zald (Ed.), Organizing for community welfare (pp. 109–159). Chicago: Quadrangle.Google Scholar
  16. Davidson, R. E., & Factor, R. M. (1987). Undesirable patients in psychiatry. Unpublished manuscript, Department of Psychiatry, University of Wisconsin.Google Scholar
  17. Davidson, R. E., & Factor, R. M. (1988). Psychiatric nursing roles in a community mental health center. Community Mental Health Journal, 24, 83–86.PubMedCrossRefGoogle Scholar
  18. Davidson, R. E., & McKee, D. (1986, August). Ideology, expressed emotion, and the Alliance for the Mentally Ill. Paper presented at the annual meeting of the Society for the Study of Social Problems, New York.Google Scholar
  19. Davie, J. S., Goldberg, B., & Rowe, D. S. (1974). Consumer acceptance of Yale health plan. Journal of the American College of Health Association, 22, 325–331.Google Scholar
  20. D’Onofrio, C. N., & Mullen, P. D. (1977). Consumer problems with prepaid health plans in California. Public Health Reports, 92(2), 121–134.PubMedGoogle Scholar
  21. Elling, R. H. (1963). The hospital support game in urban centers. In E. Freidson (Ed.), The hospital in modern society (pp. 87–88). Glencoe, IL: Free Press.Google Scholar
  22. Elliot, J. L. (1972). Cultural barriers to the utilization of health services. Inquiry, 9(4), 28–35.Google Scholar
  23. Fisher, A. W. (1971). Patients’ evaluation of outpatient medical care. Journal of Medical Education, 46, 238–244.PubMedGoogle Scholar
  24. Francis, V., Korsch, B., & Morris, M. (1969). Gaps in doctor-patient communication: Patient response to medical advice. New England Journal of Medicine, 10, 535–540.CrossRefGoogle Scholar
  25. Gartner, A., & Riessman, F. (1977). Self-help in the human services. San Francisco: Jossey-Bass.Google Scholar
  26. Gouldner, A. W. (1959). Organizational analysis. In R. K. Merton, L. Broom, & L. S. Cottrell, Jr. (Eds.), Sociology today (pp. 400–428). New York: Basic Books.Google Scholar
  27. Gray, P. G., & Cartwright, A. (1953). Choosing and changing doctors. Lancet, II, 1308–1309.CrossRefGoogle Scholar
  28. Greenley, J. R. (1980a). Sociocultural and psychological aspects of the utilization of health services. In M. H. Brenner, A. Mooney, & T. J. Nagy (Eds.), Assessing the contributions of the social sciences to health (pp. 169–207). Boulder: Westview.Google Scholar
  29. Greenley, J. R. (1980b). Organizational processes and client selectivity in social welfare services. In D. Grunow & F. Hegner (Eds.), Welfare or bureaucracy: Problems in matching welfare services to client needs (pp. 79–92). Cambridge, MA: Oelgeschlager, Gunn, & Hain.Google Scholar
  30. Greenley, J. R., & Kirk, S. (1973). Organizational characteristics of agencies and the distribution of services to applicants. Journal of Health and Social Behavior, 14, 70–79.PubMedCrossRefGoogle Scholar
  31. Greenley, J. R., & Kirk, S. (1976). Organizational influences on access to health care. Social Science and Medicine, 10, 317–322.PubMedCrossRefGoogle Scholar
  32. Greenley, J. R., & Schoenherr, R. (1981). Organization effects on client satisfaction with humaneness of service. Journal of Health and Social Behavior, 22, 2–18.PubMedCrossRefGoogle Scholar
  33. Haug, M., & Lavin, B. (1983). Consumerism in medicine. Beverly Hills: Sage.Google Scholar
  34. Herr, S. S., Arons, S., & Wallace, R. E. (1983). Legal rights and mental health care. Boston: Lexington.Google Scholar
  35. Hyman, M. D. (1970). Some links between source economic status and untreated illness. Social Science and Medicine, 4, 387–399.PubMedCrossRefGoogle Scholar
  36. Kasteler, J., Kane, R. L., Olsen, D. M., & Thetford, C. (1976). Issues underlying prevalence of “doctor’shopping” behavior. Journal of Health and Social Behavior, 17, 328–339.CrossRefGoogle Scholar
  37. Kindig, D. A., & Lastiri, S. (1986). Administrative medicine: A new medical specialty? Health Affairs, 5, 146–156.PubMedCrossRefGoogle Scholar
  38. Kirk, S., & Greenley, J. R. (1974). Denying or delivering services: The access problem. Social Work, 19, 439–447.Google Scholar
  39. Koos, E. (1954). The health of Regionville: What the people thought and did about it. New York: Columbia University Press.Google Scholar
  40. Levine, S., & White, P. E. (1961). Exchange as a conceptual framework for the study of interorganizational relationships. Administrative Science Quarterly, 5, 583–601.CrossRefGoogle Scholar
  41. Liebermann, M. A., Borman, L. D., Bond, G. R., Antze, P., & Levy, L. H. (1979). Self-help groups for coping with crises: Origins, members, processes, and impact. San Francisco: Jossey-Bass.Google Scholar
  42. Lorber, J., & Satow, R. (1977). Creating a company of unequals: Sources of stratification in a ghetto community mental health center. Sociology of Work and Occupations, 4, 281–302.CrossRefGoogle Scholar
  43. Lorber, J., & Satow, R. (1978). Cultural congruity and the use of indigenous paraprofessionals in community mental health work. Sociological Symposium, 23, 17–26.Google Scholar
  44. Mechanic, D. (1976). The growth of bureaucratic medicine. New York: Wiley.Google Scholar
  45. Merton, R. K. (1968). Social theory and social structure. New York: Free Press.Google Scholar
  46. Meyer, M. W. (1975). Organizational domains. American Sociological Review, 40, 599–615.CrossRefGoogle Scholar
  47. Mott, B. J. F. (1968). Anatomy of a coordinating council. Pittsburgh, PA: Pittsburgh Press.Google Scholar
  48. Nagi, S. Z. (1974). Gate-keeping decisions in service organizations: When validity fails. Human Organization, 31, 47–58.Google Scholar
  49. Noyes, R. W., Levy, M. I., Chase, C. L., & Vory, J. R. (1974). Expectation fulfillment as a measure of patient satisfaction. American Journal of Obstetrics and Gynecology, 118, 809–814.PubMedGoogle Scholar
  50. Olsen, D. M., Kane, R. L., & Kasteler, J. (1976). Medical care as a commodity: An explanation of the shopping behavior of patients. Journal of Community Health, 2, 85–91.PubMedCrossRefGoogle Scholar
  51. Papper, S. (1970). The undesirable patient. Journal of Chronic Diseases, 22, 777–779.PubMedCrossRefGoogle Scholar
  52. Parkin, D. M. (1976). Survey of the success of communications between hospital staff and patients. Public Health, 90, 203–209.PubMedCrossRefGoogle Scholar
  53. Perrow, C. (1979). Complex organizations. Glenview, IL: Scott, Foresman.Google Scholar
  54. Peyrot, M. (1982). Caseload management: Choosing suitable clients in a community health clinic agency. Social Problems, 30, 157–167.CrossRefGoogle Scholar
  55. Rein, M. (1980). Fact and function in human services organizations. Sociology and Social Research, 65, 78–93.Google Scholar
  56. Robinson, D. (1971). The process of becoming ill. London: Routledge & Kegan Paul.Google Scholar
  57. Rosengren, W. R. (1970). The careers of clients and organizations. In W. R. Rosengren & M. Lefton (Eds.), Organizations and clients (pp. 117–135). Columbus, OH: Merrill.Google Scholar
  58. Ross, C., & Duff, R. (1982). Returning to the doctor: The effects of client characteristics, type of practice, and experiences with care. Journal of Health and Social Behavior, 23, 119–131.PubMedCrossRefGoogle Scholar
  59. Rothman, D. J. (1971). The discovery of the asylum. Boston: Little, Brown.Google Scholar
  60. Rothman, D. J. (1980). Conscience and convenience: The asylum and its alternatives in progressive America. Boston: Little, Brown.Google Scholar
  61. Rubington, E. (1965). Organizational strains and key roles. Administrative Science Quarterly, 9, 350–369.CrossRefGoogle Scholar
  62. Sapolsky, H. M. (1977). America’s socialized medicine: The allocation of resources within the veteran’s health care system. Public Policy, 25, 359–382.PubMedGoogle Scholar
  63. Schulz, R., Greenley, J. R., & Peterson, W. (1984). Differences in direct costs between public specialty hospital and private community general hospital acute in-patient services. Inquiry, 21, 380–393.PubMedGoogle Scholar
  64. Schwartz, B. (1974). Waiting, exchange, and power: The distribution of time in social systems. American Journal of Sociology, 79, 841–870.CrossRefGoogle Scholar
  65. Schwartz, B. (1975). Queuing and waiting. Chicago: University of Chicago Press.Google Scholar
  66. Scott, R. A. (1969). The making of blind men. New York: Russell Sage Foundation.Google Scholar
  67. Sills, D. L. (1957). The volunteers. Glencoe, IL: Free Press.Google Scholar
  68. Stanton, E. (1970). Clients come last. Beverly Hills: Sage.Google Scholar
  69. Tessler, R. C., Killian, L. M., & Gubman, G. D. (1987). Stages in family response to mental illness: An ideal type. Psychosocial Rehabilitation Journal, 10, 3–16.Google Scholar
  70. Thompson, F. (1981). Health policy and the bureaucracy. Cambridge, MA: MIT Press.Google Scholar
  71. Thompson, J. D. (1962). Organizations and output transactions. American Journal of Sociology, 68, 309–324.CrossRefGoogle Scholar
  72. Thompson, J. D. (1967). Organizations in action. New York: McGraw-Hill.Google Scholar
  73. Ware, J. E., Snyder, M. K., & Wright, W. R. (1976). Development and validation of scales to measure patient satisfaction with health care services. Carbondale: Southern Illinois University School of Medicine.Google Scholar
  74. Wasserman, H. (1971). The professional social worker in a bureaucracy. Social Work, 16, 89–95.Google Scholar
  75. Weber, M. (1946). On bureaucracy. In H. H. Gerth & C. W. Mills (Eds.), From Max Weber. New York: Oxford University Press.Google Scholar
  76. Wilensky, H., & Lebeaux, C. N. (1958). Industrial society and social welfare. New York: Free Press.Google Scholar
  77. Wilkie, C. V., & Notkin, H. (1958). Community organization for health: A case study. In E. G. Jaco (Ed.), Patients, physicians and illness (pp. 148–159). Glencoe, IL: Free Press.Google Scholar

Copyright information

© Springer Science+Business Media New York 1988

Authors and Affiliations

  • James R. Greenley
    • 1
  • Robert E. Davidson
    • 2
  1. 1.Department of SociologyUniversity of WisconsinMadisonUSA
  2. 2.Department of Social ScienceIllinois Institute of TechnologyChicagoUSA

Personalised recommendations