Indiana Consortium For Mental Health
Services Research
Indiana University, Bloomington, Indiana

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Abstract

Reprint # 14: THE HUMAN AND ORGANIZATIONAL MARKERS HEALTH SYSTEM CHANGE: FRAMING STUDIES OF HOSPITAL DOWNSIZING AND CLOSURE

To date, health services research has not provided theoretical or methodological guidance to frame broad-based studies of how the massive shifts taking place in the health care system affect patients, families, health care workers, and organizations. In this paper, we develop a multidisciplinary framework that synthesizes insights from several lines of research, including organizational behavior; the stress, social support and network literatures; social psychology; and labor economics to examine the process and outcomes of system change. The framework suggests longitudinal and multilevel data collection efforts that chart the effects of change on the key stakeholders as well as how individual, organizational, and community factors buffer outcomes. As an example to tailor the framework to specific models for particular medical care sectors, we focus on the large-scale movement in mental health treatment from long-term institutional to community-based care for individuals with severe and persistent mental disorders. We describe the Central State Hospital Closing Study which used an earlier version of this approach to examine the impact of hospital closure across the spectrum of individuals and organizations involved.