Hospital-Medical School Affiliation Agreements: An Organizational Analysis. Executive Summary

摘要

An organizational analysis of affiliation relations between medical schools and hospitals in a geographically bounded region is reported. Evan's theory of organization-sets, and the resource dependence model form the theoretical foundation for investigating the relationship between resource acquisition and the development of affiliations. A model of affiliation networking is developed based on three levels of stratification within classes of hospitals and two levels of stratification within classes of medical schools. Thompson and McEwen's distinction between bargaining and cooperative interorganizational relations is introduced as the basis for examining differences in relationships within contractual groups. Much of the authority and responsibility for the functioning of affiliation relations is delegated to chairmen of departments. The effects of boundary relations on levels and intensities of undergraduate medical education in hospital departments with aspects of the affiliation are examined. The theoretical implications of the results are reported and an assessment is made of the import of the findings with regard to the move toward regionalizing medical education.