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Context in organizational groups: the case of hospital clusters.

Although previous research has shown that the structure of groups or clusters of hospitals depends upon environmental characteristics of local service areas, little work has been done to demonstrate the importance of specifying the appropriate environmental framework for hospital clusters of varying composition. Clusters composed of only community general hospitals are affected primarily by the characteristics of the local community or service area, whereas clusters composed of both community hospitals and tertiary care hospitals (such as teaching hospitals or Veterans' Administration Hospitals) must respond to both local contingencies and extra-local constraints, such as the regional demands for specialized care and the teaching andlor research activities of other tertiary care hospitals. Thus, the presence of a tertiary care facility within a hospital cluster may alter significantly the context of the cluster. Using longitudinal data on national samples of tertiary and nontertiary care settings, I tested several hypotheses concerning the structure and environmental responsiveness of community hospital clusters in these different contexts.