MANAGING FOR THE HEALTH OF IT: TURBULENCE AND ORGANIZATIONAL PERFORMANCE IN THE AMERICAN PUBLIC HEALTHCARE SYSTEM

Government institutions are responsible for providing services to their citizens. However, these public organizations face great uncertainty in both their internal and external environment that can affect citizen client outcomes. Through a series of empirical tests, this dissertation explores how exogenous and endogenous organizational shocks impact the success of public service delivery and, furthermore, how public managers can buffer and harness shocks to increase organizational performance. First, this dissertation examines how changes in historical nurse turnover rates affects different conceptualizations of performance in Veterans Health Administration Medical Centers. The results of this investigation suggest that disruptions to average turnover rates induce heterogenous effects on a multi-dimensional set of performance indicators. Second, through focusing on the introduction of open-market privatization of government services brought forth by the Veterans Choice Act of 2014, this research unpacks how environmental characteristic can moderate the effects of policy changes. The findings here demonstrate that the performance impact of planned policy shocks can be dependent on features outside of the control of governments and managers. Third, this dissertation investigates how managers can harness resources from policy shocks and boost organizational performance. Specifically, this chapter investigates the interactive effects of human and financial capital by unpacking the case of California probation department performance in the age of Medicaid expansion. This evaluation of the interaction between organizational capacity and external financial resources implies that internal resources can boost the positive effects of policy shocks and generate greater department performance. The combined results of this research offer insights into how and why shocks, both internal and external to an agency, affect organizational performance, and how these shocks can be harnessed and buffered by public managers to improve outcomes for clients.