Firms and Flexibility

As job security and long-term relationships between corporations and their white-collar workers become relics of the past, what will link these two parties in the future? According to HBS assistant professor Jeffrey L. Bradach, a new model based on flexibility may connect employers and employees. "The growth of staffing agencies suggests that we may be witnessing a slow recasting of the economy's institutional matrix where people are emerging as bundles of skills, organizations as constellations of projects, and agencies as brokers, certifiers, and developers of talent," he writes.

In his working paper "Flexibility: The New Social Contract between Individuals and Firms?," Bradach studies independent contractors, companies that use their services, and staffing agencies that bring the two parties together. "I'm trying to illuminate how this new way of organizing white-collar employment is structured," he says.

Gathering data from four temporary staffing agencies that focus on managerial and professional talent, Bradach interviewed 26 skilled temporary workers serving as independent contractors and 17 of their company clients. He found that by using contractors, companies gain flexibility in the range of projects they may undertake. "Hiring outside contractors is a way for managers to access the talent they need to get the work done," says Bradach.

Independent contractors reported a greater sense of accomplishment, as well as more autonomy and control over their time when contracting out their skills than when permanently employed. "This group clearly chose contracting as a way of working. This is not work of last resort," Bradach notes. The arrangement, he says, may give rise to a new pattern of loyalty, where contractors are committed to projects instead of companies, and agencies provide some of the health and other employee benefits once supplied by corporations.

Bradach hopes to learn whether the flexibility model represents a lasting shift in how work is to be organized. "Does this imply a new social contract? If so, who will be the winners and losers?" he asks. Bradach will continue to study these issues in future work.

Coordinating Patient Care

With tight hospital budgets and shorter hospital stays the norm today, hospitals must not only improve the coordination of patient care within their walls, but they must also communicate with a host of outside institutions to ensure that patients receive the necessary follow-up treatment. HBS assistant professor Jody Hoffer Gittell and her coauthor, Leigh M. Weiss, a doctoral student at Harvard University, are examining organizational practices that improve the coordination of patient care by encouraging effective communication among care providers.

In their working paper, "Networks and Organization Design: A Framework for Improving the Coordination of Patient Care," Gittell and Weiss argue that organization design needs to be paired with analysis of informal networks to help hospitals build cross-functional and cross-organizational teams that coordinate patient care more effectively. "Given the diversity of skills and backgrounds of doctors, nurses, therapists, social workers, and technicians, and the speed at which patients move through their hospital stays, there is ample opportunity for miscommunication," explains Gittell.

In interviewing health-care providers and administrators from nine major urban hospitals about their organizational practices, Gittell and Weiss found that hospitals are actively attempting to coordinate care using four mechanisms: case management (oversight of a patient's care on a case-by-case basis, from start to finish); care paths (preplanned procedural menus for certain illnesses and conditions); information systems (allowing accessibility of a patient's records through a central system); and patient rounds (regular meetings by physicians, nurses, and other care providers to assess the progress of patients).

The authors argue that the way hospitals hold care providers accountable for cost and quality outcomes also influences whether they work as members of individual disciplines and organizations or as members of a team. Human resource practices such as employee selection and conflict resolution affect how well care providers work together, as well.

Gittell and Weiss are currently surveying managers, care providers, and patients to further develop and test hypotheses about patient-care coordination. They hope to identify organizational practices that will help hospitals ensure healthy results for patients within and beyond their walls.

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