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Medical Care Research and Review
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Toward the Creation of an Institutional Logic for the Management of Hospitals: Efficiency in the Early Nineteen Hundreds

Margarete Arndt

Clark University

Barbara Bigelow

Clark University

This research focuses on the creation of an institutional logic—efficiency—and on its organizing principles of standardization and business practices through a study of the American Hospital Association and its publication, the Modern Hospital. In the early years of the 20th century, efficiency began to emerge as a first institutional logic for the management of hospitals. The term was defined broadly, encompassing not only economy but also quality and breadth of services, as well as access to care. This early emphasis on efficiency foreshadowed three issues that affect health policy and hospital management to this day: the pressure on hospitals to introduce new technology while containing cost, the assumption that hospitals should act like businesses, and the practice of offering large hospitals as the model for other providers.

Key Words: hospital management • hospital history • efficiency • institutional logic

Medical Care Research and Review, Vol. 63, No. 3, 369-394 (2006)
DOI: 10.1177/1077558706287044
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