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Professionalism, Organizations, and Compliance

Published online by Cambridge University Press:  27 December 2018

Toni Makkai  and
Valerie Braithwaite
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Abstract

Earlier studies haw shown that professional orientations are related to individual compliance with laws and regulations. However, no quantitative studies have focused on compliance at the organizational level and the professional orientations of the chief executive officer. Studies on dues and law breaking at the individual level have focused on professional orientations, but within an organization there are other aspects of professionalism that will be of import in determining the organization's compliance with the law. We posit that professionalism is a more complex notion for individuals located in an organizational setting. Utilizing data collected from 410 Australian nursing homes, which are characterized by a flat management structure, the data show that of three aspects of professionalism—orientation, values, and autonomy—it is professional autonomy that directly affects organizational compliance. However, the data do suggest that the relationship between professional orientations and organizational compliance are mediated by the complexity of the organization. Organizational culture is also shown to be an important factor in explaining compliance with the law.

Type
Articles
Information
Law & Social Inquiry , Volume 18 , Issue 1 , Winter 1993 , pp. 33 - 59
Copyright
Copyright © American Bar Foundation, 1993 

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References

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27 Quinney's measure of criminal violations was based on official state and federal records (11 Soc. Probs.: cited in note 3); Chappell and Barnes's measure of practice behavior comprised seven activities on which pharmacists assessed themselves (18 Soc. Sci. & Med.; cited in note 5). In this study one measure of compliance is presented—government-assessed compliance. We also had a second measure of compliance involving self-assessment. Self-assessed compliance was measured at the time of the interview with the director of nursing. The director was shown the ratings assigned to each of the standards by the inspection team and asked whether or not they agreed with the ratings. If they did not, they were then asked what they thought the correct racings were for the home. Mostly the director of nursing agreed with the inspection teams' assessment of the home. It is of note that there were occasions when the director of nursing assigned the home a lower rating than did the team. Clearly, these two measures of compliance are not independent, and this is shown by the high correlation between the official recording of compliance with the self-reported compliance—.88. For this reason we choose to only present results for government-assessed compliance. However, analysis of self-assessed compliance produced substantially the same results.Google Scholar

28 The average level of disability for each home was estimated by taking each resident's service need and multiplying it by the number of average hours of nursing and personal care (NPC) required per week by a resident with that classification. The residents service need (based on information supplied by the nursing home), also referred to as the resident's classification index (RCI), can range from 1 to 5. The standard hourly rates, as of 1 July 1988, are: 27 for an RCI of 1, 23.5 for an RCI of 2, 20 for an RCI of 3, 13 for an RCI of 4, and 10 for an RCI of 5 (Australian Department of Community Services & Health, New Nursing and Personal Care and Staffing and Funding Arrangements, 24 June 1988 (CNH 88003 (NG)).Google Scholar

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33 Unfortunately the data do not enable us to distinguish between sole owners and partners, and the two groups will be referred to as owners from this point on in the article.Google Scholar

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36 An ordinary least squares regression assumes that the model is linear and additive (Michael S. Lewis-Beck, Applied Regression: An Introduction (Beverly Hills, Cal.: Sage Publications, 1980). In estimating the model listwise deletion of missing data was used. Preliminary hierarchical regressions resulted in the same substantive conclusions drawn from the final model presented here. The exception was that when the organizational items were entered into the model as the first block, mean disability of residents was significant at.05 (one-tailed, same sign). These results are available from the authors on request.Google Scholar

37 This is true whether we use an official measure of organizational compliance or a self-reported measure of compliance.Google Scholar

38 As part of the funding arrangements all nursing homes are guaranteed a minimum occupancy rate of 98% by the federal government.Google Scholar

39 This was also found to be the case when we substituted the self-reported measure of organizational compliance for the government-assessed compliance measure.Google Scholar

40 A number of North American studies on type of nursing home and quality care have a significant correlation between compliance ratings and type of home ownership with for-profit homes having lower compliance. See Molloy, , 5 J. Long-Term Care Admin., and Koetting, Nursing Home Organization (both cited in note 31); Yong, 7 J. Health B Hum Resources Admin. (cited in note 32). An earlier study had shown no relationship between ownership and quality of care; see Holmberg & Anderson, 6 Medical Care (cited in note 32). A later study found an interaction between size and type of ownership in its impact on quality care. Large nonprofit homes had lower compliance than large for-profit homes. See Riportella-Muller & Slesinger, 22 Gerontologist (cited in note 30).Google Scholar