Organizational growth, survival and death in the U.S.

hospital industry: A population ecology perspective

Jeffrey A. Alexander1, Arnold D. Kaluzny2 and Suann C. Middleton3

1
Hospital Research and Educational Trust, 840 North Lake Shore Drive, Chicago, IL 60611, USA
2
Department of Health Policy and Administration, School of Public Health, University of North Carolina at Chapel Hill, 401 Pittsboro
3
Department of Health Administration, Duke University, Durham, NC 27706, U.S.A.

Available online 28 June 2002.

Abstract
This article develops an analytic framework for predicting organizational survival, growth and death in the
U.S. hospital industry. The population ecology perspective is used to identify the environmental conditions
under which health service organizations with specialist or generalist characteristics will survive. Hypotheses
derived from the framework focus on the particular form hospitals and multihospital systems will take, how
they are likely to develop and the configuration of the health care delivery system under different
assumptions about the environment.

Article Outline