Heterogenous Brokerage Dynamics and Organizational Performance: Improving Patient Safety in American Acute Care Hospitals
Abstract
Organization and management studies contend that firm performance and intra-organizational professional relations are theoretically important, but few studies have directly assessed the connection between them. In this paper, we expand on the idea of a brokerage profession by hypothesizing two ways that such a profession can collaborate cross-professionally. We argue that a brokerage profession can connect with specific brokerage partners from other professional and occupational groups, and they can engage in generalized brokerage with a profession or occupational group as a whole within an organization rather than specific representatives of the group. We find that specific brokerage does not directly affect organizational performance, but it operates indirectly through generalized brokerage. Organizational performance will likely improve when brokerage professions achieve generalized brokerage with lower-status occupational groups that perform "scut work." We illustrate these arguments with quantitative analyses of infection preventionists’ brokerage with nurses and doctors as part of their work to reduce healthcare-associated infections. Using data from a representative sample of 193 acute care hospitals in the United States, we show that generalized brokerage with nurses reduces rates of catheter-associated urinary tract infections and can save the healthcare system an estimated $120 million annually.