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Using resource dependency theory to measure the environment in health care organizational studies: A systematic review of the literature

Yeager, Valerie A.; Menachemi, Nir; Savage, Grant T.; Ginter, Peter M.; Sen, Bisakha P.; Beitsch, Leslie M.

doi: 10.1097/HMR.0b013e3182826624

Background: Studies using the resource dependency theory (RDT) perspective commonly focus on one or more of the following environmental dimensions: munificence, dynamism, and complexity. To date, no one has reviewed the use of this theory in the health care management literature and there exists no consensus on how to operationalize the market environment in health care settings.

Purpose: The purpose of this review is to examine and summarize the ways in which RDT has been applied in empirical studies of the external environments of health care organizations. In so doing, we identify gaps in the literature and examine the extent to which previous empirical findings aligned with hypothesized relationships based on RDT.

Methodology: We conducted a systematic review of the peer-reviewed literature using a bibliographic search of PubMed and ABI/Inform databases. To identify all health care studies that incorporated the RDT perspective, the words “healthcare” or “health care” were searched in combination with any of the following words: resource dependency theory, uncertainty perspective, environment, munificence, dynamism, and complexity. We also performed a hand search of the reference lists of all manuscripts identified in the initial search to identify additional articles.

Findings: Twenty studies were included in this review. Wide variability existed in the number of variables used to measure the environment, the environmental constructs measured, and the specific variables used to operationalizethe environmental constructs. Of the 198 tests examining the relationship between environmental variables and the outcome of interest, 26.8% resulted in findings that supported the RDT-predicted hypotheses.

Practice Implications: The RDT literature is limited to studies of hospitals, nursing homes, and medical practices. There is little consensus on how to measure or operationalize the environment in these studies. No previous studies have measured the environment for other health care settings such as ambulatory surgery centers, public health departments, or assisted living facilities.

Valerie A. Yeager, DrPH, is Assistant Professor, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana. E-mail:

Nir Menachemi, PhD, MPH, is Professor, School of Public Health, University of Alabama at Birmingham. E-mail:

Grant T. Savage, PhD, is Professor, School of Business, University of Alabama at Birmingham. E-mail:

Peter M. Ginter, PhD, is Professor, School of Public Health, University of Alabama at Birmingham. E-mail:

Bisakha P. Sen, PhD, is Associate Professor, School of Public Health, University of Alabama at Birmingham. E-mail:

Leslie M. Beitsch, MD, JD, is Associate Dean for Health Affairs, College of Medicine, Florida State University, Tallahassee. E-mail:

The authors have disclosed that they have no significant relationship with, or financial interest in, any commercial companies pertaining to this article.

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins