Thomas D'Aunno
Thomas D'Aunno
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Professor of Public Health, NYU School of Global Public Health
Professor of Management, NYU Wagner Graduate School of Public Service
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Professional overview
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Thomas D'Aunno, Ph.D., is Professor of Management at New York University’s Wagner Graduate School of Public Service and Professor of Public Health at NYU’s School of Global Public Health. His research interests include institutional theory, organizational change, and the performance of healthcare organizations. D’Aunno was previously a faculty member at Columbia University, the University of Chicago, the University of Michigan, and INSEAD, where he held the Novartis Chair in Healthcare Management. He is published in leading management and health journals, including Administrative Science Quarterly, the Academy of Management Journal, Academy of Management Review, Annals of the Academy of Management, the Journal of the American Medical Association, Milbank Quarterly, American Journal of Public Health and Health Affairs. He served as Editor-in-Chief of Medical Care Research and Review, 2014-2018. He also is a past chair of the Academy of Management Division of Health Care Management, and a recipient of its Provan Award for distinguished career contributions to research in healthcare management and the Fottler award for distinguished service to the field.
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Education
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Ph.D., Organizational Psychology, University of Michigan, Ann Arbor, MichiganUniversity of Maryland, Community-Clinical Psychology, Baltimore County, MarylandB.A., Psychology, Magna Cum Laude, University of Notre Dame, Notre Dame, Indiana
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Publications
Publications
Deborah Jamieson and the University College London Hospitals
AbstractBattilana, J., Cagna, A.-M., Gilmartin, M., D’Aunno, T., & D’Aunno, T. (n.d.).Publication year
2006Abstract~Insights from a national survey into why substance abuse treatment units add prevention and outreach services
AbstractWells, R., Lemak, C. H., D’Aunno, T., & D’Aunno, T. (n.d.).Publication year
2006Journal title
Substance Abuse: Treatment, Prevention, and PolicyVolume
1Issue
1AbstractBackground: Previous studies have found that even limited prevention-related interventions can affect health behaviors such as substance use and risky sex. Substance abuse treatment providers are ideal candidates to provide these services, but typically have little or no financial incentive to do so. The purpose of this study was therefore to explore why some substance abuse treatment units have added new prevention and outreach services. Based on an ecological framework of organizational strategy, three categories of predictors were tested: (1) environmental, (2) unit-level, and (3) unit leadership. Results: A lagged cross-sectional logistic model of 450 outpatient substance abuse treatment units revealed that local per capita income, mental health center affiliation, and clinical supervisors' graduate degrees were positively associated with likelihood of adding prevention-related education and outreach services. Managed care contracts and methadone treatment were negatively associated with addition of these services. No hospital-affiliated agencies added prevention and outreach services during the study period. Conclusion: Findings supported the study's ecological perspective on organizational strategy, with factors at environmental, unit, and unit leadership levels associated with additions of prevention and outreach services. Among the significant predictors, ties to managed care payers and unit leadership graduate education emerge as potential leverage points for public policy. In the current sample, units with managed care contracts were less likely to add prevention and outreach services. This is not surprising, given managed care's emphasis on cost control. However, the association with this payment source suggests that public managed care programs might affects prevention and outreach differently through revised incentives. Specifically, government payers could explicitly compensate substance abuse treatment units in managed care contracts for prevention and outreach. The effects of supervisor graduate education on likelihood of adding new prevention and outreach programs suggests that leaders' education can affect organizational strategy. Foundation and government officials may encourage prevention and outreach by funding curricular enhancements to graduate degree programs demonstrating the importance of public goods. Overall, these findings suggest that both money and professional education affect substance abuse treatment unit additions of prevention and outreach services, as well as other factors less amenable to policy intervention.Leadership and Change : Martin McShane at the Moss Valley Practice
AbstractBattilana, J., Cagna, A.-M., Gilmartin, M., D’Aunno, T., & D’Aunno, T. (n.d.).Publication year
2006Abstract~Outpatient substance abuse treatment and HIV prevention : An update
AbstractD’Aunno, T., D’Aunno, T., Pollack, H. A., D'Aunno, T., & Lamar, B. (n.d.).Publication year
2006Journal title
Journal of Substance Abuse TreatmentVolume
30Issue
1Page(s)
39-47AbstractTesting and counseling, along with community outreach, have been identified as valuable in the prevention of human immunodeficiency virus (HIV) and other blood-borne diseases. This article assesses the extent to which outpatient substance abuse treatment (OSAT) programs provide such services. Longitudinal data for 1988-2000 were analyzed from the National Drug Abuse Treatment System Survey (NDATSS). Random-effects regression was used to examine factors associated with the provision of prevention services. HIV testing, which had became more common between 1990 and 1995, continued to proliferate between 1995 and 2000. The proportion of units that provide HIV testing and counseling increased from 66% to 86%. The proportion of units that provide HIV community outreach increased significantly before 1995 but then slightly decreased from 77% to 73% between 1995 and 2000. In conclusion, HIV testing and counseling widely proliferated in OSAT care. However, OSAT units remain less likely to offer HIV community outreach services.Robert Jones and the Eastbourne NHS Orthotics Clinic : Make or Buy?
AbstractCagna, A.-M., D’Aunno, T., D’Aunno, T., & Gilmartin, M. (n.d.).Publication year
2006Abstract~Service Redesign at South Devon NHS Trust (A&B) : Make or Buy?
AbstractBattilana, J., Cagna, A.-M., Gilmartin, M., D’Aunno, T., & D’Aunno, T. (n.d.).Publication year
2006Abstract~The role of organization and management in substance abuse treatment : Review and roadmap
AbstractD’Aunno, T., D’Aunno, T., & D'Aunno, T. (n.d.).Publication year
2006Journal title
Journal of Substance Abuse TreatmentVolume
31Issue
3Page(s)
221-233AbstractTo develop an understanding as to why there exists a seemingly wide gap between research and practice in the field of substance abuse treatment and, more important, to understand how this gap can be closed, researchers have focused their attention on the role of organizational and management factors in the delivery of treatment services. This article's overarching goal is to stimulate research and interventions that focus on these factors so as to improve the standards and outcomes of care in substance abuse treatment. Part 1 introduces the key assumptions and perspectives that guide organization and management research. Part 2 selectively reviews empirical studies that examine relationships between treatment programs' use of research-based treatment practices and organization and management factors. The article concludes with a discussion of the next important steps for research and policy.Factors associated with interorganizational relationships among outpatient drug treatment organizations 1990-2000
AbstractD’Aunno, T., D’Aunno, T., Wells, R., Lemak, C. H., & D'Aunno, T. A. (n.d.).Publication year
2005Journal title
Health Services ResearchVolume
40Issue
5 IPage(s)
1356-1378AbstractObjective. To identify the factors associated with drug abuse treatment center participation in interorganizational relationships (IORs). Data Sources. Three nationally representative samples of outpatient drug abuse treatment units surveyed in 1990, 1995, and 1999/2000 as part of the National Drug Abuse Treatment System Survey (NDATSS), stratified by public/private status, treatment modality (methadone or nonmethadone), and organizational affiliation. Study Design. Probit analyses on 647 lagged treatment center-year observations from the years 1990 to 1995 with outcomes in 1995 and 2000, respectively. Standard errors were adjusted for clustering of center-year observations within centers. Principal Findings. Centers with greater motivation to form IORs (e.g., as a result of client diversity or government revenue) were more likely to do so, as were centers with greater opportunities to form IORs (e.g., centers whose directors participated in policy making). Conclusions. Both motivating and enabling factors promoted the formation of IORs by drug abuse treatment centers. Managed care also played a distinct role, in this case appearing to undermine interorganizational cooperation. Because IORs can improve access to care and quality, policy makers should consider using both incentives and support such as management training to promote IOR formation.Factors Associated with Interorganizational Relationships among Outpatient Drug Treatment Organizations 1990-2000 : IORs among Outpatient Drug Treatment Organizations
AbstractD’Aunno, T., D’Aunno, T., Wells, R., Lemak, C. H., & D'aunno, T. A. (n.d.).Publication year
2005Journal title
Health Services ResearchVolume
40Issue
5p1Page(s)
1356-1378Abstract~Management scholars and public policy : A bridge too far?
AbstractD’Aunno, T., D’Aunno, T., & D'Aunno, T. (n.d.).Publication year
2005Journal title
Academy of Management JournalVolume
48Issue
6Page(s)
949-951Abstract~Organizational survival in the outpatient substance abuse treatment sector, 1988-2000
AbstractD’Aunno, T., D’Aunno, T., Wells, R., Lemak, C. H., & D'Aunno, T. A. (n.d.).Publication year
2005Journal title
Medical Care Research and ReviewVolume
62Issue
6Page(s)
697-719AbstractSubstance abuse remains one of the most pressing health issues in the United States today, yet treatment supply continues to lag far behind need. Given the hostile environments treatment facilities face, their survival is a matter of pressing policy concern. Results from analyses of National Drug Abuse Treatment System Survey (NDATSS) data from 1988 through 2000 suggest that organizational attributes such as age, size, and client severity and resource dependencies such as reliance on government revenue affect survival, but their effects change over time. By the mid-1990s, director involvement in state and local policy making was positively associated with subsequent survival; later that decade, directors' professional credentials affected survival as well. Results also show that serving clients with multiple substance abuse problems became a survival liability by the late 1990s. Facilities that treat clients with multiple addictions may need additional financial support to serve these particularly vulnerable clients.Perspectives on how goverments matter
AbstractD’Aunno, T., D’Aunno, T., Ring, P. S., Bigley, G. A., D'Aunno, T., & Khanna, T. (n.d.).Publication year
2005Journal title
Academy of Management ReviewVolume
30Issue
2Page(s)
308-320AbstractThis special topic forum explores how governments matter in a number of ways: the extent to which government action can foster industry creation and economic development, the impact of corrupt governments on firm-level decision making by managers of multinational enterprises, the concept of the attractiveness of political markets and the impacts they can have on firm-level strategies, and how deregulation can affect the governance mechanisms of firms. Here we offer readers four views on research issues intended to complement the STF articles and to suggest other avenues for fruitful research.Gender differences in the impact of comprehensive services in substance abuse treatment
AbstractD’Aunno, T., D’Aunno, T., Marsh, J. C., Cao, D., & D'Aunno, T. (n.d.).Publication year
2004Journal title
Journal of Substance Abuse TreatmentVolume
27Issue
4Page(s)
289-300AbstractThis study examines the impact of comprehensive services on treatment outcomes for women and men. The study uses data collected from 1992 to 1997 for the National Treatment Improvement Evaluation Study, a prospective, cohort study of substance abuse treatment programs and their clients. The analytic sample consists of 3,142 clients (1,123 women and 2,019 men) from 59 treatment facilities. The results show that substance abuse treatment benefits both women and men. Further, both women and men benefit from comprehensive services provided as part of substance abuse treatment: specifically, the receipt of educational, housing and income support services is related to reduced post-treatment substance abuse for both women and men. Gender differences are revealed by the fact that, overall, greater proportions of women receive services and, when individual, service, and treatment organizational characteristics are controlled, women show greater reductions in post-treatment substance use. Further, women and men differ in their responsiveness to organizational characteristics: the availability of on-site services and the frequency of counseling significantly predict reduced post-treatment substance use for men but not for women.Globalization and its many faces : The case of the health sector
AbstractBurns, L. R., D’Aunno, T., D’Aunno, T., & Kimberly, J. R. (n.d.).Publication year
2004Page(s)
395-421AbstractPrevious chapters in this book have addressed particular challenges that firms face as they globalize, such as governance or branding or supply chain management. Or they have addressed themes in globalization such as the cross-border funding of entrepreneurial ventures or government responses to globalization issues. This chapter addresses the many faces of globalization as they play out in the management decisions within a particular sector of national economies- healthcare. The authors examine the complex forces driving and impeding globalization, and the opportunities they create for different players in different places in the world. Rolf Schmidt, the CEO of a major global pharmaceutical company, looks out of his office at the twinkling lights of a major European city that has been its home for more than a century. The current conglomerate that occupies these offices bears little relationship to the sleepy little chemical company that was founded in the historic offices where the chief executive now paces late into the night. The company now operates across a global patchwork of complex regulations governing its pricing, advertising, and drug development and approval. Its research and development organization is stretched across diverse centers in the United States, Europe, and Asia. Its marketing initiatives are a combination of resource-intensive global brands and increasingly tightly tailored local brands. Its global supply chains and financing create new risks and make the company susceptible to unexpected shocks as it gears up for the rapid production of new drugs that have an ever-narrower window of opportunity.Globalization in the health care sector
AbstractD’Aunno, T., D’Aunno, T., Burns, L., & Kimberly, J. R. (n.d.).Publication year
2004Abstract~Accessibility of addiction treatment : Results from a national survey of outpatient substance abuse treatment organizations
AbstractD’Aunno, T., D’Aunno, T., Friedmann, P. D., Lemon, S. C., Stein, M. D., & D'Aunno, T. A. (n.d.).Publication year
2003Journal title
Health Services ResearchVolume
38Issue
3Page(s)
887-903AbstractObjectives. This study examined organization-level characteristics associated with the accessibility of outpatient addiction treatment. Methods. Program directors and clinical supervisors from a nationally representative panel of outpatient substance abuse treatment units in the United States were surveyed in 1990, 1995, and 2000. Accessibility was measured from clinical supervisors' reports of whether the treatment organization provided "treatment on demand" (an average wait time of 48 hours or less for treatment entry), and of whether the program turned away any patients. Results. In multivariable logistic models, provision of "treatment on demand" increased two-fold from 1990 to 2000 (OR, 1.95; 95 percent CI, 1.5 to 2.6), while reports of turning patients away decreased nonsignificantly. Private for-profit units were twice as likely to provide "treatment on demand" (OR, 2.2; 95 percent CI, 1.3 to 3.6), but seven times more likely to turn patients away (OR, 7.4; 95 percent CI, 3.2 to 17.5) than public programs. Conversely, units that served more indigent populations were less likely to provide "treatment on demand" or to turn patients away. Methadone maintenance programs were also less likely to offer "treatment on demand" (OR,.65; 95 percent CI, .42 to .99), but more likely to turn patients away (OR, 2.4; 95 percent CI, 1.4 to 4.3). Conclusions. Although the provision of timely addiction treatment appears to have increased throughout the 1990s, accessibility problems persist in programs that care for indigent patients and in methadone maintenance programs.Alternative perspectives on institutional and market dynamics in the US healthcare sector
AbstractD’Aunno, T., D’Aunno, T., & Alexander, J. A. (n.d.).Publication year
2003Abstract~Community referral sources and entry of treatment-naïve clients into outpatient addiction treatment
AbstractD’Aunno, T., D’Aunno, T., Friedmann, P. D., Lemon, S. C., Stein, M. D., & D'Aunno, T. A. (n.d.).Publication year
2003Journal title
American Journal of Drug and Alcohol AbuseVolume
29Issue
1Page(s)
105-115AbstractThis study assessed the association of sources of client referral with enrollment of treatment-naïve clients. Data from the 1995 (n = 618) and 2000 (n = 745) waves of the National Drug Abuse Treatment Survey (DATSS), a panel study of outpatient substance abuse treatment units (OSAT), were analyzed. Enrollment of treatment-naïve clients was defined as the percentage of OSAT clients who entered treatment in the past 30 days with no prior treatment for substance abuse. A generalized estimating equation model simultaneously assessed the association of each referral source with the dependent variable, while controlling for potential confounding and accounting for correlation of unit-level responses over time. In the multivariable model, OSAT units with a greater proportion of treatment naïve clients had received more referrals from employee assistance programs and the criminal justice system, and fewer referrals from mental health agencies. No effect of referral from medical or social service agencies was observed. These results highlight the role of coercive community institutions in treatment outreach efforts to persons in earlier phases of the "addiction career".Trends in comprehensive service availability in outpatient drug abuse treatment
AbstractD’Aunno, T., D’Aunno, T., Friedmann, P. D., Lemon, S. C., Durkin, E. M., & D'Aunno, T. A. (n.d.).Publication year
2003Journal title
Journal of Substance Abuse TreatmentVolume
24Issue
1Page(s)
81-88AbstractComprehensive medical and psychosocial services are essential to quality addiction treatment, but their availability declined in the 1980s. To determine whether this downward trend in the availability of comprehensive services continued in the 1990s, we analyzed data from a national panel study of outpatient substance abuse treatment units in 1990, 1995, and 2000. Response rates were greater than 85%. Regarding the availability of comprehensive services, including physical examinations, routine medical care, mental health services, financial counseling and employment counseling, administrators reported whether any substance abuse treatment client received the service in the past year. With the exception of physical examinations, whose reported availability increased from 1990 to 1995, and financial counseling, whose reported availability decreased during the same time, the reported availability of comprehensive services changed little during the 1990s. These findings highlight the continuing need to monitor access to comprehensive services and other quality markers in addiction treatment over time.Changes in methadone treatment practices : Results from a national panel study, 1988-2000
AbstractD’Aunno, T., D’Aunno, T., D'Aunno, T., & Pollack, H. A. (n.d.).Publication year
2002Journal title
Journal of the American Medical AssociationVolume
288Issue
7Page(s)
850-856AbstractContext: Results from several studies conducted in the early 1990s showed that the majority of US methadone maintenance programs did not use treatment practices that met established standards for the care of heroin users. Effective treatment for heroin users is critical given the upsurge in heroin use and the continued role of injection drug use in the human immunodeficiency virus and hepatitis C epidemics. Objectives: To examine the extent to which US methadone maintenance treatment programs have made changes in the past 12 years to provide adequate methadone doses and to identify factors associated with variation in program performance. Design, Setting, and Participants: Program directors and clinical supervisors of nationally representative methadone treatment programs that varied by ownership (for-profit, public, or private not-for-profit) and setting (eg, free-standing, hospital-based) were surveyed in 1988 (n=172), 1990 (n=140), 1995 (n=116), and 2000 (n=150). Main Outcome Measures: Percentage of patients in each treatment program receiving methadone dosages of less than 40, 60, and 80 mg/d. Results: The percentage of patients receiving methadone dosage levels less than the recommended 60 mg/d has decreased from 79.5% in 1988 to 35.5% in 2000. Results also show that programs with a greater percentage of African American patients are especially likely to dispense low dosages, while programs with Joint Commission on Accreditation of Healthcare Organizations accreditation are more likely to provide adequate methadone doses. Conclusions: Efforts to improve methadone treatment practices appear to be making progress, but many patients are still receiving substandard care.Patient-physician communication as organizational innovation in the managed care setting
AbstractD’Aunno, T., D’Aunno, T., Levinson, W., D'Aunno, T., Gorawara-Bhat, R., Stein, T., Reifsteck, S., Egener, B., & Dueck, R. (n.d.).Publication year
2002Journal title
American Journal of Managed CareVolume
8Issue
7Page(s)
622-630AbstractDespite changes in the healthcare system, the relationship between patients and physicians remains fundamental to high-quality care. Managed care rules and restrictions, such as constraints on choice of providers, review processes, and decreasing length of visits, are creating potential conflicts between patients and their physicians. To strengthen the patient-physician relationship, some managed care organizations are implementing communication skills training for physicians. This article provides case studies describing how 2 large managed care organizations successfully incorporated communication skills training into their environments. An organizational perspective is used to delineate the 3 stages - adoption, implementation, and institutionalization - that managed care organizations generally traverse in incorporating communication skills programs and making them an integral part of their organizational culture. Specific suggestions are provided for physician leaders and administrators who are considering similar programs in their settings.Linkage to Medical Services in the Drug Abuse Treatment Outcome Study
AbstractD’Aunno, T., D’Aunno, T., Friedmann, P. D., Lemon, S. C., Stein, M. D., Etheridge, R. M., & D'Aunno, T. A. (n.d.).Publication year
2001Journal title
Medical careVolume
39Issue
3Page(s)
284-295AbstractBackground: An episode of substance abuse treatment is an opportunity to link substance-abusing patients to medical care at a time when management of medical problems might stabilize recovery and long-term health. However, little is known about the ability of organizational linkage mechanisms to facilitate the delivery of medical care to this population. Objectives: The goal of this study was to examine whether organizational linkage mechanisms facilitate medical service utilization in drug abuse treatment programs. Research design: This was a prospective secondary analysis of the Drug Abuse Treatment Outcome Study, a national longitudinal study of drug abuse treatment programs and their patients from 1991 to 1993. Hierarchical linear models evaluated the effect of on-site delivery, formal and informal referral, case management emphasis, and transportation on the log-transformed number of medical visits at the 1-month in-treatment patient interview. Measures: Program directors' surveys provided organizational information, including the linkage mechanism used to deliver medical care. Patients reported the number of medical visits during the first month of drug abuse treatment. Results: Exclusive on-site delivery increased medical utilization during the first month of drug abuse treatment (β estimate, 0.22; standard error [SE], 0.06; PManaging the care of health and the cure of disease : Arguments for the importance of integration
AbstractD’Aunno, T., D’Aunno, T., & D'Aunno, T. (n.d.).Publication year
2001Journal title
Health Care Management ReviewVolume
26Issue
1Page(s)
85-87Abstract~Selective contracting in managed care : The case of substance abuse treatment
AbstractD’Aunno, T., D’Aunno, T., Lemak, C. H., Alexander, J. A., & D'Aunno, T. A. (n.d.).Publication year
2001Journal title
Medical Care Research and ReviewVolume
58Issue
4Page(s)
455-481AbstractThe authors address two critical questions concerning managed care and outpatient substance abuse treatment organizations. Specifically, they consider (1) to what extent selective contracting occurs between managed care firms and treatment providers and (2) what attributes of treatment providers and their operating environments are associated with selective contracting. Using data from a nationally representative sample of outpatient treatment organizations, the authors find evidence of systematic selection. Several indicators of providers' quality and costs, including accreditation status, private ownership, size, and prior experience with managed care, are positively associated with managed care contracting. By contrast, units providing methadone treatment are less likely to be involved in managed care. To a lesser extent, characteristics of treatment providers' operating environment, including extent of competition based on costs and attributes of the Medicaid managed care program, are also positively associated with managed care contracting.The organization of service delivery. Overview.
AbstractD’Aunno, T., D’Aunno, T., & D'Aunno, T. (n.d.).Publication year
2001Journal title
Recent developments in alcoholism : an official publication of the American Medical Society on Alcoholism, the Research Society on Alcoholism, and the National Council on AlcoholismVolume
15Page(s)
3-7Abstract~
Contact
tdaunno@nyu.edu
New York, NY