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
The organization of substance abuse managed care.
AbstractD’Aunno, T., D’Aunno, T., Sosin, M. R., & 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)
27-49AbstractManaged care came to dominate the delivery of substance abuse services during the 1990s. This paper uses literature and new data to describe and analyze the set of arrangements it implies. The description suggests that substance abuse managed care typically is "carved out" of the general health care plan and treatment is coordinated by a behavioral health managed care company that manages treatment access, length, type, and intensity. This administrative agent is provided financial incentives to keep costs low and otherwise faces such mandates as to ensure timely access to treatment and to deliver reports. A typical agent has some interest in improving the quality of decision-making, but has few incentives for controlling the treatment technology. In contrast, agents tend to control treatment providers through relatively rigid rules that substitute outpatient for inpatient care, regulate the length and intensity of services, provide limited social services, mandate accreditation, allow limited clinician discretion, administer an entire "network" of providers as an only slightly differentiated mass, and rarely shape the details of the treatment process. These patterns are analyzed in terms of transaction cost economics and institutional and resource dependency theories. In general, it is argued that managed care reflects an interest in controlling costs but also in ensuring access within an environment where there is uncertainty accompanying competing demands, varying conceptions of the client, and controversies over the efficacy of specific treatment technologies.Increasing access and providing social services to improve drug abuse treatment for women with children
AbstractD’Aunno, T., D’Aunno, T., Marsh, J. C., D’Aunno, T. A., & Smith, B. D. (n.d.).Publication year
2000Journal title
AddictionVolume
95Page(s)
1237-1247AbstractAims. To assess the impact of a substance abuse treatment program for women with children designed to increase access to treatment through transportation, outreach and child-care services. Also, to assess the impact of using access services on the use of other services and on treatment effectiveness. Design. A quasi-experimental non-equivalent control group design was used with path analysis to examine the impact of participation in an enhanced services program that provided transportation, outreach and child-care services on the use of other social services and on the use of alcohol and illicit drugs. Setting. Treatment clients were interviewed in- person at enhanced treatment programs and regular substance abuse programs. Participants. Study participants included a randomly selected sample of women with children who were clients of the Illinois Department of Children and Family Services. Participants were enrolled in enhanced or regular substance abuse treatment programs. Measurements. Study participants completed in-person interviews about their characteristics, services use and past and current substance use. Findings. Participation in the enhanced program was negatively related to substance use. Further, use of access services was related to use of social services which in turn, was negatively related to substance use. Conclusion. The study indicates that services that enhance access to treatment and respond to the range of social service needs of women are important for effective substance abuse treatment for women with children.Medical and psychosocial services in drug abuse treatment : Do stronger linkages promote client utilization?
AbstractD’Aunno, T., D’Aunno, T., Friedmann, P. D., D'Aunno, T. A., Jin, L., & Alexander, J. A. (n.d.).Publication year
2000Journal title
Health Services ResearchVolume
35Issue
2Page(s)
443-465AbstractObjective. To examine the extent to which linkage mechanisms (on-site delivery, external arrangements, case management, and transportation assistance) are associated with increased utilization of medical and psychosocial services in outpatient drug abuse treatment units. Data Sources. Survey of administrative directors and clinical supervisors from a nationally representative sample of 597 outpatient drug abuse treatment units in 1995. Study Design. We generated separate two-stage multivariate generalized linear models to evaluate the correlation of on-site service delivery, formal external arrangements (joint program/venture or contract), referral agreements, case management, and transportation with the percentage of clients reported to have utilized eight services: physical examinations, routine medical care, tuberculosis screening, HIV treatment, mental health care, employment counseling, housing assistance, and financial counseling services. Principal Findings. On-site service delivery and transportation assistance were significantly associated with higher levels of client utilization of ancillary services. Referral agreements and formal external arrangements had no detectable relationship to most service utilization. On- site case management was related to increased clients' use of routine medical care, financial counseling, and housing assistance, but off-site case management was not correlated with utilization of most services. Conclusions. On-site service delivery appears to be the most reliable mechanism to link drug abuse treatment clients to ancillary services, while referral agreements and formal external mechanisms offer little detectable advantage over ad hoc referral. On-site case management might facilitate utilization of some services, but transportation seems a more important linkage mechanism overall. These findings imply that initiatives and policies to promote linkage of such clients to medical and psychosocial services should emphasize on-site service delivery, transportation and, for some services, on-site case management.The financial performance of hospitals belonging to health networks and systems
AbstractD’Aunno, T., D’Aunno, T., Bazzoli, G. J., Chan, B., Shortell, S. M., & D'Aunno, T. (n.d.).Publication year
2000Journal title
InquiryVolume
37Issue
3Page(s)
234-252AbstractThe U.S. health industry is experiencing substantial restructuring through ownership consolidation and development of new forms of interorganizational relationships. Using an established taxonomy of health networks and systems, this paper develops and tests four hypotheses related to hospital financial performance. Consistent with our predictions, we find that hospitals in health systems that had unified ownership generally had better financial performance than hospitals in contractually based health networks. Among health network hospitals, those belonging to highly centralized networks had better financial performance than those belonging to more decentralized networks. However, health system hospitals in moderately centralized systems performed better than those in highly centralized systems. Finally, hospitals in networks or systems with little differentiation or centralization experienced the poorest financial performance. These results are consistent with resource dependence, transaction cost economics, and institutional theories of organizational behavior, and provide a conceptual and empirical baseline for future research.The role of institutional and market forces in divergent organizational change
AbstractD’Aunno, T., D’Aunno, T., Succi, M., & Alexander, J. A. (n.d.).Publication year
2000Journal title
Administrative Science QuarterlyVolume
45Issue
4Page(s)
679-703AbstractThis paper focuses on a radical change, in which organizations abandon an institutionalized template for arranging their core activities, that is likely to occur in organizational fields that have strong, local market forces and strong but heterogeneous institutional forces. We examine the role of market forces and heterogeneous institutional elements in promoting divergent change in core activities among all U.S. rural hospitals from 1984 to 1991. Results support the view that divergent change depends on both market forces (proximity to competitors, disadvantages in service mix) and institutional forces (state regulation, ownership and governance norms, and mimicry of models of divergent change).An institutional analysis of HIV prevention efforts by the nation's outpatient drug abuse treatment units
AbstractD’Aunno, T., D’Aunno, T., D'Aunno, T., Vaughn, T. E., & McElroy, P. (n.d.).Publication year
1999Journal title
Journal of health and social behaviorVolume
40Issue
2Page(s)
175-192AbstractDrawing from an institutional-theory perspective on innovations in organizations, this paper examines the use of human immunodeficiency virus (HIV) prevention practices by the nation's outpatient substance abuse treatment units during a critical period from 1988 to 1995. An institutional perspective argues that organizations adopt new practices not only for technical reasons, but also because external actors actively promote or model the use of particular practices. We examine the extent to which treatment units use several practices to prevent HIV infection among their clients and among drug-users not in treatment. Results from random-effects regression analyses of national survey data show that treatment units significantly increased their use of HIV prevention practices from 1988 to 1995. Further, the results show that treatment units' use of prevention practices was related to clients' risk for HIV infection, unit resources available to support these practices, and organizational support for the practices. Implications are discussed for an institutional view of organizational innovation as well as for research on HIV prevention.Changes in methadone treatment practices : Results from a panel study, 1988-1995
AbstractD’Aunno, T., D’Aunno, T., D'Aunno, T., Folz-Murphy, N., & Lin, X. (n.d.).Publication year
1999Journal title
American Journal of Drug and Alcohol AbuseVolume
25Issue
4Page(s)
681-699AbstractResults from several studies conducted in the late 1980s and early 1990s showed that the majority of the nation's methadone treatment units did not use effective treatment practices. Since then, however, many efforts have been made to improve critical treatment practices. This paper examines the extent to which key methadone treatment practices (dose levels, treatment duration, client influence in dose decisions) changed from 1988 to 1995 in a panel sample of methadone maintenance units. We also examine factors that may account for variation in methadone treatment practices. We use panel data from a national random sample of 172 units in 1988 (82% response rate), 140 units in 1990 (87% response rate), and 116 units in 1995 (89% response rate). Unit directors and clinical supervisors provided phone survey data on clients influence on doses, upper limits on doses, average dose levels, unit emphasis on decreasing doses, time when clients are encouraged to detoxify, and average length of treatment. Results from random effects regression analyses indicate that treatment practices concerning methadone dose levels, client influence in dose decisions, and treatment duration improved significantly between 1988 and 1995. Several characteristics of clients (race, age) and treatment units (staff, ownership, geographic location) are associated with the use of less-effective treatment practices. Efforts to improve treatment practices appear to be making progress and certainly need to be continued.Managing strategic alliances
AbstractZajac, E., D’Aunno, T., D’Aunno, T., & Burns, L. (n.d.). (S. Shortell & A. Kaluzny, Eds.; 4th ed.).Publication year
1999Abstract~Motivating People
AbstractD’Aunno, T., D’Aunno, T., Fottler, M., & O’Connor, S. (n.d.). (S. Shortell & A. Kaluzny, Eds.; 4th ed.).Publication year
1999Abstract~On-site primary care and mental health services in outpatient drug abuse treatment units
AbstractD’Aunno, T., D’Aunno, T., Friedmann, P. D., Alexander, J. A., Jin, L., & D'Aunno, T. A. (n.d.).Publication year
1999Journal title
Journal of Behavioral Health Services and ResearchVolume
26Issue
1Page(s)
80-94AbstractProviding health services to drug abuse treatment clients improves their outcomes. Using data from a 1995 national survey of 597 outpatient drug abuse treatment units, this article examines the relationship between these units' ouganizational features and the degree to which they provided on-site primary care and mental health services. In two-stage models, Joint Commission on Accreditation of Healthcare Organizations-certified and methadone programs delivered more on-site primary care services. Units affiliated with mental health centers provided more on-site mental health services but less direct medical care. Units with more dual-diagnosis clients provided more on-site mental health but fewer on-site HIV/AIDS treatment services. Organizational features appear to influence the degree to which health services are incorporated into drug abuse treatment. Fully integrated care might be an unattainable ideal for many such organizations, but quality improvement across the treatment system might increase the reliability of clients' access to health services.Organizational correlates of access to primary care and mental health services in drug abuse treatment units
AbstractD’Aunno, T., D’Aunno, T., Friedmann, P. D., Alexander, J. A., & D'Aunno, T. A. (n.d.).Publication year
1999Journal title
Journal of Substance Abuse TreatmentVolume
16Issue
1Page(s)
71-80AbstractPrimary care and mental health services improve drug abuse treatment clients' health and treatment outcomes. To examine the association between clients' access to these services and the characteristics of drug treatment organizations, we analyze data from a national survey of the unit directors and clinical supervisors of 618 outpatient drug abuse treatment programs in 1995 (88% response rate). In multivariate models controlling for client characteristics and urban location, public units, units with more human resources, and methadone programs delivered more primary care services. Public units, Joint Commission on Accreditation of Health Care Organizations- accredited units, nonmethadone units, and units with more staff psychiatrists or psychologists delivered more mental health services. We conclude that organizational factors may influence drug abuse treatment clients' access to primary care and mental health services. Changes in the treatment system that weaken or eliminate public programs over-burden staff, de-emphasize quality standards or lessen methadone availability may erode recovering clients' tenuous access to these services.A conceptual framework for the analysis of health care organizations' performance
AbstractD’Aunno, T., D’Aunno, T., Sicotte, C., Champagne, F., Contandriopoulos, A. P., Barnsley, J., Beland, F., Leggat, S. G., Denis, J. L., Bilodeau, H., Langley, A., Bremond, M., Baker, G. R., D'Aunno, T., & Fottler, M. D. (n.d.).Publication year
1998Journal title
Health Services Management ResearchVolume
11Issue
1Page(s)
24-48AbstractOrganizational performance remains an elusive concept despite its importance to health care organizations' (HCOs') management and analysis. This paper uses Parsons' social system action theory to develop a comprehensive theoretically grounded framework by which to overcome the current fragmented approach to HCO performance management. The Parsonian perspective focuses on four fundamental functions that an HCO needs to ensure its survival. Organizational performance is determined by the dynamic equilibrium resulting from the continual interaction of, and interchange among, these four functions. The alignment interchanges allow the creation of bridges between traditional models of organizational performance that are usually used as independent and competing models. The attraction of the Parsonian model lies in its capacity to: (1) embody the various dominant models of organizational performance; (2) present a strong integrative framework in which the complementarity of various HCO performance perspectives are well integrated while their specificity is still well preserved; and (3) enrich the performance concept by making visible several dimensions of HCO performance that are usually neglected. A secondary objective of this paper is to lay the foundation for an integrative process of arbitration among competing indicators and perspectives which is absolutely necessary to make operational the Parsonian model of HCO performance. In this matter, we make reference to the theory of communicative action elaborated by Habermas. It offers, we think, a challenging and refreshing perspective on how to manage HCO performance evaluation processes.Commentary 1
AbstractD’Aunno, T., D’Aunno, T., & D'aunno, T. (n.d.).Publication year
1998Journal title
Health Services Management ResearchVolume
11Issue
1Page(s)
41-43Abstract~Determinants of mental health providers' expectations of patients' improvement
AbstractD’Aunno, T., D’Aunno, T., Alexander, J. A., Lichtenstein, R., D'Aunno, T. A., McCormick, R., Muramatsu, N., & Ullman, E. (n.d.).Publication year
1997Journal title
Psychiatric ServicesVolume
48Issue
5Page(s)
671-677AbstractObjective: Characteristics of individual mental health providers and of treatment settings were examined to determine their effects on providers' expectations about the improvement of patients with serious mental illness. Methods: The sample consisted of 1,567 treatment providers working in 107 inpatient and outpatient units or programs in 29 Veterans Affairs mental health facilities. They completed a questionnaire about their prognostic expectations and a broad range of attitudes toward job satisfaction, professional relations, and team functioning. Unit or program directors of all 107 units completed another questionnaire about the average functional ability of patients, unit workload, and unit size. Hierarchical linear modeling was used to assess the effects of both individual and unit-level attributes on providers' expectations of improvement in clinical symptomatology and social-functional skills of patients in their care. Results: The providers had generally low expectations about the improvement of patients with serious mental illness. Expectations were higher among staff in units or programs that were smaller and that had an outpatient focus, a greater proportion of staff involved in the treatment team, and higher- functioning patients. Individual characteristics significantly associated with prognostic expectations were occupation, age, and membership on the treatment team. Conclusions: Prognostic expectations among providers of care to persons with serious mental illness vary with identifiable individual and unit or program characteristics. The latter may be amenable to manipulation and intervention to improve mental health providers' prognostic expectations.Leadership of Public Bureaucracies: The Administrator as Conservator, Larry D. Terry
AbstractD’Aunno, T., D’Aunno, T., & D'Aunno, T. (n.d.).Publication year
1997Journal title
Journal of Policy Analysis and ManagementVolume
16Issue
3Page(s)
489-492Abstract~Linking substance abuse treatment and primary health care
AbstractD’Aunno, T., & D’Aunno, T. (n.d.).Publication year
1997Abstract~Business as usual? Changes in health care's workforce and organization of work
AbstractD’Aunno, T., D’Aunno, T., D'Aunno, T., Alexander, J. A., & Laughlin, C. (n.d.).Publication year
1996Journal title
Hospital and Health Services AdministrationVolume
41Issue
1Page(s)
3-18AbstractMajor changes are occurring in the health care workforce and organization of work. Such changes include, for example, a shift in workforce composition from specialists to generalists in medical care, as well as a shift from autonomous work performance to work performed in teams. This article provides a survey of such major changes. It identifies patterns of change and examines their causes. Further, we raise questions about the implications of these changes for practice and research in the health care field.Determinants of Profound Organizational Change : Choice of Conversion or Closure among Rural Hospitals
AbstractAlexander, J. A., D’Aunno, T., D’Aunno, T., & Succi, M. J. (n.d.).Publication year
1996Journal title
Journal of health and social behaviorVolume
37Issue
3Page(s)
238-251AbstractBecause of severe operating and resource constraints, many rural community hospitals are confronted with pressures to abandon core strategies related to acute inpatient care. Little is known, however, about why hospitals would choose to convert to organizations that provide non-acute care health services as an alternative to closure. We argue that rural hospitals are more likely to convert when conditions are in place that enable them to make major shifts from their current domains to ones that are more hospitable. To the extent that resources are available in alternative domains and rural hospitals possess the strategies necessary to exploit these resources, rural hospitals are more likely to convert rather than close. To examine our proposed hypotheses, we analyze national data from all rural hospitals from 1984 through 1991. Results indicate that conversion is more likely to occur than closure when resources in the market are abundant, competition for hospital resources is high, and hospitals have established strategies to provide alternative forms of health care. Findings from this study indicate that environmental and organizational factors can increase a rural hospital's risk of conversion as an alternative to closure.Determinants of Rural Hospital Conversion a Model of Profound Organizational Change
AbstractD’Aunno, T., D’Aunno, T., Alexander, J. A., D'Aunno, T. A., & Succi, M. J. (n.d.).Publication year
1996Journal title
Medical careVolume
34Issue
1Page(s)
29-43AbstractOne widely discussed response to the severe problems faced by many rural hospitals is to convert them into organizations that provide health services other than general, acute inpatient care. This study identifies conversions that occurred nationally from 1984 to 1991. The study also empirically examines the determinants of conversion, using rural hospitals that did not convert (between 1984 and 1991) as a comparison group. The authors examine a set of factors that makes radical organizational change necessary (eg, poor performance) and reduces resistance to such change (eg, proximity to other hospitals). Results from discrete-time logistic regression show that converters are more likely than nonconverters to: have poor performance and fewer beds; be located very near to or very distant from similar hospitals; operate in larger communities; devote more of their care to areas other than acute inpatient care; and be members of multihospital systems. Converters also are less likely to be government owned. The need for future research on the effects of conversion is discussed.The effects of treatment team diversity and size on assessments of team functioning
AbstractD’Aunno, T., D’Aunno, T., Alexander, J. A., Lichtenstein, R., Jinnett, K., D'Aunno, T. A., & Ullman, E. (n.d.).Publication year
1996Journal title
Hospital and Health Services AdministrationVolume
41Issue
1Page(s)
37-53AbstractTeam-based health care assumes that groups representing multiple disciplines can work together to implement care plans that are comprehensive and integrated. It also assumes that professionals can function effectively in an interdependent relationship with members of other occupational groups. However, we know little about what makes effective team functioning. This article examines the factors related to health care team functioning, with specific emphasis on team demographic composition and size. Hierarchical linear modeling is used to analyze 106 multidisciplinary teams (1,060 members) that provide mental health care in 29 Veterans Affairs (VA) hospitals. Results indicate that individuals who operate on more heterogenous and larger teams have lower perceptions of team functioning.An organizational analysis of service patterns in outpatient drug abuse treatment units
AbstractD’Aunno, T., D’Aunno, T., D'Aunno, T., & Vaughn, T. E. (n.d.).Publication year
1995Journal title
Journal of substance abuseVolume
7Issue
1Page(s)
27-42AbstractThe effectiveness of drug abuse treatment depends in part on meeting clients' medical and social needs related to drug abuse. Yet, we know little about the type and amount of medical and social services that clients receive in outpatient drug abuse treatment units. This article addresses this issue, drawing from conceptual perspectives in organizational theory and using data from a national random sample of 481 outpatient treatment units that participated in a phone survey in both 1988 and 1990. We examine the extent to which clients in these units receive: physical (medical) and mental health care; special treatment for multiple drug abuse; and employment, financial, and legal counseling. Results from a multivariate analysis of variance (MANOVA) indicate that there was a significant decrease from 1988 to 1990 in all of the services we examined. Regression analyses were conducted to identify organizational and client characteristics related to these decrease. Results show that changes in both client characteristics and key organizational factors (e.g., resources, staffing) are significantly related to decreases in the services clients receive. Implications for meeting the medical and social service needs of drug abuse clients are discussed.Managing strategic alliances
AbstractZajac, E., D’Aunno, T., & D’Aunno, T. (n.d.). (S. Shortell & A. Kaluzny, Eds.; 3rd ed.).Publication year
1994Abstract~Motivating People
AbstractD’Aunno, T., D’Aunno, T., & Fottler, M. (n.d.). (S. Shortell & A. Kaluzny, Eds.; 3rd ed.).Publication year
1994Abstract~Hospital corporate restructuring and financial performance
AbstractD’Aunno, T., D’Aunno, T., Clement, J. P., D’Aunno, T. A., & Poyzer, B. L. (n.d.).Publication year
1993Journal title
Medical careVolume
31Issue
11Page(s)
975-988AbstractIn the last decade, an important innovation in the organizational structure of acute care hospitals occurred. Many hospitals restructured by creating subsidiaries that segment assets or services into separate corporations. We know relatively little about the effects of such restructuring. This paper examines the association of restructuring with financial performance of not-for-profit hospital firms. The study uses data from all not-for-profit acute care hospital firms in Virginia, the only state for which the unique study data are available. We find that the consolidated financial performance of hospital firms is influenced by factors that affect the hospital’s financial performance (i.e., payer-mix, staffing and service mix) but not the number or size of non-hospital subsidiaries. Future research should examine the effect of restructuring on other types of performance.Strategic Choices for America's Hospitals: Managing Change in Turbulent Times (S.M. Shortell, E.M. Morrison, and B. Friedman)
AbstractD’Aunno, T., D’Aunno, T., & D'Aunno, T. (n.d.).Publication year
1993Journal title
Administration and Social WorkVolume
17Page(s)
148-151Abstract~
Contact
tdaunno@nyu.edu
New York, NY