Health, Program Evaluation, and Demography: Research Instruments in Social Gerontology [1 ed.] 9780816655304, 9780816611126

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Research Instruments in Social Gerontology

Volume 3 Health, Program Evaluation, and Demography Publications in the Health Sciences

Research Instruments in Social Gerontology Edited by David J. Mangen and Warren A. Peterson The editors and the University of Minnesota Press gratefully acknowledge the assistance provided this project by the Administration on Aging through contract number HEW 105-76-3107 and grant number 90-A-13 70 to the Institute for Community Studies at the University of Missouri-Kansas City, grant number 90-AR-0024-01 to the Minnesota Family Study Center at the University of Minnesota, and grant number 90-AR-0024A to the Ethel Percy Andrus Gerontology Center at the University of Southern California. Without the assistance of the Administration on Aging, this project would not have been possible. Publication of this book was assisted by a McKnight Foundation grant to the University of Minnesota Press's program in the health sciences.

Research Instruments in Social Gerontology

Volume 3

Health, Program Evaluation,

and Demography Editors David J. Mangen Warren A. Peterson With the assistance of Toshi Kii and Robert Sanders

UNIVERSITY OF MINNESOTA PRESS MINNEAPOLIS

Copyright 1984 by the University of Minnesota. All rights reserved. Printed in the United States of America. Published by the University of Minnesota Press, 2037 University Avenue Southeast, Minneapolis, Minnesota 55414 Library of Congress Cataloging in Publication Data Main entry under title: Research instruments in social gerontology. Includes bibliographies and indexes. Contents: v. 1. Clinical and social psychology — v. 2. Social roles and social participation — v. 3. Health, program evaluation, and demography. 1. Gerontology Research—Addresses, essays, lecturesCollected works. 2. Aged—Social conditions—Research—Addresses, essays, lectures—Collected works. 3. Aged—Economic conditions—Research—Addresses, essays, lectures—Collected works. 4. Aged—Medical care—Research—Addresses, essays, lectures—Collected works. 5. Aged. 6. Social welfare—United States. 7. Sociology. 8. Health services research—United States. I. Mangen, David J. II. Peterson, Warren A., 1922HQ1061.R44 1984 305.2'6 81-16449 ISBN 0-8166-1096-7 (v. 2) ISBN 0-8166-1112-2 (v. 3)

The University of Minnesota is an equal-opportunity educator and employer.

Contents Preface

vii

How to Use These Volumes

xiii

Contributors to Volume 3 xv Chapter 1: Introduction 3 David ]. Mangen Chapter 2: Functional Capacity 9 Marvin Ernst and Nora Sue Ernst Chapter3: Health 85 Sidney M. Stahl Chapter 4: Utilization of Health Services Rodney M. Coe

117

Chapter 5: Individual Needs and Community Resources Betty Havens Chapter 6: Social Program Tracking and Evaluation Raymond M. Steinberg Chapter 7: The Effectiveness of Long-term Care 217 Nancy N. Eustis and Sharon K. Patten Chapter 8: Evaluating of Cost of Services Jay N. Greenberg

317

Chapter 9: Organizational Properties 349 John O'Brien and Greg Chaille Chapter 10: Indexes for the Aging of Populations 391 Toshi Kii Chapter 11: Demographic Characteristics 399 Toshi Kii Chapter 12: Geographic Mobility 417 Toshi Kii Indexes

439

175

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Preface

Research Instruments in Social Gerontology: Health, Program Evaluation, and Demography is the last of a three-volume series of books designed to serve the need of researchers, evaluators, and clinicians to have access to instruments used in the field of aging. The size of this collection of instruments and the amount of work involved in preparing the manuscript greatly exceeded our expectations. Over four hundred measures are reviewed in the three volumes, with topics ranging from formal demography to intelligence and personality. Volume 3 differs significantly from the first two volumes of this series. Many of the instruments reviewed in this volume are not discrete, limited collections of items that purport to measure a single concept; rather, an instrument might contain many items measuring several concepts (i.e., an interview schedule). This is especially true of the material dealing with program evaluation. Often, these concepts are reviewed in volumes 1 and 2, while at other times the focus of the program evaluation is very narrow and yields little in the way of unique measurement information. As a result, the instruments reviewed in the program evaluation chapters were often long (e.g., in excess of 50 pages) and narrow in focus. Consequently, only sample items or lists of concept areas are presented in Chapter 4, 5, 6, and 7 of this volume. Although we regretted not being able to reprint the actual research protocols, we wanted to be able to present the more valuable abstracted information. Chapter 8, "Evaluating the Cost of Services," also does not include reprinted instruments. In this case, it was our collective opinion that addressing the more basic question of what is conceptually required in order to do a cost study would be more valuable to the gerontological community than a series of detailed reviews on inadequately conceptualized cost studies. vii

viii / PREFACE

Chapters 10, 11, and 12 discuss the demographic factors of an aging population and the data that are available from the U.S. Census Bureau for the study of the aging of the population, the demographic characteristics of an aged population, and the geographic mobility of the elderly. Here, too, instruments are rarely presented, since most of these data are readily available from the Census Bureau. These three chapters focus, therefore, on the ways in which census data are manipulated in order to address demographic concerns. However, a number of different scales measuring geographic mobility potential and behavior are reviewed in Chapter 12. Of the chapters in volume 3, chapters 2, 3, and 9 most closely resemble those in volumes 1 and 2. Given the critical importance of health and health-related concerns for an older population, we felt that it was essential to include research instruments tapping the illness, disease, and functional capacity dimensions of health. Moreover, these measures tended to be discrete and relatively specific in orientation. Similarly, the newly developing area of organizational analysis as applied to service organizations aimed at older persons has tended to borrow instruments from organizational sociology. As a consequence, this area is more amenable to review within the framework utilized in Research Instruments in Social Gerontology. For these three chapters, therefore, the actual research instruments are included along with narrative overviews and abstracts. The increasing size of the aging population in the United States has brought a corresponding increase in the amount of interest in the processes of aging and the effectiveness of social programs for the elderly. Today more than ever before, researchers need conceptually explicit instruments designed to assess the status and changes in individual and social behaviors, attitudes, and traits in the aging population. Measures are needed to help effectively construct programs of social assistance and to evaluate those programs. It was in this spirit that we undertook our project, and we feel that, on the whole, our efforts have been successful. To be sure, not every researcher will be able to turn the pages of these volumes to find the ideal instruments for his or her purposes. Indeed, such uncritical adoption of already-developed measures would reflect an intellectual stagnation that would be perilous to the growth of aging as a field of inquiry. In such cases, we would hope that Research Instruments in Social Gerontology would serve as a benchmark to assist the researcher who is developing measures avoid reinventing the wheel. We also hope that our efforts will alert researchers to the necessity of clearly specifying their constructs and the differences between those constructs and other related measures. In short, we hope that our efforts will encourage reseachers to use a theoretical basis — either deductively, inductively, or retroductively derived — in developing new measures.

PREFACE / ix

In many cases, however, researchers will find that appropriate measures are reviewed and presented in these three volumes. In such cases, a central repository of knowledge about instruments can greatly ease the burdens of a literature search. For the user of existing measures, we repeat our plea: recognize the implicit or explicit theoretical basis behind an existing measure and contribute to the growth of knowledge about that measure: examine its reliability and validity, and report the findings in publications deriving from the project. Each use of a measure constitutes only one case in the scientific development of a measure, and the importance of developing a cumulative body of knowledge about the use of measures in diverse populations and environments cannot be overstated. The responsibility for the scientific development of a measure lies not only with the original authors, but also with those who choose to use it. In the interest of promoting the continued development of exisitng measures, the precise development of new ones, and the ready dissemination of all measures, the senior editor (David J. Mangen) will continue his efforts at compiling and evaluating measures. We hope to update Research Instruments in Social Gerontology sometime in the future, a task that the community of scholars involved in the study of aging could ease through providing correspondence about the development and uses of instruments. Undoubtedly, some instruments have escaped our attention. We intended to exclude no instruments, and we apologize for any oversights that may have occurred. Correspondence with the senior editor will ensure that these omissions will be rectified in the second edition. The sorts of information contained within the instrument reviews, together with reprints, complete bibliographies, and the research instruments themselves should be included in the correspondence. Collegial cooperation will improve the soundness of our research efforts. We have been blessed with a high degree of cooperation from many persons throughout the life of this project. We thank the authors of instruments who graciously provided us with information about their work and who gave us permission to publish their materials. The many journals and publishing houses that gave us permission to quote extensively from their publications have acted as true partners in the scientific process by recognizing both the utility of our work and the limitations of our budget. We thank them for their assistance. A special note of thanks is owed the members of the administrative committee for the project, who assisted us in developing the outline for the books' format and the methods for evaluating the instruments. We are further indebted to our esteemed colleagues—Donald McTavish of the University of Minnesota, Harold Orbach of Kansas State University, Ed Powers of Iowa State University, and Ethel Shanas of the University of Illinois, Chicago Circle—for their assistance in securing the collabora-

x/PREFACE

tion of appropriate chapter authors. Furthermore, they used their own professional contacts to alert the discipline about the existence and the importance of this project. The individual chapter authors undertook a task that seemed to grow and expand while we worked. Their efforts in searching the literature were monumental; indeed, some of their original contributions could almost qualify as books themselves. A massive amount of editing was required in order to produce a manageable manuscript. We hope that we have not distorted their conclusions in the editorial process. Many of the contributors have written us to say that additional instruments had already emerged while we were editing. Unfortunately, we had to close off substantive revisions in order to finish the manuscript. To the chapter authors, therefore, we extend a hearty thank-you. Their long efforts and devotion to detail were impressive, and the collegial bonds that developed are still a source of pleasure to us. As is always the case with a massive undertaking such as this one, a number of people have provided vital assistance. Toshi Kii, now of Georgia State University, was one of the original research associates for the project as well as the author of three chapters in volume 3. His assistance in developing the topical outline for the books and the format for instrument evaluation must be noted. After the initial chapter contributions were received and while the three-pronged editorial review process was under way, Robert Sanders was in charge of disseminating research instruments to interested scholars. He, together with Julie Edgerton, was responsible for most of the work involved in securing copyright clearances. These were no small tasks in an effort of this magnitude. They were ably assisted in their efforts by Nellie Lynde, the project secretary during the Kansas City phase of the project. After the project was transferred to the University of Minnesota, two persons provided a good deal of assistance. Robert Leik, director of the Minnesota Family Study Center, arranged for clerical and secretarial support to assist in preparing the final proposal to the Administration on Aging. After that proposal was approved, Pamela Adelmann joined the project staff. Nominally she was the project's secretary, but functionally she was a research associate who assisted in documenting sources, obtaining copyrights, and conducting literature searches in addition to preparing much of the final manuscript. Fortuitously, Ms. Adelmann was scheduled to attend graduate school at the University of California, Irvine, when the project was transferred to the University of Southern California. Her continued involvement through this stage was critical in making the transition relatively painless. After the project was transferred to the University of Southern California, two more persons assumed important roles. Mimi Kmet was

PREFACE / xi

charged with the responsibility of proofreading the entire manuscript, and Grace Greer incorporated the modifications, assisted in handling the indexes, and handled project correspondence. To all of these people we extend our thanks; they have done much of the work and, unfortunately, will receive little of the credit. As noted above, the Administration on Aging of the U.S. Department of Health and Human Services has provided financial assistance through contract number HEW 105-76-3107 and grant number 90-A-1370 to the Institute for Community Studies of the University of Missouri-Kansas City, grant number 90-AR-0024-01 to the Minnesota Family Study Center of the University of Minnesota, and grant number 90-AR-0024A to the Ethel Percy Andrus Gerontology Center at the University of Southern California. A special note of thanks is due to David Dowd, the project officer throughout the life of this project. Research Instruments in Social Gerontology is a product of the Midwest Council for Social Research on Aging, an interuniversity group of scholars devoted to increasing knowledge about aging. We would like to dedicate our efforts to the memory of two colleagues on the Midwest Council, Arnold Rose and Leonard Breen. David J. Mangen Minneapolis, Minnesota Warren A. Peterson Kansas City, Missouri

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How to Use These Volumes

In this three-volume series, most of the chapters are composed of three parts. The first part is a concise narrative review of the major theoretical concerns and measurement strategies within that research domain. The second part of each chapter is a collection of abstracts. Each abstract presents a conceptual definition and description of a specific instrument, together with data about samples, reliability, validity, scaling properties, and correlations with age. Each abstract concludes with a list of references and, when the instrument is reproduced, a code number referring the reader to the instrument itself. The instruments themselves constitute the third part of only 4 of the 12 chapters in volume 3. For a variety of reasons, not every abstract includes a separate instrument. At times, we were unable to secure permission to reproduce a copyrighted instrument. Other times, the length of an instrument precluded its publication. And, in volume 3 especially, instruments often were too long to be included. This was a difficult editorial decision to make, but one that was necessary in order to limit this work to three volumes. The code numbers on the instruments reproduced in the sections at the end of some of the chapters consist of four parts. The first part refers the reader to the volume in the three-volume series; the three volumes are represented by Vl, V2, and V3. The second part of the code number refers to the chapter that reviews that instrument. Usually, the instrument is presented within the same chapter and volume. Occasionally, however, instruments are conceptually relevant to several chapters, and cross-referencing is necessary. The third part of each code number is a roman numeral that refers to a subtopic of the general concept reviewed in the chapter (in a few cases, a chapter covers only one main topic, and Xlll

xiv / HOW TO USE THESE VOLUMES

so roman numeral I's are used in all of the code numbers on that chapter). The final part of each code number is a letter code that is sequential after each roman numeral. The roman numerals and letter codes correspond to the codes listed in the tables at the ends of the narrative reviews. The coding system is strictly hierarchical; for example, V3.2.I.b refers to the third volume, the second chapter (by Ernst and Ernst), and the first (and only) subtopic of the chapter. Instrument b is the Functional Life Scale. (See Table 2-1.) Most of the research instruments reviewed in volume 3 are not reproduced in instrument sections. This is due to problems with copyrights or length or the necessity of using cross-references. Often, however, the simplest way to describe a very brief research instrument was to include the item or items in the abstract. When this is the case, a reference is usually made to the appropriate section of the abstract. We recommend, therefore, that readers review chapter narratives first and then go on to the abstracts. Only after the first two parts of the chapters have been read will the contents of the instrument sections be meaningful.

Contributors to Volume 3

Gregory Chaille University of Connecticut Storrs, Connecticut Rodney M. Coe Department of Community Medicine St. Louis University Medical School St. Louis, Missouri Marvin Ernst Gerontology Program University of Northern Colorado Greeley, Colorado Nora Sue Ernst Health Sciences Center University of Texas Dallas, Texas Nancy N. Eustis Hubert Humphrey Institute for Public Affairs University of Minnesota Minneapolis, Minnesota Jay N. Greenberg Florence Heller Graduate School Brandeis University Waltham, Massachusetts Betty Havens Department of Health and Social Development Winnipeg, Manitoba Canada

Toshi Kii Department of Sociology Georgia State University Atlanta, Georgia David J. Mangen Mangen & Namakkal 511 llth Avenue South Minneapolis, Minnesota John O'Brien Department of Sociology Portland State University Portland, Oregon Sharon K. Patten Hubert H. Humphrey Institute for Public Affairs University of Minnesota Minneapolis, Minnesota Sidney M. Stahl Department of Sociology Purdue University Lafayette, Indiana Raymond M. Steinberg Andrus Gerontology Center University of Southern California Los Angeles, California

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Research Instruments in Social Gerontology

Volume 3 Health, Program Evaluation, and Demography

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Chapter 1

Introduction David J. Mangen

Research instruments can be found in a surprisingly large number of publications in every field, and certainly gerontology is no exception. Since many journals, books, dissertations, and unpublished manuscripts contain empirical instruments, the task of reviewing the measurement literature can be difficult. Few scholars have access to all the relevant literature, and the limited time frames of funded research may preclude the exchange of information necessary for developing cumulative research strategies. As a result, researchers often devise their own instruments, and knowledge becomes progressively more fragmented. The fragmentation of knowledge has important theoretical and empirical consequences for any area of inquiry. Researchers who address the same theoretical questions but use different measurement devices cannot always build upon each other's work when attempting to reintegrate their findings into theory. Different findings may not be a function of different populations. Rather, the findings may be a function of different techniques of measurement. From an empirical perspective, the continued development of new measurement devices precludes the establishment of a cumulative record of reliability and validity. Each use of an instrument constitutes only one case in the scientific study of an instrument; yet, many cases are required before validity or reliability can be shown to be established. Thus, there are many reasons for developing a central repository of instruments. The three volumes of Research Instruments in Social Gerontology are intended to address these concerns. This volume addresses three primary concerns: health, program evaluation, and demog3

4 / MANGEN

raphy. The range of different measurement strategies reviewed is very broad. Many of the measures are conceptually distinct scales designed to qualify a distinct concept; this is especially true of Chapters 2, 3, and 9. A large number of the research instruments reviewed in this volume are actually entire interview schedules. This generally characterizes Chapters 4, 5, and 6, which focus on program evaluation. Also included throughout the chapters are batteries of possible homogeneous items for which summary rankings have never been developed and single-item indicators. Volume 3 differs from volumes 1 and 2 in that several of the chapters do not present instruments per se but focus on either conceptual issues related to developing measures (Chapter 8) or ways of approaching already-collected census data in order to develop concepts that are theoretically meaningful for demographic analysis (Chapters 10, 11, and 12). Given the importance of basic demographic trends for understanding the aging of the population, including these data seemed important. Similarly, the emphasis on cost analysis that currently characterizes program evaluation necessitated including a treatment of the basic issues of cost studies.

Contents of This Volume The introductory chapter of volume 1 in this series presents the major criteria followed in the evaluations of the instruments and an overall evaluation of the status of measurement in aging research. Readers are encouraged to review carefully that chapter's treatment of psychometric theory and the criteria of instrument assessment. In Chapter 2 of this volume, Marvin and Nora Sue Ernst review measures of functional capacity. Their review focuses upon the "basic" activities of daily living as an aspect of functional capacity. The 10 unique instruments reviewed in their chapter include measures appropriate for use with institutionalized as well as noninstitutionalized populations. Datacollection procedures for these measures include both self-ratings and observer ratings. Readers interested in the general area of functional capacity are also urged to examine portions of Chapter 7 on measuring the effectiveness of long-term-care environments. Although functional capacity is a crucial aspect of health, it by no means captures all of the facets connoted by that term. Sidney M. Stahl makes a useful distinction in Chapter 3 between illness and disease as aspects of health. He reviews six instruments that attempt to measure these concepts. In Chapter 4, Rodney M. Coe review six measures that focus on the utilization of health services. He raises several methodological issues re-

INTRODUCTION / 5

garding the measurement of the consumption of health services, including: (1) recall period, (2) reliability, (3) validity, (4) record linkage problems, (5) confidentiality and invasion of privacy, and (6) sampling. He suggests that problems remain in each of these areas. Furthermore, substantive issues pertaining to the interpretation of utilization data also need to be addressed by persons involved in this area of inquiry. In Chapter 5, Betty Havens reviews 16 measures of individual needs and community resources. By distinguishing between individual needs and community resources, Havens escapes the tautological trap of equating service utilization with need while also recognizing that utilization can take place only within the context of available resources. In Chapter 6, Raymond M. Steinberg addresses the complex task of reviewing measures of program evaluation. Since a multitude of evaluation studies have been done, a comprehensive review was not attempted. Rather than attempting to be exhaustive, Steinberg suggests that program evaluations may be seen as addressing four broad but not mutually exclusive categories of concepts: (1) utilization, (2) inputs, (3) performance, and (4) outcomes. He reviews 20 program evaluation studies, each of which addresses different aspects of these broad concepts. His narrative also includes an extensive bibliography of program evaluations in the field of aging. Nancy N. Eustis and Sharon K. Patten review measures used in evaluating long-term-care environments in Chapter 7. Their extensive review of 48 measurement techniques delineates 10 conceptual areas that are important considerations for the evaluator of environments. Many of these areas overlap with the material presented in volumes 1 and 2 of this series. Jay N. Greenberg does not review any instruments per se in his review of issues to be considered in evaluating the cost component of service programs for the elderly. Chapter 8 focuses on the conceptual issues involved in any cost study. The author develops a hierarchy of cost studies and differentiates among cost studies, cost-effectiveness studies, and costbenefit studies. The information needs of each type of study are shown to be progressively more complex and demanding. In Chapter 9, John O'Brien and Greg Chaille examine strategies for measuring the properties of formal organizations (e.g., service agencies) involved with older persons. Although this developing area is currently underresearched from an age-specific perspective, a wide range of measures have been developed as part of organizational sociology. The authors' review of 10 measures focuses on interorganizational relationships but suggests that attention should be given to intraorganizational concepts as well.

6 / MANGEN

Chapters 10, 11, and 12 by Toshi Kii all address the demographic aspects of aging. Indexes that assess the relative age of an entire population are reviewed in Chapter 10. Chapter 11 details the rich array of data that are available to the researcher who is willing to capitalize on censusgathered information. Chapter 12 addresses the thorny problems involved in measuring the geographic mobility of older persons.

Summary The 11 substantive chapters in volume 3 review instrumentation in areas critical in the development of contemporary gerontology. The general construct of health is perhaps the single most important explanatory variable used at this time in gerontological research. Readers who are interested in other methods of measuring health and health-related behavior are encouraged to review the Reeder, Ramacher, and Gorelnik (1976) compendium on instruments. The efforts of Andersen, Kasper, and Frankel and their Associates (1979) to analyze the sources of measurement error in a national survey of the use of health services are also valuable. With the increased number of social service programs targeted for the elderly has come a parallel increase in the demand for evaluations of the quality and efficacy of such programs. The nature and extent of the effects of treatment in this immensely complex area requires excellent measurement and research design. Quality measurement is crucial because, all other things being equal, measurement error will reduce sample correlations. Hence, an efficacious program evaluated with poor instrumentation may appear to be ineffective. Moreover, during an era of shrinking budgets, it is in the best interest of both older persons and the gerontological community to retain those programs that are effective and to weed out those that are failures. Furthermore, gerontologists need to recognize the fact that social innovations may yield undesirable consequences (Mosteller, 1981). It is readily apparent that gerontology is a growing field because demographic trends in the United States are producing a rapidly aging population. A vast array of data are available to describe the elderly population, data that gerontology as a discipline needs to utilize more fully when beginning research or planning social innovations. Thus, demographic data and measurements are a logical first step in the research or planning process. However, it is important to consider more than the current composition of the older population. The entire age structure of the population, and the demographic facts associated with that population, must also be considered. For example, the interstate geographic mobility of older per-

INTRODUCTION / 7

sons may have consequences for service delivery in both the areas of origin and destination (Biggar, Longino, and Flynn, 1980; Lee, 1980). In short, aging is a complex set of biological, social, and psychological processes in which changes at one level of the system may have dramatic consequences on other levels in the system. It is hoped that users of Research Instruments in Social Gerontology will find that the information provided will help them to address the complexities of aging as they conduct their research. Furthermore, this effort should help to stem the unwarranted proliferation of new research techniques in areas already well conceptualized and measured. This does not imply that gerontological measurement has been established and is no longer in need of development. On the contrary, much work is needed to refine, to report, and to further conceptualize almost every area of intellectual inquiry in social gerontology. What this series can do, however, is to allow a research team to develop measures for only those concepts that are inadequately measured and to borrow measures whenever possible. In this way, new measures can be more rigorously developed at the same time a cumulative record of validity and reliability in existing measures is developed. REFERENCES Andersen, R., J. Kasper, M. Frankel, and Associates. Total Survey Error: Applications to Improve Health Surveys. San Francisco: Jossey-Bass, 1979. Biggar, J., C. Longino, and C. Flynn. "Elderly Interstate Migration: The Impact on Sending and Receiving States, 1965 to 1970." Research on Aging, 1980, 2: 217-32. Lee, A. "Aged Migration: Impact on Service Delivery." Research on Aging, 1980, 2: 243-53. Mosteller, F. "Innovation and Evaluation." Science, 1981, 211: 881-86. Reeder, L., L. Ramacher, and S. Gorelnik. Handbook of Scales and Indices of Health Behavior. Pacific Palisades, Calif.: Goodyear Publishing Company, 1976.

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Chapter 2

Functional Capacity Marvin Ernst and Nora Sue Ernst

Gerontologists frequently lament the fact that chronological age is at best a poor indicator of the actual capacity of an individual. Chronological age tends to mask individual differences, and it constitutes a broad categorical description of persons whose only common trait is that they happen to have been born on the same date, in the same year, or during the same time period. Cohort analysts are quick to tell us that, though a particular cohort may have certain similarities because its members were born and socialized during the same period of time, individual variance within the cohort cluster must still be considered the dominant feature. Using chronological age is often a seductive approach, both in practice and in research. For the practitioner, the definition of age by the number of years a person has lived allows for broad categorical definitions by which program allocations can be awarded. Mandatory retirement, the Older Americans Act, and Social Security are a few examples of programs in which age is the determining criterion for eligibility. For the researcher, chronological age approximates an interval-level measure that can be used in conducting extensive, sophisticated statistical analyses. It also affords an easy measure that usually can be elicited by a single question within a much larger instrument. Using chronological age in this way allows the researcher to devote more time and attention in his or her instrument to more abstract processes of theoretical concern. Unfortunately, what using chronological age does is to homogenize a broad collection of people. It ignores individual differences and the multifaceted complexities of individual variation in functional ability. To overcome the limitations of chronological age, a number of instruments have been developed that attempt to measure an individual's functional capacity, both within and across age strata. 9

10 / ERNST AND ERNST

The term functional capacity itself is defined as the maximum output or ability of a person to perform natural and expected activities within the framework of environmental circumstances. The initial problem in constructing a measure in this area is a description of what behaviors or activities should be classified as natural and expected and in what context these activities should occur. The range of possible areas for inclusion in such a measure is as broad and diverse as human behavior itself. However, test development in the area of functional capacity has tended to concentrate on measures of physical health, mental health, social and economic problems, and activities related to personal self-care and/or daily living. Each of these broad conceptual areas of individual functioning influences the other areas and requires multidimensional assessment in the measurement of functional capacity. Although such measurement is desirable, it is not easy to achieve. Multidimensional analysis can prove to be costly and time-consuming. To structure an accurate assessment of function in a myriad of areas, multidisciplinary research must be conducted. This limits the number and types of organizations that are qualified to conduct the necessary investigations. Multidisciplinary research requires a community of interested scholars who have both time for and an interest in conducting such research. Moreover, since change in capacity constitutes a crucial question, adequate scale development requires a stable research population that is willing to participate over time. Problems of participant selection, respondent dropout, natural attrition, and generalizability of the population often inhibit serious attempts to conduct the necessary research. In lieu of this, researchers often select specific populations residing in a particular geographic area or in similar environmental circumstances. Although this provides the researchers with the necessary subject population, initial preselection bias may influence the outcome of the research. In addition, selecting the cluster of variables to be included requires asking some crucial methodological questions. Confronted with the gamut of variables that could be included in functional assessment, researchers must choose which dimensions to include and which to leave out. The advantages of using a measure of functional capacity, however, outweigh the complexities of test development. First, if it is possible to measure functional capacity, then the anomalies that occur in data might be explained. The researcher, for instance, who finds systematic variation within a cohort but who cannot explain the differences by the chronological age of the individual would have at his or her disposal an analyti-

FUNCTIONAL CAPACITY / 11

cal tool with which to add depth to the investigation. Second, using appropriate functional capacity measures would allow the investigator to set aside age stereotypes and facilitate the eradication of evaluation methods based on age stereotypes as well as prejudgments of what a person can or cannot do. This would provide the gerontologist with the research data needed to assess individuals on their own abilities and not by some broad categorical framework that masks rather than accentuates individual differences. Third, a measure of functional capacity would allow a researcher to compare individuals in both functional capacity and chronological age. Normative data on the basis of such factors as physical and mental health and chronological age would broaden knowledge in the area of human development and offer the opportunity to study changes in capacity that are correlated with the aging process. Fourth, true measurement of an individual's functional capacity might allow for more accurate predictive models of the life-course trajectory of the individual. Being able to define a person's functional status at a particular point in time would help both researchers and practitioners estimate the future impact of environmental events on a person. Although causal relationships have yet to be determined, there is considerable variation among different individuals in the slope of decline. Thus, predictive models of functioning would bring a rationale to intervention techniques that are designed to facilitate the life maintenance of a person. It is very possible, for instance, that age-related changes in functional capacity could be used as an analytical tool to diagnose the relative decline or improvement of individuals who are subjected to different treatment modalities. The measures selected for inclusion in this chapter reflect attempts to come to grips with the problem of functional assessment and the issues involved in developing such measures. Each of the scales addresses itself to the problem of assessing functional capacity. Some of the measures, particularly the OARS, are true attempts at multidimensional assessment. Others, like the Katz-ADL Scale, have selected a limited range of behaviors and concentrated on a single cluster of activities. Collectively, they constitute considerable progress in the measurement of functional capacity. They have not, however, completed the process. If measurement of functional capacity is to achieve a refined state of the art, research needs to be continued in the development of valid and reliable scales that are usable on a broad range of populations and that can be readily included within the research context. At the present time, most of the scales either are population bound (and this is not always at variance with the researchers' intentions) or require so much time to administer that they

12 / ERNST AND ERNST

preclude the inclusion of other sets of variables. What is needed, therefore, is a series of investigations that direct attention to the triangulation of the results of different measurement techniques used on similar populations and in similar conceptual areas. Initially used within the same population of elderly and with tight research controls, the results of these experimentations could be expanded to include a broader and more diverse set of the elderly. Each of the scales selected for inclusion in this chapter has strengths and weaknesses that are evident in the individual scale reviews. However, some general problems with all the scales should be noted. First, several of the measurement devices (such as the OARS and the Stockton Geriatric Rating Scale in particular) require extensive training of observers prior to the implementation of the measurement procedure. Other users of the scale may not be as rigorous in their training or may not have perceptions of scale graduations like those of the initial research group. A lack of well-defined and rigorous training may result in judgments being made by data gatherers that are not consonant with the intentions of the scale developers. The reliability and validity of the protocols may limit the general applicability of the scale. This is not an indictment of the scales but rather a warning that other researchers need to be as rigorous as the scale developers. Second, several of the measurement devices were developed with atypical populations of the aged. The Stockton Geriatric Rating Scale used institutionalized geriatric subjects. Although these measures are appropriate within the institutional context, they are necessarily limited in their generalizability to the population at large. Third, most of the scales (the PAMIE and the Stockton Geriatric Scale, for instance) are observational in nature. The major problem encountered, other than observer training and reliability, is that a particular behavior may not be observed during a brief exposure to the research population. The consequence of this is that the observer must either ask the respondent to perform or attempt to perform a task or simply fill in the category without a real opportunity to observe the subject's performance of the task. The researcher is then in a position of accepting the data as facts when in reality a number of the responses may be fabrications of the data collectors. Fourth, a number of the measures included have not used rigorous psychometric evaluations in their development. In order for a measure to be widely applicable, it is necessary that its developer is fully informed of the necessity of conducting appropriate psychometric evaluations. The validation and reliability of the measurement should not be determined solely by manipulating data obtained during the initial measurement de-

FUNCTIONAL CAPACITY / 13

sign period. This technique ignores the possibility that the measure may have been designed under a unique situation or with a unique sample. Therefore, the generalizability of the instrument would be minimal. Good examples of rigorously applied alternative approaches are the Stockton Geriatric Rating Scale and the OARS methodology. A number of the scales, the OARS and the PAMIE are examples, are multidimensional. Unfortunately, some investigators tend to believe that the dimensions are additive and not discrete measures. The addition of subscale scores to obtain an overall definition of functional level masks the multidimensional complexity of the measure. Individuals who use these measurements must be aware of their multidimensionality and apply the total measure with the realization that a single overall score or a single subscale score is difficult to interpret. They must realize that the profile across dimensions is crucial for understanding. It is important to note that the multidimensional scales were developed as holistic approaches to the assessment of individuals. Although the functional capacities are not additive, the interrelated nature of functional capacities may preclude the use of a single subset of items within a specific research effort. Research on the consequences of using only part of a broad-based scale may reveal serious errors in interpretation since the multidimensional conceptualization assumes that the separate components must be considered when an overall assessment of functional capacity is being made. In general, these scales represent considerable progress in the assessment of functional capacity. Since the relationship between age and capacity is not linear, no normative data exist regarding the capacities of given individuals for specific activities at different ages. It is possible that future research may establish links between a number of age-related changes and various deficits in capacities. Until that time, these scales may prove to be particularly useful in determining comparative capacities of individuals in similar situations and the determination of therapeutic goals related to individual potentials. The OARS and the PAMIE appear to hold promise for future research efforts in the measurement of capacity, particularly from the multidimensional standpoint. For specific assessment on a limited range, the ADL and the Guttman Health Scale for the Aged seem to be quite applicable. As in most cases in which the subject matter is quite complex and the potential usability quite high, considerably more effort needs to be expended toward the determination of the reliability and validity of the scales and their utility in determining outcomes. The difficulty in assessing sensitivity to age-related variables is compounded by the fact that

14 / ERNST AND ERNST

gerontologists have not yet determined the relationship between age and ability to perform certain activities. When, where, and whether capacities begin to decline may be related more to environmental circumstances than to the individual's age when the decline begins to occur. The instruments included in this review, the populations for which they are appropriate, and the data-collection procedures required are listed in Table 2-1. TABLE 2-1 Instrunicnts Reviewed in Chapter 2 Instrument

a.

Activities of Daily Living '

b.

Functional Life Scale '

c.

Geriatric Rating Scale1'4

d.

Minimal Social Behavior

e.

Scale1'4 OARS Multidimensional Functional Assessment

Author(s) Date

Code Number

Katzet al. (1963) Sarno, Sarno, and Levita (1973) Plutchik et al. (1970) Farina, Arenberg, and Guskin (1957)

V3. 2.1.a V3.2.I.b V3.2.I.C V3.2.I.d

Center for the Study of Aging and Human Development (1975)

V3.2.I.e

Gurelet al. (1970) Parachek and Miller (1974)

V3.2.I.f V3.2.I.g

Meer and Baker (1966)

V3.2.I.h

Questionnaire '

PAMIE Scale1'4 Parachek Geriatric Behavior Rating Scale1'3 h. Stockton Geriatric Rating

f. g.

Scale '

i.

Suinn-Feldman Scale '

j. k.

Vulnerability Scale2'5 Health Scale for the Aged 2 ' 3

1. 2. 3. 4. 5.

Suinn and Feldman (1973) Cantor, (1977) Rosow and Breslau (1966)

Not reproduced V3.2.I.J V3.3.H.a

Instrument appropriate for use with institutionalized populations. Instrument appropriate for use with noninstitutional populations. Data-collection procedures use interview and/or self-rating techniques. Data-collection procedures use observer ratings. Data-collection procedures use both interview/self-ratings and observer ratings.

REFERENCES Cantor, M. The Elderly in the Inner City. New York: New York City Office for the Aging, New York, 1977. Center for the Study of Aging and Human Development, Multidimensional Functional Assessment: The OARS Methodology , (1st ed.). Durham, N.C.: Center for the Study of Aging and Human Development, Duke University, 1975. Farina, A., D. Arenberg, and S. Guskin. "A Scale for Measuring Minimal Social Behavior. "Journal of Consulting Psychology, 1957, 21: 265-68. Gurel, L., M. W. Linn, and B. S. Linn. "Physical and Mental Impairment-of-Function Evaluation in the Aged: The PAMIE Scale." Journal of Gerontology, 1972, 27: 83-90. Katz, S., T. D. Downs, H. Cash, and R. C. Grotz. "Progress in Development of the Index of ADL." The Gerontologist, 1970, 10 (1): 20-30

FUNCTIONAL CAPACITY / 15 Meer, B., and J. A. Baker. "The Stockton Geriatric Rating Scale." Journal of Gerontology, 1966, 21: 392-403. Parachek, J. F., and E. R. Miller. "Validation and Standardization of a Goal-Oriented QuickScreening Geriatric Scale." Journal of the American Geriatrics Society, 1974, 22: 278-83. Plutchik, R., H. Conte, M. Lieberman, M. Bakur, J. Grossman, and N. Lehrman. "Reliability and Validity of a Scale for Assessing the Functioning of Geriatric Patients." Journal of the American Geriatrics Society, 1970, 18: 491-500. Rosow, I., and N. Breslau. "A Guttman Scale for the Aged." Journal of Gerontology, 1966, 21: 556-59. Sarno, J. E., M. T. Sarno, and E. Levita. "The Functional Life Scale." Archives of Physical Medicine and Rehabilitation, 1973, 54: 214-20. Suinn, R. M., and D. J. Feldman. "Preliminary Report on the Progress with the Suinn-Feldman Scale." Canadian Journal of Occupational Therapy, 1973, 40: 143-48.

Abstracts ACTIVITIES OF DAILY LIVING (ADD S. Katz, A. B. Ford, R. W. Moskowitz, B. A. Jackson, and M.W.Jaffe,1963 Definition of Concept The ADL was developed as a measure of function in chronically ill and aging populations. It is based on the concept that recovering patients pass through three stages: (1) return of independence in feeding and continence, (2) recovery in transference and going to the toilet, and (3) recovery of independence in dressing and bathing.

Description of Instrument The ADL is a six-item observational scale. It summarizes a patient's performance in six functions: bathing, dressing, toileting, transference, continence, and feeding.

Method of Administration This six-item observer scale should be completed by a member of the nursing staff. Knowledge of the subject is required. Direct observation of the subject may be used to compute an accurate assessment from multiple observations. Observers must be trained in using the forms and grading systems. They should be familiar with the definition given for each function and with the levels on the rating scale. Administration time should be less than 5 minutes for observers familiar with their subjects.

Theoretical Development The scale was originally developed from observations made'on elderly people with fractures of the hip. Early in the use of the ADL, it was observed that the recovering patients passed through the three stages described above. This pattern parallels the order of functions on the ADL scale.

Sample The ADL scale has been used extensively with older populations. A description of the samples is included in the normative information given in Table 2-2.

Norms Table 2-2 lists the ADL classifications of persons in various community settings.

TABLE 2-2 Index of ADL Classification of Persons in Various Community Settings Where Aged Get Care

Nature of Sample Home care program Consecutive applicants during 1 year Home for the aged Consecutive admissions during 1 year County Hospital for 1 in 4 random selection of consecutive prolonged illness admissions excluding custodial and terminal patients General hospital

1-day survey of all patients in hospital for 30 days or longer

Outpatient clinic of 1 in 5 random selection of consecutive new general hospital medical admissions during a 3-month period Consecutive admissions: Discharges from fracture of the hip hospital for prolonged illness First cerebral infarction With G.I. in 1 year (evaluated 6 months after onset of illness) Nonhospitalized patients with multiple sclerosis

Index of ADL Class (Persons, Number) A B C D E F G Other Total 24 16

9

6

6

3 29 16 13

5

2

11 15 12

11

118

2

0

31

5 77 54 30

5

209

3

4

41

3

1 19 10

6

0

0

80

27

0

0

1

0

0

0

28

52 21 20 12 11 4

8 4 9

5 19 13 9 6 14 15 13 3 9 14 6

3 2 4

130 86 60

41 18

8

7

6

8

7

8

103

8

0

Consecutive admissions to longitudinal study of nutrition

Consecutive admissions Hospitalized to longitudinal study patients with hip of urinary tract fracture infections

1

2

1

1 41

1

3

58

Custodial patients

Consecutive admissions to hormone therapy study

7

5

4

3 11 16 11

0

57

Practices of orthopedic surgeons

Consecutive patients with fractures of the hip who were not admitted to chronic disease hospitals (evaluated 1 year after fracture)

18

8

3

0

1

4

41

262110 61 5 5 2 2 4 1 5 6 93

40

1,001

Totals

5

2

FUNCTIONAL CAPACITY / 17 SOURCE: S. Katz, A. B. Ford, R. W. Moskowitz, B. A.Jackson, and M. W. Jaffa. "Studies of Illness in the Aged: The Index of ADL, a Standardized Measure of Biological and Psychosocial F'unction." Journal of the American Medical Association, 1963, 185:914-19. Copyright 1963, American Medical Association. Reprinted by permission of authors and publisher.

Scoring The performance of the subject is graded by an observer, A through G, where A is the most independent grade level and G the most dependent. The observer completes this rating after observing the subject and judging his or her status during the preceding 2-week period. The observer must determine whether another person assisted the subject or whether the subject functioned alone. Assistance is defined as (1) active personal assistance, (2) directive assistance, or (3) supervision. Data reported on the Evaluation Form (see the instrument) are converted into an index of ADL grades through the use of the conversion form included with the instrument. These "grades" can then be used for making comparisons.

Formal Tests of Validity The ADL's predictive validity has been studied through correctional techniques. Overall ADL scores were correlated with a range of motion test, the Raven test of intellectual function, and a test of orientation and mental control modified after Wechsler's measure. These correlations ranged from .55 to .20 in magnitude (Katz et al, 1970). Evidence of concept validity is based on the scale's paralleling the pattern of physical development.

Usability on Older Populations The scale has been used extensively with older populations. Several examples are cited in the references.

General Comments and Recommendations The ADL has a good theoretical concept base and has been used with a number of older populations. However, further empirical reliability analysis, including work on observer effects, would be useful.

References Katz, S., T. D. Downs, H. R. Cash, and R. C. Grotz. "Progress in Development of the Index of ADL." The Gerontologist, 1970, 10 (1): 20-30. Katz, S., A. B. Ford, A. B. Chinn, and V. A. Newell. "Prognosis after Strokes." Medicine, 1966, 45: 236-46. Katz, S., A. B. Ford, R. W. Moskowitz, B. A. Jackson, and M. W. Jaffe. "Studies of Illness in the Aged: The Index of ADL, a Standardized Measure of Biological and Psychosocial Function." Journal of the American Medical Association, 1963, 185:914-19. Steinberg, F. U., and M. Frost. "Rehabilitation of Geriatric Patients in a General Hospital: A Follow-up Study of 43 Cases." Geriatrics, 1963, 18: 158-64.

Instrument See Instrument V3. 2. I. a.

18 / ERNST AND ERNST

FUNCTIONAL LIFE SCALE (FLS) J. E. Sarno, M. T. Sarno, and E. Levita, 1973 Definition of Concept The Functional Life Scale is intended to give a replicable, quantitative description of a disabled patient's overall functioning at any point in the morbidity continuum following the onset of disease or injury. It is directed toward estimating an individual's ability to participate in all of the basic daily activities that are customary for human beings.

Description of Instrument This instrument is a 44-item battery designed to measure five elements of performance on four qualities of performance. The elements are cognition, activities of daily living, activities in the home, outside activities, and social interaction. The qualities are self-initiation, frequency, speed, and overall efficiency.

Method of Administration Interview/observational in nature, the scale requires the observation of the patient in his or her real life situation (not hospitalized or institutionalized). Administration time is 15 or 20 minutes. The rater must be highly critical of responses, and he or she must be sure that the patient is not expressing wishful thinking. "Normal" activities are defined as the set of activities that are so basic that one can reasonably expect all persons not disabled to perform them. Spaces are provided on the instrument for "not applicable" responses.

Context of Development The scale was initially developed to gauge the success or failure of rehabilitation. It was designed for use in the home or community as a measure of what a patient actually does and not his or her capacity to perform. The items were developed through observations and interviews of hospitalized patients.

Sample The initial sample included 15 male and 10 female patients ranging in age from 21 to 70 years, with a mean age of 46 years. The length of the subjects' disability ranged from 3 months to 62 years (mean of 27 years). The subjects' educational levels ranged from 4 to 13 years.

Scoring Each of the four elements within the 44 items is rated on the following continuum: 0, does not perform the activity at all; 1, very poor; 2, deficient; 3, approaches normal; and 4, normal. The scoring of the FLS is a matter of finding the proportion of the patient's scores with respect to his or her maximum possible score. (See Table 2-3.) Scores are obtained for each category and each quality of performance being measured. The overall score obtained is the proportion of the patient's total score in all five categories compared to his or her maximum possible total. Item totals are added and placed on the scoring sheet. For nonapplicable items, a total of 16 is placed in the total column. All nonapplicable items are then totaled. Nonapplicable totals are subtracted from the maximum score. The patient's total score is then put over his or her adjusted maximum score and this fraction is converted to a percentage. For social interaction, either item 43 or item 44 is rated, but the other item is not marked as nonapplicable. To obtain the four qualities of performance, the same procedure is followed. The work proceeds vertically rather than horizontally. (See Table 2-3.)

Formal Tests of Reliability Test-retest coefficients of reliability averaged across all raters and patients are listed in Table 2-4. Sarno, Sarno, and Levita (1973, p. 217) presented rater-specific test-retest reliability coefficients.

FUNCTIONAL CAPACITY / 19 TABLE 2-3 Scoring Sheet for the Functional Life Scale

Maximum Score Cognition

NA

Maximum Adjusted (Maximum -NA)

Total Score Adjusted Maximum

Proportion

104

ADL

92

Home activities

112

Outside activities

96

Social interaction

60 464

Overall Score

Self-initiation score

136

Frequency score

104 84

Speed score Overall efficiency score

140

SOURCE: J. E. Sarno, M. T. Sarno, and E. Levita. "The Functional Life Scale." Archives of Physical Medicine and Rehabilitation, 1973, 54:220. Reprinted by permission of the authors and publisher.

TABLE 2-4 Test-Retest Coefficients of Reliability (Pearson): All Raters over All Patients Self-initiation Score

Frequency Score

Speed Score

Overall Efficiency Score

Overall Score

0.90

0.90

0.88

0.88

0.91

NOTE: All correlation coefficients significant beyond 0.001 level. SOURCE: J. E. Sarno, M. T. Sarno, and E. Levita, "The Functional Life Scale." Archives of Physical Medicine and Rehabilitation, 1973, 54: 217. Reprinted by permission of the authors and publisher.

Formal Tests of Validity Table 2-5 shows the intercorrelations among the scales of the Functional Life Scale. Ratings on the FLS were compared with an external and independent criterion measure defined in terms of clinical judgment. One person rated a series of 31 patients by using the FLS. A psychiatrist evaluated the 31 patients within a nine-point ordinal ranking from upper to lower. Spearman rank order correlation yielded a value of .69, significant beyond the .001 level on a two-tailed test.

20 / ERNST AND ERNST TABLE 2-5 Pearson Product-Moment Intercorrelations among Scores on Functional Life Scale Home Outside Social SelfOverall Activ- Activ- inter- initia- FreCogEffiities action tion quency Speed ciency nition ADL ities Cognition

ADL Home Activities Outside Activities Social Interaction Self-initiation Frequency Speed Overall Efficiency Overall Score

— 0.36 0.57 0.26 0.24 0.49 0.49 0.58 0.75 0.59

— 0.60 0.36 0.20 0.53 0.50 0.81 0.68 0.68

— 0.41 0.24 0.68 0.69 0.76 0.84 0.81

— 0.60 0.83 0.90 0.49 0.56 0.77

— 0.71 0.73 0.27 0.46 0.63

— 0.94 0.61 0.76 0.93

— 0.65 0.78 0.94

— 0.84 0.82

0.92

NOTE: All values of r were significant beyond the 0.001 level, two tailed. SOURCE: J. E. Sarno, M. T. Sarno, and E. Levita, "The Functional Life Scale." Archives of Physical Medicine and Rehabilitation, 1973, 54: 217. Reprinted by permission of the authors and publisher.

Usability on Older Populations Although the scale was developed on a broadly distributed age population, it appears to be appropriate for use with an aging population.

Sensitivity to Age Differences It appears that the scale would discriminate between variables that may be a function of age. Data are not available to indicate its ability to discriminate differences among different age-groups.

General Comments and Recommendations The FLS seems to have a good potential for use in research on aging. Further tests are needed, however, with broader populations in different settings. Reliability appears to be high, but additional tests of validity and factor analysis of the scale would improve its usability.

Reference Sarno, J. E., M. T. Sarno, and E. Levita. "The Functional Life Scale." Archives of Physical Medicine and Rehabilitation, 1973, 54: 214-20.

Instrument See Instrument V3. 2. I. b.

GERIATRIC RATING SCALE (GRS) R. Plutchik, H. Conte, M. Lieberman, M. Bakur, J. Grossman, and N. Lehrman, 1970 Definition of Concept This scale was developed to measure a patient's ability to function in an integrated manner.

FUNCTIONAL CAPACITY / 21

Description of Instrument This is a 31-item rating scale of patient behavior. The scale was intentionally made brief, objective, and simply worded.

Method of Administration This is an observational rating scale that can be completed by a member of the nursing staff. Training time beyond that needed to gain familiarity with the items and definitions is minimal. Administration takes approximately 15 minutes.

Context of Development This scale is based on the Stockton Geriatric Rating Scale, form II. Three items were used verbatim, the wording of 19 items was changed, and 9 new items were added. A principal-factor varimax-rotation factor analysis of the scores of 370 ambulatory patients on the geriatric service of Harlem Valley Psychiatric Center was conducted. These subjects were rated on the GRS by one of the therapy aides. The sample consisted of 138 males and 232 females, who had an average age of 74.26 years (Smith, Bright, and McCloskey, 1977). Three factors accounting for 87.5% of the common variance were identified. No item was included in more than one factor. Those items that loaded .40 and above were included in a factor. Factor I, withdrawal/apathy, includes items 15, 16, 17, 18, 19, 20, 21, 22, 23, 24 and 25. Factor II, antisocial disruptive behavior, contains items 13, 27, 28, 29, 30, and 31. Factor III, deficits in activities of daily living, includes items 1, 2, 3, 5, 6, and 14 (Smith, Bright, and McCloskey, 1977).

Sample The original sample consisted of 220 geriatric patients at Bronx State Hospital. There were 126 geriatric females with a mean age of 77.39 years and 17 nongeriatric females with a mean age of 36.59 years. There were 58 geriatric males with a mean age of 72.24 years and 19 nongeriatric males with a mean age of 33.00 years.

Norms Each item is rated on a scale between 0 and 2 in described categories. The item scores are added to obtain a total GRS score. Factor scores can be obtained by adding item scores within each identified factor. The higher rating is indicative of a higher degree of functional impairment. Plutchik and associates (1970) reported mean scores for males (22.48; SD, 9.14) and females (24.63; SD, 10.33) together with percentile distributions. Smith, Bright, and McCloskey (1977) reported mean scores for males and females on each dimension as well as total scores. Their results are presented in Table 2-6.

Formal Tests of Reliability Interrater reliability was reported as .87 over 86 cases (Plutchik et al., 1970).

Formal Tests of Validity Validity can be inferred from this scale's close approximation of the Stockton Geriatric Rating Scale. Additionally, chi-square analyses indicate that, of 28 items, 20 discriminate at the .001 level of significance between those patients who were most impaired and those who were least impaired (Meer and Baker, 1966).

Usability on Older Populations This scale was developed for use on a geriatric population.

Sensitivity to Age Differences Although developed on an aged population, the factors contained in the scale are not necessarily age related.

22 / ERNST AND ERNST TABLE 2-6 Summary Statistics on the GRS Total Scores

I

II

III

28

11

6

7

74.26 75.00 9.69 46-99

20.84 20.00 9.53 1-49

12.28 13.00 5.98 0-22

1.63 1.00 2.18 0-11

3.64 3.00 3.15 0-14

71.64 9.68

19.70 8.34

12.30 5.71

1.17 1.80

2.89 2.71

75.82 9.37

21.51 10.13

12.27 6.14

1.90 2.34

4.09 3.31

4.10*

1.77

0.04

3.12*

3.60*

Age Number of items Entire Sample (N=370) Mean Median SD Range Males (#=138) Mean SD Females (#=232) Mean SD t between males and females

SOURCE: J. M. Smith, B. Bright, and J. McCloskey. "Factor Analytic Composition of the Geriatric Rating Scale (GRS)1.' Journal of Gerontology, 1977, 32:61. Reprinted by permission of the authors and publisher. NOTE: Factor I: withdrawal/apathy. Factor II: antisocial disruptive behavior. Factor III: deficits in activities of daily living. *p 2

>5 2

20

3

25

4

30

5

35

6

40

7

45

8

50

9

55

10

60

> 3

>5

> 6

>5

> 8

>5 >5

> 10 > 14

>5

> 16

>5

> 18

> 5 >5

> 20

ample is increasing at a constant rate; that is, the marginal cost of nursing home service is constant ($5.00). In contrast, the total cost of in-home service is increasing at an increasing rate; that is, the marginal cost of inhome care is increasing. With this in mind, let us examine how we would make incremental decisions on where to spend each successive dollar based on the marginal cost of producing that unit of service. Recall that our objective is to provide as much service as possible for each dollar that we spend. It should be obvious that an equivalent objective would be to provide each unit of service at the lowest additional cost until we have spent our entire budget. If we do this for each unit of service produced, then we will have produced the total number of units of service at the lowest possible cost. Put another way, since the sum of all marginal costs of serving .Z number of clients is equal to the total variable cost of serving Z number of people, it follows that, if each marginal unit was at least cost, then the total cost must be at a minimum for that level of production as well. The reader should note that the concepts of opportunity cost and marginal analysis are two of the most fundamental concepts of

EVALUATING THE COST OF SERVICES / 333

microeconomic theory. The reader is also cautioned that, if the marginal cost of service is decreasing rather than remaining constant or increasing, marginal analysis may lead to the wrong answer. To verify this, the reader can construct a simple numerical example or check any good intermediate economics text (e.g., Baumol, 1972, p. 37).

Some Problems in Measurement Basic Input Data "It is true that poor cost analysts can misuse even the best data, but even the best analysts cannot do much with inadequate data" (Hatry, 1967, p. 55). In order to develop a valid and reliable cost study, data must be collected from a cost-accounting system that is both accurate and uniform across the industry of concern to the analysis. In addition, when cost comparisons are undertaken, no meaningful comparisons can be made unless accounting systems are adjusted so that the elements that make up the cost of service are consistent across the settings being compared. According to a report by the National Council of Homemaker/Home Health Aide Services, "A uniform system of recording and reporting both fiscal and statistical data is lacking for the homemaker/home health aide field, as it is through most of the health and social service fields" (Robinson, 1974, p. 2). Likewise, the quality of accounting data in the nursing home industry has been noticeably deficient, both in terms of detail and accuracy. The federal government's reluctance to require uniform accounting procedures has exacerbated the situation. There are at least three components that are required of an accounting system for valid interfacility or interprogram comparisons (Sorenson, 1975). They are (1) consistent definitions of services and programs, (2) uniform cost-accounting procedures, and (3) uniform statistical allocation. Each of these conditions will be briefly discussed.

Definitions of Service and Program Clearly, if two organizations are calling different services the same name or the same service by different names, any cost comparison based on those definitions could be seriously misleading. To use a familiar expression, it would be like comparing apples to oranges. For example, we are currently engaged in a cost study that is attempting to compare the cost of nursing home services with the cost of in-home supportive services for the chronically ill elderly. Within the inhome-service sector, it was discovered that the definition of what constitutes home health aide services differs considerably across agencies. In

334 / GREENBERG

some agencies home health aide services consist mainly of "quasimedical" and personal care, but in other agencies these services also include light housekeeping and homemaker services. It was found that across settings (nursing home versus in-home service) the elements of a service that are provided under the service title "home health aide" in an in-home setting are often considered part of routine nursing service in a nursing home setting. Some very important services lack precise definition even within a given institution; "case management" is a good example. Although there may be little disagreement as to what the concept of case management is, there seems to be little agreement as to how one measures it for purposes of modeling or making cost estimates.

Uniform Cost-Accounting Procedures In its most basic form, a cost-accounting system is a set of procedures used for recording and distributing the costs that an organization accrues in providing its services. In other words, one of the fundamental tasks of the cost-accounting system is cost determination (Matz, Curry, and Frank, 1967). If different organizations use different classification systems, comparative studies of service cost become problematic. Thus, the cost-accounting system can be seen as a device for defining and classifying the inputs of the production process. Allocation Procedures Once services and programs are defined and the cost-accounting procedure is specified, it becomes necessary to develop procedures for allocating costs to the service or program with which they are associated. For purposes of cost allocation, cost can be usefully broken down into two categories: direct and indirect. Direct costs are those that are directly traceable to a single service or program, such as salaries and supplies. Indirect costs are those items that are common to several services, such as rent, utilities, and administrative costs. Since indirect costs do not directly accrue to particular services, it is necessary to devise a system of allocating them to the various activities of the organization. Again, when different organizations use different allocation procedures, it becomes difficult to compare the particular services provided by different organizations in order to determine whether the differences in cost are real or just due to different allocation procedures. As indicated above, there is currently no uniform methodology for classifying and allocating costs in the human service fields. Therefore, if we want to engage in cost analysis and are not willing to wait until uniform accounting procedures are adopted, cost methodologies must be developed that can be utilized for research purposes.

EVALUATING THE COST OF SERVICES / 335

The Time Value of Money Alternative service programs may have different cost streams over time. Some programs may encounter more of their costs during their early years, and others may face more of their costs either at the end of the program or spread more evenly over time. Some programs have a short time horizon; others may have a very long time horizon. This potential differential in time streams creates problems when one is trying to evaluate the cost of alternative programs. Other factors being equal, people would rather have money, goods, and services now than in some future period. An investment of X dollars that results in a return of Y dollars immediately is worth more to the investor than receiving Y dollars 5 years later. The question is how much should present consumption or return to investment be valued in relation to future consumption or return? Since having a dollar today is worth more than receiving it 5 years from now and since projects have different cost streams, it is necessary to collapse these various cost streams into a point in time. Furthermore, the mechanism used to collapse them should reflect this notion of time preference. A technique known as discounting to determine present value, or just present value, is such a mechanism. Basically, what this technique does is develop a single index of cost that is equal to the weighted sum of the cost streams. The weight that is used is called the discount rate. The equation that defines present value is as follows.

where V0 — value (cost) at the present time, Vt — (cost) at the end of period t, and r = the rate of discount (interest). Notice that, if you solve equation 1 for Vt instead of for V0 for any given point, the following relationship emerges.

Equation 2 may look familiar; it is the equation for determining the future cost or value of transactions today under a situation of compound interest. Thus, present value is nothing more than compound interest in reverse. The use of a simple example helps illustrate the importance that the rate of discount (r) plays in evaluating the cost of alternative programs. Table 8-3 presents the hypothetical cost stream for two alternative projects (A and B, respectively). Now assume that the correct rate of dis-

336 / GREENBERG TABLE 8-3 Hypothetical Cost Streams

Program A B

1 $100

$200

Year 2

3

$100 $ 85

$100 $ 0

count is 10%. What is the cost of each project in current (present) dol lars? Using equation 1, we obtain the following.

Thus, given a rate of interest of 10% and the above cost streams, project A is less expensive than project B. Suppose that the correct rate of discount is 5% rather than 10%. What effect does this change in discount rate have on the relative cost of the two projects? Based on a discount rate of 5%, the discounted cost of project A is $272.32 and the discounted cost of project B is $267.58. Project B is now less expensive than project A. Why? As the rate of discount goes down, the value of costs placed in the future increases relative to the costs incurred in the present time period. Now look at the time stream of the costs associated with A and B, respectively. Project A has its stream of costs uniformly spread over time. In contrast, most of project B's expenses occurred near the beginning of the project. Thus, as the discount rate drops, project B looks better and better. This example demonstrates the importance of the discount rate on the determination of the relative costs of projects. The use of a correct discount rate is essential for valid cost comparison, particularly for projects with very long time horizons. First, since the discount rate helps determine whether a public investment is worth undertaking, the rate of discount helps determine the resources that will be required by the government sector and, hence, those that will remain available to the private sector. Thus, the discount rate, if used, helps determine the relative size of the public sector versus the private sector. Second, since various projects have different time streams for both costs and benefits, the discount rate helps determine the temporal dispersion of benefits and costs. Low discount rates favor projects in which costs are borne early in the project (e.g., larger capital projects such as dams and roads). Yet, the calculation of the "correct" discount rate is not a trivial task.

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Conceptually, the determination of the appropriate discount rate is rather straightforward and follows directly from the basic concept of opportunity costs. As indicated above, if the government is going to utilize resources for public projects, then this implies that there are going to be fewer resources at the disposal of the private sector. What is the social cost of this transfer of resources from the private sector to the public sector? It is the value or return that would have accrued from private usage of resources. Thus, the benefits forgone represent the opportunity cost of the government project. This would imply that the correct discount rate to be used in the evaluation of a government project is the percentage rate of return that the resources utilized would have provided in the private sector (Baumol, 1968). Furthermore, it can be shown that, if all markets are competitive, if full employment prevails, and if all uses of resources have the same relative risk, then one rate of return will prevail for all private resource decisions (Mishan, 1973). A detailed discussion of the impact that the violation of one or more of these assumptions has on the choice of the appropriate discount rate is beyond the scope of this chapter. For the purposes at hand, it will suffice to say that the above conditions usually do not obtain; thus, more than one interest rate will prevail at any one time. This would imply that before the "appropriate" rate of discount can be determined, the analyst must first determine what part of the private sector these resources have been diverted from and then he or she must estimate the rate of return in that particular subsector. The preceding discussion tries to make a complex issue simple and so leaves out many difficult conceptual and empirical issues. However, we hope that two points have emerged from the discussion. First, the actual rate of discount that is utilized may have a significant impact on the evaluation of the costs of alternative projects. Second the determination of the appropriate rate to be used is a difficult task. However, as Baumol (1975, p. 361) recently stated: With the help of the principles and data now available, one should be able to arrive at reasonable approximations to the social rate of discount. Secondly, it should be possible to derive figures considerably more defensible than the conventional cost calculations that are all too often utilized to justify projects not all of which are clear in their economic merits.

Our goals are to make the reader aware of the need to use discounting techniques when costs (and benefits) accrue over a long period of time and to sensitize the reader to how difficult the estimation of the appropriate rate is. Clearly, this brief review of the subject will be inadequate for those readers who are currently involved in, or contemplating becoming involved in, the evaluation of such projects and programs. Therefore, we

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have included in the references a rather generous sampling of the literature on this subject.

Heterogeneity of Services Although the selection of the appropriate unit of measurement is sometimes a difficult task, an even more perplexing problem is the handling of the heterogeneous mix of outputs produced by programs that serve the elderly. In order to make meaningful cost comparisons, either the products or the services we are comparing must be very similar or we should have a way of controlling these differences in the study design and/or analysis. Skinner and Yett (1970) indicated that in the past investigators who attempted to deal with the problem of heterogeneous outputs have for the most part employed one of more of the following three approaches: (1) Samples of institutions or programs have been partitioned so that those providing similar outputs were grouped together for separate analysis. (2) Standardizing variables have been introduced in the cost equation in order to mark out differences in the types of outputs. (3) Weighted output measures have been constructed. Each of these methods will be briefly discussed.

Partition Samples The simplest data analytic technique for controlling the heterogeneity of product mix is the stratification, or the partitioning (sometimes called subclassification), of the sample. First, significant product mix variables must be identified. Then, based on the value or values of these variables, each organization, institution, or program is placed into the appropriate stratum. The cost analysis is then performed within each stratum. Since the analysis is stratum specific, the effect of the product mix is controlled. The degree of control is related to the narrowness of each stratum. It is clear that, when the number of product mix variables is large, the use of this technique to control the effect of all known product mix variables may not be possible or desirable. Berry (1967) successfully utilized this technique in an examination of the relationship between the amount of output (patient days) of hospitals and the associated average cost per patient day (i.e., he was testing the hypothesis of whether returns to scale exist in the hospital sector). He obtained service and facility data on over 5,000 hospitals in the United States. He then developed groupings of hospitals so that within each group the hospitals were similar with respect to services provided and facilities available. Forty groups of hospitals were obtained through this procedure. Within-group correlations between output and average cost

EVALUATING THE COST OF SERVICES / 339

were then calculated. Of the 40 groups, 36 showed a negative correlation, thus supporting the hypothesis that as output increases, average cost decreases. The reader is reminded that the sample size used in this study was over 5,000. This very large sample permitted the use of a large number of strata (40) and still allowed the researcher enough degrees of freedom in each to do the within-group analyses.

Standardizing Variables Another general category of data analytic techniques that has been used to control for product differentiation is the use of statistical models that adjust for product differentiation in the analysis. The most common of these models is the analysis of covariance. The reader not familiar with this statistical technique is referred to any good introductory statistics text (e.g., Snedecor and Cochran, 1967). Skinner and Yett (1970) utilized this technique in a study that was designed to estimate cost functions for nursing homes. They could not obtain data on service mix, but they were able to obtain case mix data (e.g., diagnosis, disability level, age, sex, etc.). They utilized the patient mix variables as proxies for service mix. Their results suggested that, after adjusting for the effects of patient mix, the average cost function for nursing homes in their sample would appear to support the hypothesis of returns to scale in that industry. Their use of patient mix variables raises an important point. In making cost comparisons, not only is it important to be able to describe and to control for program differences, but it is often equally important to be able to describe and control for client differences. Again, using the longterm-case example, several studies claim to show cost savings or potential savings by using home care in lieu of nursing home care. What did these claims of cost savings mean? Do they mean that it is less expensive to care for patients at home regardless of the characteristics of the client, such as initial impairment level? Or do they mean that up to a certain level of disability or impairment it is less expensive to care for a patient in his or her home? The point is that, until it is specified for whom a particular program or service is less expensive, a cost study cannot help in making rational policy decisions. Indeed, if the study does not control for relevant patient/client characteristics at all, then there is no way to distinguish cost savings due to differences in the types of services or programs from the cost savings due to caring for "healthier" people.

Weighted Output Measures Unlike the standardizing variables approach that utilizes one measure of output (patient days, client visits, etc.) and adjusts for various input

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mixes, the weighted output approach attempts to isolate the specific outputs that are produced, to estimate the input intensities of each, and then to weight the overall outcome measure accordingly. For example, Saarthoff and Kurtz (1962) divided patient days in acute hospitals into the following specific outputs: (1) adult and pediatric patient days, (2) newborn days, (3) obstetrical services, (4) surgical services, (5) X-ray services, (6) laboratory services, and (7) outpatient days. They then estimated the relative input intensity of each output. These relative input intensities were then used to develop a weighted index of output(s) for each hospital. Specifically, they used the following relationship: Si (index of output for the /th hospital) = (adult, pediatric, and newborn days + 2 (surgical and obstetrical admissions) + 0.3 (X-ray diagnostic procedures) +' 0.1 (lab tests and tissue exams) + 0.2 (outpatient department visits). Although none of these approaches has been found to be completely successful, the literature suggests that the best results are often obtained by using standardized variables on a sample of institutions or agencies that are as similar as possible (Lave, 1966; Mann and Yett, 1968). Clearly, an important constraint for controlling for heterogeneity is a lack of good data on input and output mixes. However, in the case of services to the elderly, we would argue that a lack of knowledge and understanding of exactly what the products of the various agencies serving the elderly are may be an even greater constraint to valid cost measurement and comparisons. With regard to understanding the products that these programs provide, it has been argued that the problems of heterogeneous services or programs can be avoided when one uses cost-effectiveness analysis rather than estimating the cost of services. According to this argument, since the measure of output in a cost-effectiveness study would no longer be the unit of service itself but rather some outcome measure, the difference between programs becomes irrelevant for the purposes of estimating costs. It can be argued that what is important is the cost per unit of outcome that is achieved. Although this approach to the problem has a certain amount of appeal, it should be recognized that, if a program is "successful," we might not understand what made it different from other programs that were not successful and we might not be able to generalize study findings to other settings or environments with any assurance or validity. Therefore, having a firm understanding of the nature of the intervention is essential for purposes of generalizability.

Secondary or Systems Effects The preceding discussion of cost analysis can be viewed as only partial in the sense that it has implicitly assumed that a change of policy toward

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the use of one program or service would not affect the cost of other services or programs. Often, each service is part of a "system" of health and social services, however fragmented that system may be. Being part of that system implies that the changes in one service may cause changes in other parts of the system. Therefore, it is important to investigate the potential effects a change in policy toward a particular service might have on costs in other service sectors, in particular, on how it might affect underlying cost relationships and utilization rates. For example, if the cost of care for an individual is a function of the individual's level of impairment, then it holds that the cost of caring for a particular service population is a function of that population's average disability level. For the long-term-care example again, the cost per patient day of nursing home care may be a function of patient mix, again defined in terms of disabilities and other conditions. Therefore, if there is a policy change in the direction of deinstitutionalizing that part of the nursing home population that is the least disabled, then the costs of caring for each remaining nursing home patient will increase. Unless this potential system change was considered, average nursing home costs will be underestimated. Figure 8-1 is a graphic representation of these phenomena. It is assumed that there is a fixed population of older persons having a particular distribution of disability levels. FIGURE 8-1. The effect of deinstitutionalization on nursing home costs.

Of this population, Y numbers are presently in nursing homes. To keep the argument as simple as possible, it is assumed that the average cost curve (AC]) for nursing homes is a horizontal line at B dollars. The total cost of caring for Y number of patients is the rectangle OBAY. Now let us assume that OF-OZ patients are discharged and provided the same

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care in their homes. It would appear that the total costs of nursing home care would be the rectangle OBEZ or a gross reduction of ZEAY. However, this would only be the case if the patients released to home care were chosen in such a way as to keep the patient mix (disability levels and conditions) the same. It would seem closer to reality to assume that people selected for placement in their homes did not require intense nursing care or supervision. In other words, they would have relatively lower disability levels. If the hypothesis about the relationship between disability and cost is correct, then, as the patient mix increases in average disability level, the average cost curve will shift up. This upward shift in the average cost curve is represented in the diagram by the line G-AC2. It is clear that the total nursing home cost reduction is no longer represented by the rectangle Z.YAE but by the smaller and possibly negative amount ZYAE minus BEFG. The cost of in-home care must then be subtracted from this to get the net savings or loss resulting from deinstitutionalizing. (See Greenberg, 1974, for an empirical investigation of this phenomenon.) Increased or decreased use of other services may also affect total costs. In most cost comparisons between institutional and home care, it is explicitly or implicitly assumed there would be no significant difference in the usage of hospital facilities for comparable individuals if the utilization of nursing homes and home care settings changed. As a consequence of this assumption, these studies often do not collect data on hospital usage for the two groups. It may be that, because of the preventive health care philosophy behind the home-care delivery system, differential hospital usage patterns will occur. Or it could be that home-care clients might tend to overutilize emergency rooms. The point is that, given the magnitude of the per diem cost of a hospital stay, even small changes in hospital utilization could lead to significant cost differentials. Therefore, it is important when discussing potential cost savings of various policies to realize that this change in policy may affect the underlying cost relationships. These relationships must be investigated if the true cost of the new program or policy is to be evaluated accurately.

Generation of Cost Data: Some Alternative Models Thus far, we have discussed some of the conceptual and measurement issues involved in obtaining valid and reliable cost data. Now we will briefly discuss alternative strategies for generating those data. Because of the rather technical nature of some of the methods, we must restrict ourselves to a rather general and, we are afraid, shallow presentation of the topic. Again, the references at the end of this chapter will be a useful supplement to the text.

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The goal of cost analysis is to estimate the cost associated with alternative programs or services that are being considered. Ideally, we would prefer to examine how these various programs would operate in the "real world." However, time and money constraints often do not permit this. Thus, we rely on models. These models are abstractions and simplifications of the real world. To the extent that the model is an adequate reflection of the real-world situation, the results that are generated will be useful in estimating what the costs of the alternative programs will be if they are adopted. Four our purposes, it is useful to divide the domain of possible alternative models into three classes: (1) demonstration and pilot projects, (2) simulation models, and (3) analytical models.

Demonstration and Pilot Projects The closest approximations to the real world are demonstration or pilot projects. The characteristic that distinguishes the demonstration and pilot projects from the other classes of models is that in the demonstration the proposed service or program is, to a limited extent, actually initiated (e.g., the Section 222 adult day care/homemaker projects). If the demonstrations are performed in an environment that is representative of the environment that would be encouraged if the proposed program were adopted, then an accurate and comprehensive accounting of costs is all that is required to estimate the cost of adopting the program. Needless to say, if the services provided, the persons served, or the organizational structures used are not sufficiently similar to what will occur upon adoption, extrapolation of the cost information generated by the demonstration project may be subject to serious error.

Simulation Models Simulation models are farther removed from the real world than demonstrations in that new programs are not actually initiated and some or all of the components of the system are simulated by a simple algorithm. For example, if we wish to simulate the cost of a new long-term-care program (say, for personal care organizations), the following model might be appropriate: (1) Enumerate the services that the new program will provide. (2) Use past data to estimate the cost of those services that have previously been provided (adjusting them appropriately), and develop estimates of the cost of each new service. (3) Develop case histories of clients that are likely to be eligible for the program. (4) Have the appropriate persons review the cases and prescribe placement and the amount and type of service required. (5) Utilize the results of steps 2 and 4 to estimate the total cost of providing this program to the specified population.

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The determination of how much of the system can be meaningfully simulated by algorithms is a function of our state of knowledge. For example, if a great deal were known about optimal placement and service requirements in long-term care, then that phase of the system could be modeled. Thus, phase 4 could be replaced by a set of explicit decisionmaking rules.

Analytical Models Analytical models are even farther removed from the real world than simulations. When using an analytical model, the analyst generates a system of equations that relates the characteristics of the program, on the one hand, to measures of cost (and/or effectiveness), on the other. Examples of this are linear programming models, Markov models, and the whole class of systems of equations.

Advantages and Disadvantages Each class of models has certain advantages and disadvantages associated with it. The main advantage of demonstration projects is their proximity to reality. Their main disadvantages are the time and money they require. More often than not, the time table for public decision making does not permit sufficient time to develop, to operate, and to analyze the results of a demonstration. Second, by their nature, demonstrations are expensive. This being the case, the number, size, and type of demonstrations that will be financially feasible are clearly limited. On the other hand, simulation models and analytical models are usually less expensive than demonstrations. And, since services are not actually provided, they require less time. Furthermore, once the model has been constructed, the various assumptions and parameters that the model is based on can be manipulated. By their nature, simulations and analytical models are based on a large number of assumptions. That is, as we move farther from the actual experience, hypothesized or assumed relationships must be substituted for actual data. Some of these assumptions and procedures seem heroic at times. Yet, if time and resources do not permit an experimental or demonstration project to be developed, the second best world of abstract modeling may be the only alternative. As Hatry (1967, p. 57) pointed out: It should be noted that in the process of using such statistically derived equations, the extreme extrapolation beyond the sample data may sometimes make any statistician shudder. However, it should be recalled that estimating the costs of a new system with novel features requires such extrapolations no matter how the costs are estimated. The use of a statistical

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approach seems in such cases to offer tangible assistance in making better, though still uncertain, cost estimates.

Because of the great amount of uncertainty that is often involved in modeling, it is incumbent upon the researcher to discuss explicitly or to report on the level of uncertainty that is involved in the model and, hence, the results that are generated from it. Often, all that is possible is a quantitative presentation of this uncertainty. It is then left to the reader to evaluate the results accordingly. Other times, it is possible to identify the assumptions that are most questionable, to identify likely ranges for them, and to rerun the analysis, based on these alternative sets of assumptions (parameters). In this way, the "sensitivity" of the results to particular values of the parameters can be empirically ascertained. Even more desirable than the use of sensitivity analysis on point estimates of the model parameters is the development of a subjective probability distribution or likelihood of obtaining the various parameter values. It would be desirable to be able to specify which method of generating data is "best." Although we are not in a position to judge which model is best, the decision for a particular research problem should be based on the resources available, the time constraints, the state of knowledge, the availability of data, and the precision of results desired.

Summary In this chapter we have presented a rather broad overview of some of the issues and elements important to the development of valid and reliable cost measurement. We began by developing a hierarchy of cost studies in which the distinction between cost-benefit analysis and costeffectiveness analysis was discussed. We are of the opinion that until such time as valid methods of estimating benefits have been demonstrated to be both conceptually sound and "do-able," we should rely on alternative, less-powerful methods. One suggested method is the use of cost-effectiveness analysis. As was indicated in the text, regardless of the type of cost study to be carried out, the appropriate concept of cost must be decided on, a uniform chart of accounts has to be developed, cost finding and allocation procedures must be uniform across programs, the units of service must have common definitions, heterogeneity of services across programs must be controlled, and, finally, a model for generating the cost data must be decided on. As was indicated, these tasks are not trivial. However, if we are to make progress toward improving our ability to analyze the costs of services to the elderly, both time and money must be

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devoted to the study of these issues. The steps toward solving these problems include recognizing that problems do exist and then moving toward an understanding of their nature. REFERENCES Acton, J. P. Evaluating Public Programs to Save Lives: The Case of Heart Attacks. Santa Monica, Calif.: Rand Corporation, R-950-RC, 1973. Measuring the Monetary Value of Lifesaving Programs. Santa Monica, Calif.: Rand Corporation, P-S675, 1976. Bator, F. "The Simple Analytics of Welfare Maximization." American Economic Review, 1957, 47: 22-59. Baumol, W. J. "On the Social Rate of Discount." American Economic Review, 1968, 58: 788-802. Economic Theory and Operations Analysis (3rd ed.). Englewood Cliffs, N.J.: Prentice-Hall, 1972. "On the Discount Rate for Public Projects." In Social Accounting: Theory, Issues and Cases, L. J. Seidler and L. L. Seidler (eds.), pp. 347-363. Los Angeles, CA: Melville Publishing, 1975. Berry, R. E. "Returns to Scale in the Production of Hospital Services." Health Services Research, 1967,2:123-39. Brandl, J. E. "On the Treatment of Incommensurables in Cost-Benefit Analysis." Land Economics, 1968,44:523-25. Conley, R. W. The Economics of Vocational Rehabilitation. Baltimore: Johns Hopkins University Press, 1965. Crystal, R. A., and A. Brewster. "Cost Benefit and Cost Effectiveness Analyses in the Health Field: An Introduction."Inquiry, 1976,3 (4): pp. 3-13. Dorfman, R. (ed.). Measuring Benefits of Government Investments. Washington, D.C.: Brookings Institution, 1965. Fein, R. Economics of Mental Illness. New York: Basic Books, 1958. Feldstein, M. Economic Analysis for Health Service Efficiency. Amsterdam: New Holland, 1967. Goldman, T. A. (ed.). Cost-effectiveness Analysis: New Approaches in Decision-making. New York: Praeger, 1967. Greenberg, J. N. "The Costs of In-Home Services." In A Planning Study of Services to Noninstitutionalized Older Persons in Minnesota, N. Anderson (ed.), part 2, pp. 1-71. Minneapolis: School of Public Affairs, University of Minnesota, 1974. Hatry, H. "The Use of CPS Estimates." In Cost-Effectiveness Analysis: New Approaches in Decision Making, T. A. Goldman (ed.), pp. 44-68. New York: Praeger, 1967. Klarman, H. E. "Syphilis Control Programs." In Measuring Benefits of Government Investments, R. Dorfman (ed.), pp. 367-410. Washington, D.C.: Brookings Institution, 1965. Lave, J. R. "A Review of the Methods Used to Study Hospital Costs." Inquiry, 1966,3: 57-81. Lawrence, J. (ed.). Proceedings of the Fifth International Conference on Operations Research. Venice and London: Tavistock Publications, 1969 and 1970. Mann, J., and D. Yett. "The Analysis of Hospital Costs: A Review Article." Journal of Business, 1968,41:191-202. Matz, A., O. J. Curry, and W. J. Frank. Cow Accounting (4th ed.). Cincinnati, Ohio: Southwestern Publishing Company, 1967. Mishan, E. J. "Evaluation of Life and Limb: A Theoretical Approach." Journal of Political Economy, 1971,79:687-705. Economics for Social Decisions: Elements of Cost-Benefit Analysis. New York: Praeger, 1973. Niskanen, W. A. "Measures of Effectiveness." In Cost-Effectiveness Analysis: New Approaches in Decision Making, T. A. Goldman (ed.), pp. 17-32. New York: Praeger, 1967.

EVALUATING THE COST OF SERVICES / 347 Pliskin, J., M. Weinstein, and P. Shepard. Utility Functioning for Life Years and Health Status. Cambridge, Mass.: Harvard School of Public Health, 1974. Pollak, W. "Costs of Alternative Care Settings for the Elderly." Washington, D.C.: Urban Institute working paper, 1973. Prest, A., and R. Turvey. "Cost-Benefit Analysis: A. Survey." Economic Journal, 1965, 75: 683-731. Rice, D. P. Estimating the Cost of Illness. Health Economics Series No. 6, Public Health Service Publication No. 947-6. Washington, D.C.: U.S. Department of Health, Education, and Welfare, 1966. Robinson, N. Cost of Homemaker-Home Health Aide and Alternative Forms of Service. New York: National Council for Homemaker-Home Health Aide Services, 1974. Rosenthal, G. " E v a l u a t i n g H u m a n Service Programs." In Developments in Human Services, Volume 2, H. Schulberg and F. Baker (eds.), pp. 211-230, New York: Behavorial Publications, 1975. Saarthoff, D., and R. Kurtz. "Cost per Day Comparisons Don't Do the Job." Modern Hospital, 1962, 94(4): 14, 16, 162. Samuelson, P. Economics (7th ed.). New York: McGraw-Hill, 1967. Schelling, T. C. "The Life You Save May Be Your Own." Proceedings of the Second Conference on Government Expenditures. Brookings Institution, Washington, D.C., 1966, pp. 127-76. Seidler, L. J., and L. L. Seidler. Social Accounting: Theory, Issues and Cases. Los Angeles: Melville Publishing, 1975. Skinner, D. E., and D. E. Yett. "Estimation of Cost Functions for Health Services: The Nursing Home Case." Paper presented in the meeting of the Southern Economic Association, November 12, 1970. Smith, R. S. "Compensating Wage Differentials and Hazardous Work." Washington, D.C.: U.S. Department of Labor, 1973. Smith, W. "Cost-Effectiveness and Cost-Benefit Analyses for Public Health Programs." Public Health Reports, 1968, 83: 899-906. Snedecor, G. W., and W. G. Cochran. Statistical Methods (6th ed.). Ames, Iowa: Iowa State University Press, 1967. Sorenson, J. "Uniform Cost Accounting in Long Term Care." Medical Care, 1975, 14 (supplement): 154-59. Taylor, V. How Much Is Good Health Worth? Santa Monica, Calif.: Rand Corporation, P-3945, 'l969. Thaler, R. H. "The Value of Saving a Life: A Market Estimate." Ph.D. dissertation, University of Rochester, 1974. Thaler, R., and S. Rosen. "The Value of Saving a Life: Evidence from the Labor Market." Paper presented at the National Bureau of Economic Research Conference on Income and Wealth, Washington, D.C., November 1973. Usher, D. "An Imputation to the Measure of Economic Growth for Changes in Life Expectancy." In The Measurement of Economic and Social Performance, M. Moss (ed.), pp. 193-225. New York: National Bureau of Economic Research, 1973. Weinstein, M., R. Shepard, and J. Pliskin. "Decision-Theoretic Approaches to Valuing a Year of Life." Cambridge, Mass.: Harvard School of Public Health, 1975. Weisbrod, B. A. Economics of Public Health. Philadelphia: University of Pennsylvania Press, 1961. Weissert, W. G. "Costs of Adult Day Care: A Comparison to Nursing Homes." Inquiry, 1978, 15: 10-19. Wiseman, J. "Cost-Benefit Analysis and Health Service Policy." Scottish Journal of Political Economy, 1963,10:128-45.

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Chapter 9

Organizational Properties John O'Brien and Greg Chaille

This chapter describes general measurement problems and examples of instruments that assess the properties of formal organizations. It is unlike most chapters in this series, which concentrate on instruments that measure the properties of individuals. At both levels of analysis, a tremendous variety of empirical work has been undertaken. Obviously, there is no way that a single chapter on organizational measurement can do justice to this broad, expansive field. For that reason, what is included here is not a comprehensive catalog of instruments. Instead, the introductory text and the short sample of specific instruments are intended to serve as a guide for other investigators searching and reviewing the literature before undertaking their own work. The first part of the chapter is an overview of studies dealing with three topics: organizational research, organizational environment research, and interorganizational research. A short methodological section concerned with the reality and measurement of organizational properties follows. The last section contains a brief paragraph describing the derivation and potential usefulness of each of the 10 instruments presented at the end of this chapter.

General Issues in Organizational Research Before discussing the instruments themselves, a brief review of the broader developments in organizational research is in order because many users may have problems that, although not amenable to the application of specific instruments reviewed later, may benefit by reference to other studies available. The review covers four types of studies conventionally undertaken that involve problems of organizational measurement: (1) 349

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studies of member-enterprise relationships, (2) case studies of single enterprises, (3) historical analyses of organizational processes, and (4) practically focused studies addressing the problem of organizational effectiveness. One of the most difficult aspects of conducting research on organizations is separating the study of the behavior of organizations from the study of the behavior of individuals in organizational settings. That distinction, although far from rhetorical, is often very difficult to make. As a result, inexperienced investigators who "go to the literature" in order to design studies of organizational problems frequently become confused. A careful reading of the literature reveals that a substantial number of investigations about organizations were not specifically intended to measure the properties of organizations at all (Katz and Kahn, 1966). Rather, they sought to investigate selected attributes of the individuals who are located in some particular organizational situation (Argyris, 1962). Over the years, numerous studies of this type have been undertaken, with particular emphasis on the behaviors of workers in the work place. Examples of the types of issues addressed in these studies include the determinants of worker satisfaction (Davis and Cherns, 1975), the motivations of workers to work (Herzberg, Mausner, and Snyderman, 1959), the characteristics of work groups that affect output (Rothlisberger and Dickson, 1939), the effects of job design on workers' attitudes (Lawler, Hackman, and Kaufman, 1973), the types of characteristics associated with workers' willingness to accommodate themselves to organizational change (Lawrence, 1969), and the attributes of effective leaders (McGregor, 1960). The study of such issues is critical, and readers wishing to investigate these questions should consult these and related studies. Doing so will provide methodological aids suited to investigating the psychosocial processes of workers at work. The structural determinants or components of organizational behavior per se will, at best, be tangential to such analyses. A second type of study involves the investigation of organizational principles by undertaking an in-depth case study of a single agency or enterprise. A number of these works are considered classics in the field. Included are analyses of issues such as the circumstances under which democratic governance arises in voluntary associations (Lipset, Trow, and Coleman, 1956), the extent to which bureaucratic organizations can facilitate rather than hinder change (Blau, 1963), the processes by which leadership succession can lead to greater bureaucratization of an enterprise (Gouldner, 1954), and the way in which co-optation of grass-roots organizations by a large enterprise for purposes of short-term gains can

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lead to a long-term deflection of the enterprise from the accomplishment of its primary goals (Selznick, 1949). Without question, much can be learned both substantively and strategically from these studies. But, by their nature, reliable, valid, and standardized instruments are rarely a direct by-product of these case studies. A third important issue addressed in organizational research is concerned with the relationship (or lack of it) between the sociocultural macroforces of a society and the organizational microprocesses of the enterprises working in that society. Although the comparative/historical methodology used in this type of work is extremely prone to the intrusion of ideology, many of the better-known works of this type were undertaken from a relatively neutral, analytical viewpoint. For instance, Weber (1958) analyzed how a particular dominant moral ethic of a society (Protestantism) is associated with the tendency of the society to evolve a capitalistic industrial style; Bendix (1956) attempted to account for differences in patterns of industrial organization in the United States, Great Britain, the Soviet Union, and East Germany by examining the historical circumstances present at the time of the industrialization in each country; Udy (1959) attempted to show how the organization of work (such as the division of labor) is dependent on the technology but independent of the culture in a country; and Crozier (1963) undertook to show how the informal work group so common in the United States work place is relatively unknown in France because that style of work is inconsistent with the culture of that country. Again, owing to methodological realities intrinsic to the comparative/historical approach, this set of important works provides little in the way of standardized instrumentation. As discussed above, the psychosocial, case study, and comparative/ historical approaches to the study of organizations necessarily do not yield instruments of the type sought for inclusion here. However, there is a fourth type of work that, by design, ought to prove more fertile. Here we refer to the quantitative studies of the determinants of organizational effectiveness. In the studies of effectiveness, although there commonly is a rough orienting model to guide the researchers' decisions about what to measure (Georgopolous and Tannenbaum, 1957), the basic thrust is to gather data across broad fronts thought to be associated with organizational effectiveness (Mott, 1972; Negandhi, 1975b). Mass data reduction and analytic techniques are used to find out what explains the variance in effectiveness (Seashore and Yuchtman, 1967). Because these survey studies often involve rather large sets of data and incorporate multimethod, multilevel, and multimeasure designs (Steers,

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1975), one might expect to find many sophisticated instruments. Unfortunately, different investigators tend to use different indicators of effectiveness; examples include goal achievement, adaptation, productivity, program innovation, stability, integration, morale, resource acquisition, and strain. (See Mulford et al., 1976-1977, for a review of a number of related studies.) Beyond that, there is generally thought to be insufficient attention given to the conceptual linkages between the indicators used and the notion of effectiveness (Thorndike, 1949; March and Simon, 1958; Perrow, 1961; Simon, 1969). Because of these problems, it is difficult at this time to designate a single instrument that is likely to be useful as a measure of effectiveness for application across the range of organizations. Because of the importance of this matter, we have included here one instrument that was developed in a study of hospital effectiveness (Georgopolous and Mann, 1962) and is likely to be adaptable to multiagency human service programs.

The Organizational Environment Although the general field of organizational research has been in existence for a long time, specific concern for the measurement of interorganizational properties is considerably more recent. Roland Warren's (1967) conceptual piece entitled "The Interorganizational Field as a Focus for Investigation" is generally acknowledged to have been the first major effort to draw attention to interorganizational analysis as a potentially fruitful area of inquiry. Even before Warren's publication, attention had already begun to turn to the importance of external factors as determinants or constraints on internal organizational processes. By the 1960s, an awareness that what went on inside an organization was not insulated from forces coming from beyond the organization's boundaries had grown (Simon, 1961). Some of this attention represented the application of the "open systems" concept as an alternative to the bureaucratic, closed systems ideas about organizations that had dominated thinking (Buckley, 1967). Other early work, while avoiding the "systems" argument, represented a pragmatic recognition that the sensible and, hence, successful guidance of internal organizational processes could best be accomplished when organizational members paid attention to environmental realities (Thompson and McEwen, 1955). Since that time, theoretical and empirical investigation has increased a great deal. But the cumulative quality of that work has been limited, primarily because the many studies of the relationships among external environmental factors and the otherwise autonomous actions of organizations differ in terms of the way the environment is defined. Those

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differences involve both a lack of similarity in assumptions about the critical elements that make up the environment and inconsistencies regarding the dynamic properties of the environment in terms of its alleged influence on organizations (Aldrich and Pfeffer, 1976). Specific instances of definitions of the environmental components are remarkable both for their lack of precision and for their variability. For instance, the notion of organizational environment has been conceptualized by different authors as follows: (1) the supply of scarce and valued resources that organizations need (Seashore and Yuchtman, 1967); (2) the field of interacting organizations of which one particular unit is a part (Warren, Rose, and Bergunder, 1974); (3) the sociopolitical forces that surround an organization (Meyer and Brown, 1977); (4) groups of consumers, suppliers, competitors, and regulators (Dill, 1957); (5) the general and specific influences on an organization, including technological, legal, political, economic, demographic, ecological, and cultural conditions (Hall, 1977); (6) market behavior and rules (Williamson, 1975); (7) any unit with which the focal organization has input-output transactions (Thompson, 1967); and (8) those external phenomena that influence but cannot be readily affected by the organization (Hurwicz, 1972). Beyond differences of definition regarding the components or elementary units that make up environments, there are also differences of perspective regarding the dynamic properties of the environment and their subsequent effects on organizations. For instance, Emery and Trist (1965) claimed that the environment is a rapidly changing social system constituting a "moving ground" that generates more and more uncertainty, thereby requiring the organizations in it to associate with one another in joint ventures in order to cope with the pressure. Elsewhere, Terreberry (1968) claimed that the environment is a gradually evolving system growing increasingly complex and becoming a progressively greater source of externally induced organizational change. Burns and Stalker (1961) and Lawrence and Lorsch (1967) stipulated that the environment (technological and market conditions) may be rapidly changing or placid, requiring organizations to have specific internal structures in order to succeed. Hickson and associates (1971) looked at how the ability of particular subunits in an organization to cope with environmentally induced contingencies leads to patterns of power and influence in the enterprise. Van de Ven and associates (1975) claimed that the environment is an interacting collective consisting of all organizations with which the focal unit is connected and in which any particular organization can do well only to the extent that the interorganizational collective does well. Hannan and Freeman (1977) suggested that the environment is an ecological system consisting of other organizations that

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exert forces that select (in the biological sense of selection) for or against various types of organizational forms. And Aldrich (1979) saw the environment as a resource controller that effects the start-up and survival chances of organizations. Not surprisingly, the lack of consistency in the definitions of organizational environment has allowed little progress in the development of easily used, widely accepted measures. As summarized by Downey and Ireland (1979), immense theoretical and measurement problems currently exist regarding what is widely believed to be the critical set of forces, called the "environment," that bear on organizations. This is certain to be a very active area for investigation of organizational behavior in the coming decade.

Interorganizational Activity During the past 15 years, the attention given to interorganizational relations has expanded greatly. At issue is the general question of what are the "natural" or "purposive" circumstances under which organizations establish linkages with one another. Of further interest is the extent to which those linkages generate particular consequences for the members of the involved organizations, for the individual organizations themselves, for the set of interconnected organizations, or for the community at large. Other than to say that patterns of linkages appear to affect the achievement of collective goals, the success of individual enterprises, and the feelings of competency of individual actors, there is no formal theory of interorganizational relationships to date (Negandhi, 1975a). One implication of this theoretical lacuna has been the lack of success in developing widely recognized and meaningful measurement tools of the type that would usually be included in this kind of compendium. However, the novice investigator can still learn a great deal about how to proceed in the design of future research even from unsuccessful efforts. Hence, attention is briefly drawn to the interorganizational literature to help orient the reader to its more efficient use. The material dealing with the causes and consequences of interorganizational behavior is arranged according to how it deals with four major issues: (1) the location and distribution of resources, (2) the establishment and maintenance of power and influence, (3) the management of conflict, and (4) the pursuit of public interests (such as human or community welfare). First, if Yuchtman and Seashore (1967) were correct in envisioning the environment as a resource context on which organizations are dependent, then some processes must exist for securing and distributing those resources. One particularly common notion of how this occurs contends

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that organizations engage in the social exchange of vital, scarce resources in order to secure the means to their own success (Levine and White, 1961). The particular resources that might be bartered in social exchanges include money, staff, information, technology, access to information, and access to influential (O'Brien and Mullaney, 1979). Other investigators consider the process from a more narrow economic model and have explored the way in which independent units come together to engage in market transactions (Williamson, 1975) or reach joint decisions about the distribution of "goods" or "bads" arising from collective problems, such as water pollution (Tuite, Chisholm, and Radnor, 1972). One of the implicit matters not settled in the social exchange or market approaches to interorganizational behavior concerns the type of norms or rules that the participant units use to guide their bargaining behavior. In that regard, O'Brien (1976) formulated and later explored (O'Brien, Wetle, and Lindsey, 1978) the extent and circumstances under which self versus common interests dominate interorganizational transactions. Benson (1975) chose to formulate the matter as one guided by rules of the political economy as they govern the distribution of money and authority among enterprises. The somewhat nihilistic notion of interorganizational linkages oriented solely for the purpose of trafficking in money and authority leads to the second major issue addressed by investigators of organizational behavior: the use of such linkages to manage the power and influence structure of a community. Examples of work along this line are the work of Laumann and Pappi (1976), who analyzed interorganizational networks as means by which organizational elites express and consolidate community influence; of Clark (1965), who described how organizations with similar purposes (i.e., education) establish alliances in order to protect themselves from potentially excessive policy intrustions from the federal government; of Blau (1964), who pointed out how the potential interdependencies of units are evaluated before entering into them on the basis of the power and control implications inherent in dependency situations; and of Perrucci and Pilisuk (1970), who examined how patterns of organizational linkages form the base on which community power rests and from which power is exercised. The discussion of patterns of power and influence leads to the next category of concern in interorganizational research: the management of conflict among units that are located in the same task environment. In this connection, one set of analyses has been directed at showing how organizational coalitions (Coleman, 1966), linkage networks (Turk, 1973), and coordinating councils (Mott, 1968) serve the essential function of helping channel or mediate conflict so as to maintain order in commu-

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nity affairs. Considering the issue of conflict to be more spontaneous and less managed, Assael (1969) attempted to demonstrate how constructive conflict improves communication among organizations, thereby allowing the legitimate expression of differences of belief or interests. O'Brien and Wetle (1974) explored how conflict is a sign of changes of patterns in community life and, hence, how it is an inevitable aspect of successful efforts at purposive changes aimed at achieving new policy objectives. Finally, one turns to the set of investigations and expository works that analyze multiorganizational behavior in terms of the part it plays in the pursuit of public problems, such as community or personal welfare. For instance, Litwak and Rothman (1970) discussed the importance of agency confederations that help mediate differences in order to expedite pursuit of social welfare goals. Warren, Rose, and Bergunder (1974) analyzed how interorganizational relations contribute to the achievement of urban reform. Spencer (1974) discussed how federal policies can promote needed integration to help improve the local delivery of human services. Pfeffer (1972) analyzed how managers of private enterprises are more committed to the government's interests when the dependencies of their enterprise on the government are high and their interaction with it are frequent. Schermerhorn (1975) laid out a logical scheme for explaining the circumstances under which organizations would establish relationships with one another. And Hage (1974) used case material to discuss strategies of establishing more smoothly multiagency human service delivery systems. As suggested earlier, the tremendous volume of written material on interorganizational behavior has generated remarkably few research instruments. In part, this is because most investigators have relied on simple sociometric measures, such as asking executives to choose from a list the other organizations with which they frequently exchange money, support, or information. Unfortunately, the meaning and significance of "linkages" established in this somewhat cursory manner have yet to be validated. Beyond that, the expository work of many investigators has simply not been followed up with careful empirical studies. In large part, this is due to the expensive and difficult task of studying a large number of multiorganizational networks. Hence, this area will also be a very active topic of investigation in future years. Collecting Data on Organizational Level One of the more knotty issues to be confronted in organizational research regards the strategic processes by which the properties of organizations

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are to be assessed. One logical possibility is the examination of written documents, public statements of policy, and the like (Blau, 1957; Blau, Hydebrand, and Stauffer, 1966). There is some skepticism about the extent to which such rhetorical expressions capture the true dynamics of organizations. Because of unwritten customs and informal processes, the way in which channels are followed, rules adhered to, decisions centralized, information transmitted, coalitions established, market conflict waged, and the public interest pursued, these variables may be only moderately related to citable pronouncements of the enterprises' leadership (Cyert and March, 1963; Perrow, 1961). An alternative to a reliance on public documents is to ask members to discuss the structure and processes of the enterprise during an interview situation. Here, other fundamental dilemmas must be resolved concerning both the degree to which individual responses might be distorted and, more critically, the extent to which an individual answer to a question can ever be interpreted as a valid measure of an organizational property (Coleman, 1958-1959). The former issue is encountered in any study involving the use of obtrusive measures (interviews, questionnaires, and public observations) to gather data. In general, the conventional belief is that with adequate care the possibility of respondent-instrument-investigator distortions can be adequately minimized (Stone, 1978). If so, then other requirements for the use of alternative research designs and matters of reliability and validity of measurement can be addressed (Mowday and Steers, 1979; Bouchard, 1976). The latter issue concerning the establishment of organization-level properties based on the statements of members is more controversial (Simon, 1961). First, it is essential to believe that organizations constitute logically meaningful social systems separate from, and more than the sum of, the properties of the members who belong to it (Warriner, 1956). Accepting that premise allows the conclusion that organizations are goaloriented, boundary-maintaining systems of activity that employ some type of technology for doing work (Aldrich, 1979). There is another unsettled debate about whether the organization constitutes an instrument by which executive will is expressed (Perrow, 1979) or whether the organization is a living system that, in a fashion analogous to a human being, is capable of processing information, making judgments, and taking purposive action (Turk, 1973). In general, it is necessary that one accept the idea that organizations exist in order to apply any of the topics discussed in this chapter. Regarding the question of whether one is also willing to engage in the anthropomorphological assumption that the organization can act and react as a system, it is probably

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also necessary to answer in the affirmative in order to make this work sensible (Hall, 1977). To return to data-collection problems, based on considerable experience studying organizational behavior, it is the opinion of John O'Brien and others (Lazarsfeld and Menzel, 1961) that carefully followed field strategies can ensure that the responses of members do represent organization-level data. To do so, it is recommended that respondents be approached not as individual citizens or as encumbents of particular roles in the enterprise but as key informants who are qualified to speak as experts regarding the enterprise on the basis of their experience in occupying some particular strategic position in it. This particular approach is based on an underlying assumption regarding the way in which information and judgments are maintained in the respondent's mind and subsequently brought out during an interview. The presumption is that one's mental content is not stored randomly but is arrayed in patterns that facilitate access for negotiating one's day-to-day life. As sociologists, we believe that this means that one important set of categories according to which mental content is stored consists of the social positions and accompanying roles that the individual recurrently enacts. Furthermore, we assume that individuals can cognitively determine which role categorization to apply in confronting, enacting, describing, or evaluating any particular situation. For instance, a hypothetical individual might express opinions regarding consumer issues from the perspective of five roles: as a parent, a spouse, a worker, a taxpayer, or a recreation-oriented adult. It is quite likely that differences would be noted if he or she were interviewed, depending on which particular role was dictating the mental set applied to the answers. Furthermore, if the individual were indeed able to hold the mental role set constant while cognitively selecting which particular role orientation to apply, then it should be possible to interview the same set of individuals on two different occasions in order to prepare two separate reports presenting data on what "parents" think of the current consumer situation in one and what "recreation-oriented adults" think of the current consumer situation in the other. Indeed, though not explicitly stated, this premise is fundamental to most public opinion polls, market surveys, and social science field studies. We suggest that a procedure similar to this one can be used when asking an individual to provide data regarding the organization of which he or she is a member. Initially, the individual is instructed that he or she has been chosen to participate in the study based upon his or her extensive experience in the enterprise and that it is the wish of the investigators that he or she assume the role of an expert key informant. Furthermore, he or

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she is told that, in the face of some questions, he or she may feel that the potential response as a concerned citizen or jobholder may differ from the best judgment of how the matter under scrutiny normally occurs in the organization. Under such circumstances, he or she is told to feel free to tell the interviewer about that "personal" perspective but, in each case, what will be entered on the interview schedule will be his or her best judgment regarding the organization as a whole. In a related vein, one recent study (O'Brien, Wetle, and Lindsey, 1978) offered each informant a $25.00 fee to do the interview. The rationale for that action was not simply to "purchase" cooperation but to stress the importance of the "informant" role. During the interview, the respondent was "working for the research team" in the role of consultant rather than being a concerned citizen or worker. In conclusion, substantial effort has been invested in studying organizational issues. Yet, for numerous and plausible reasons, the quality of measurement growing out of the work has not been high. We interpret this as a sign of multiple theoretical and methodological goals; hence, the work of the many investigators tends to be logically unlinked and the collective product, noncumulative. At the risk of overburdening the point, we might conclude that organizational research is a science in search of a paradigm (Kuhn, 1970). At this time, we can only speculate on what breakthrough could unify the field and overcome a paradox which looms large: Why is organizational research so disorganized?

Overview of Instruments Although the introduction to this chapter is cast broadly, the instruments included in this chapter represent a restricted set of examples and concern only the measurement of interorganizational properties. That narrowness results from the application of selection principles that were used to filter out the very few instruments included here. (The brief set of instruments presented here was chosen after the application of the following four principles. First, attention was given to the interests of the U.S. Administration on Aging [AoA], which sponsored the development of this three-volume series. That agency includes in its mission the undertaking of actions aimed at promoting changes in the relationships among organizations for purposes of increasing the adequacy and equity of benefits for older persons. However, for numerous reasons, including a concern for the proper role of federal bureaus, the AoA undertakes much less action aimed directly at affecting the internal properties or processes of other agencies or enterprises. Hence, it was decided that, although more general measurement issues would be overviewed, specific

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instruments to be included would need to address interorganizational rather than intraorganizational problems. Further support for this decision is that there are now on the market other inventories of intraorganizational instruments. [See Price, 1972, for example.] The implicit duplication seemed unjustified. In any event, since the vast majority of past studies addressed processes or problems that occur within organizations, this criterion radically reduced the field of choice. A second consideration regarding what to include rested on the decision to select, when possible, measures developed in studies that were conducted in relationship to human aging/gerontology issues. Again, this is out of consideration for the fact that the AoA funded the development of this work in order that it serve an audience primarily consisting of applied research workers interested in investigating aging-related problems. We concluded that this audience would be best served by including instruments developed in aging studies rather than instruments developed in studies addressing other substantive matters. Third, for reasons partly related to those stated above and partly related to our belief in the unique properties of human service, or people-processing, organizations, instruments were selected only when they appeared to do well suited for use on organizational behavior in the public-service-providing sector, and we excluded those that seemed applicable only in the private-goodsproducing sector [Lind and O'Brien, 1971]. Finally, following the specific instructions of the series editors, we eliminated from consideration single-item measures, measures that might not be easily applied by inexperienced researchers, and instruments for which reliability and validity considerations were not formally addressed or reported in the sources available to us. All in all, after applications of these criteria, very few instruments could be included in this chapter.) We were, in general, interested in instruments whose development was documented and that appeared to have theoretical meaning that did not bind their use to specific kinds of interorganizational contexts (i.e., industrial contexts). Although none of the instruments listed in Table 9-1 is restricted in its potential use to interorganizational contexts involving the elderly, all are applicable for use in studying those contexts. The measure of Organizational Effectiveness developed by Georgopolous and Mann (1962) provides a means of assessing effectiveness as it is reported by key informants within an organization. Effectiveness is viewed as a goal achievement question. The problem of goal identification has been reduced to manageable proportions by identifying the day-to-day activities of the organization (in this instance, hospital patient care). The instrument, however, is adaptable to interorganizational situations in which one wishes to assess effectiveness.

ORGANIZATIONAL PROPERTIES / 361 TABLE 9-1 Measures Reviewed in Chapter 9 Instrument

Author(s) (Date)

Code Number

a. Organizational Effectiveness b. Scale of Intensity of Interorganizational Relations c. Interorganizational Ties in the Social Services Network d. Openness to Interorganizational Cooperation e. Domain Consensus f. Perceptions of the Formal and Informal Organization g. Formalization of Interorganizational Relations h. Measure of Community Policy Impact i. Organizational Resistance to Policy Compliance Mechanisms j. Organizational Self Interest— Common Interest

Georgopolous and Mann (1962) Rogers (1974)

V3.9.I.a V3.9.I.b

Klonglan et al. (1976)

V3.9.I.C

Schermerhorn (1976)

Not reproduced

Benson et al. (1973) Reif, Monczka, and Newstrom (1973) Wetle et al. (1976)

Not reproduced Not reproduced V3.9.I.g

O'Brien and Wetle (1974)

V3.9.I.h

O'Brien and Mullaney (1979)

V3.9.I.i

O'Brien, Wetle, and Lindsey (1978)

V3.9.I.J

Rogers's (1974) Scale of Intensity of Interorganizational Relations measures the intensity of interorganizational interaction. This variable refers to the kind and amount of resource investment that takes place between two organizations. A very similar measure that adds two items to Rogers's original six-item scale is Interorganizational Ties in the Social Services Network (Klonglan et al., 1976). Here, the concern is also with the resource investment taking place between organizations, but resource investment is differently evaluated within each of three hierarchical levels of the social services delivery system. Both of these instruments provide a means for assessing the extent of contacts between serviceproviding organizations and can be used to map effectively a network of service organizations within a community. Schermerhorn's (1976) measure of Openness to Interorganizational Cooperation is really several measures, all of which form an index hypothesized to be predictive of hospital administrators' openness to cooperation with other organizations. We think that this measure is primarily descriptive and allows for the evaluation of the cooperative conditions present within service-providing networks. The measure of Domain Consensus developed by Benson, Kunce,

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Thompson, and Allen (1973) is an instrument for measuring interagency agreement about the provision of specific services to client populations. However, its strength might prevent it from being too widely used in that it is necessary to list specifically the full range of services the organizations provide. When it is possible to build a sample from a specific range and type of organization, this measure can be easily and effectively used. Although the Reif, Monczka, and Newstrom (1973) measure of Perceptions of the Formal and Informal Organization was applied to an intraorganizational setting, it can be used to uncover perceptions regarding these same concepts at the interorganizational level. However, it is a lengthy instrument that may be difficult to use in combination with other instruments in a survey research project. Several suggestions are made about potential uses for this i n s t r u m e n t in service-providing organizational settings. The last four instruments presented in this chapter were all developed by John E. O'Brien in conjunction with a series of studies of human service organizations. The initial study was a 3-year longitudinal analysis of 22 organizations from a single community that were involved in a service-integration demonstration project (O'Brien and Whitelaw, 1973). It was followed by three survey research cross-sectional studies. Included were 71 organizations in six communities (O'Brien and Wetle, 1974), 126 organizations in three communities (Wetle, et al., 1976), and 180 organizations in six communities (O'Brien, Wetle, and Lindsey, 1978). The studies were designed to explore the way in which community, organizational, and administrative procedures affect the outcome of federal policy actions aimed at improving human services for elderly persons. In each study, the organizations studied were chosen on the basis of their current involvement in service delivery to community-residing elderly persons. Left out were organizations that exclusively provided residential services, such as nursing homes and, to a large extent, hospitals. Since the organizations were clustered within communities, by definition they shared the same "task environment" or "service market." Since 1973, the U.S. Administration on Aging has funded the establishment of approximately 530 area agencies on aging in virtually all major communities/service markets in the United States. Those agencies are specifically charged with undertaking planning and coordination functions in order to try to improve the coherence and fit of the demand and supply of services to the elderly in the area that they oversee. O'Brien and associates' research was concerned with numerous issues relating to the policy objective of services integration and was approached from the theoretical perspective of social organization and so-

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cial control (Olson, 1965). They set out to define and to develop the means to measure the output of service-coordination programs; to explicate the part played by conflict in the integration of functions from separate enterprises; to explore the mechanisms by which separate enterprises generate, barter, compete for, or exchange critical resources; and to study the personal processes and institutional mechanisms by which federal policy ventures could achieve particular patterns of change at the local level. A further, overarching goal was to determine the extent to which variability among communities was associated with variability in the structure and processes that guided action within and among organizations. It was thought that an improved understanding of those relationships might provide insights by which to develop and to implement federal policies that are more responsive to local variability. The measure of Formalization of Interagency Relations (Wetle et al., 1976) was developed as a tool that might aid in identifying the relative degree of formal structuring of service coordination that would fit local interests. Although the achievement of services integration is of recurrent public interest, there can be substantial variability among programs in terms of the relative preservation of the autonomy of involved units. This instrument was to allow the identification of dispositions to endorse or resist highly formalized coordination arrangements so as to allow for more effective policy planning at the local level. The Measure of Community Policy Impact (O'Brien and Wetle, 1974) was designed as a measure of the degree to which collective goals are being accomplished by a set of separate organizations working in the same task environment and on behalf of a particular target group (in this case, the elderly). Again, in multiorganizational service programs, it is difficult to assess the joint product. This instrument is based on an idealtype model of a "comprehensive service system" that describes a situation that might be approached in a particular community but never entirely reached. The instrument was to be periodically reapplied so that timeseries data would demonstrate the relative rate of change in accomplishing various aspects of the ideal-type service system. Effectiveness, then, would be defined as the rate of change along the dimensions measured by the instrument, with change rates rather than absolute levels being comparable across communities. The scale of Organizational Resistance to Policy Compliance Mechanisms (O'Brien and Mullaney, 1979) was designed to assess the level of resistance to, or acceptability of, various strategies by which service policies are implemented. The presumption is that policy implementation requires changes in organizational behavior. Various compliance mecha-

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nisms are used to promote desired changes. The problem is selecting a compliance mechanism that will promote desired changes without instigating rebellion. These dispositions are thought to vary, and this instrument is intended to capture that variability so as to enhance strategic policy planning. The measure Organizational Self Interest —Common Interest (O'Brien, Wetle, and Lindsey, 1978) is also intended to measure the variability that might enable public goals to be more easily accomplished. The SI—CI instrument was specifically designed to assess the strength of organizational self-interest versus organizational common interest as important rules governing interorganizational transactions. In order to succeed, all service-coordination programs must change relationships between organizations. Behaviorially speaking, interorganizational relationships are transactionns of various types. Since all transaction systems are governed by rules or norms, influencing such systems requires an understanding of the rules that govern behavior. A coordination agency in a community might use the instrument "diagnostically." The agency could then take actions to promote the desired changes while deferring to local customs as much as possible. Summary As with most research on organizational activity, the intent of the studies from which these instruments were taken was problem oriented rather than purely scientific. Justifying expensive and intrusive research of this type requires strong pragmatic appeals to the issues of the day. However, a serious consequence of this applied emphasis is that far too little attention has been given to the theoretical and methodological issues involved. This undoubtedly accounts for the dearth of instruments that might otherwise have been included in this chapter. It is hoped that this situation will change during the coming years.

REFERENCES Aiken, M., and J. Hage. "Organizational Alienation: A Comparative Analysis." American Sociological Review, 1966, 31:497-507. "Organizational Interdependence and Intra-organizational Structure." American Sociological Review, 1968,33:912-30. Aldrich, H. E. Organizations and Environments. Englewood Cliffs, N.J.: Prentice-Hall, 1979. Aldnch, H. E., and J. Pfeffer. "Environments of Organization." In Annual Review of Sociology, A. Inkeles (ed.), vol. 2, pp. 79-105. Palo Alto, Calif.: Annual Review, Inc., 1976. Argyris, C. Interpersonal Competency and Organizational Effectiveness. Homewood, 111.: IrwinDorsey Press, 1962.

ORGANIZATIONAL PROPERTIES / 365 Assael, H. "Constructive Role of Interorganizational Conflict." Administrative Sciences Quarterly, 1969, 14:573-82. Bendix, R. Work and Authority in Industry. New York: Wiley, 1956. Benson, J. "The Interorganizational Network as a Political Economy." Administrative Sciences Quarterly, 1975, 20: 229-49. Benson, J., J. Kunce, C. Thompson, and D. Allen. Coordinating Human Services: A Sociological Study of an Interorganizational Network. Research Series No. 6. Columbia, Mo.: Regional Rehabilitation Research Institute, 1973. Blau, P. M. "Formal Organization: Dimensions of Analysis." American Journal of Sociology, 1957, 43: 58-69. The Dynamics of Bureaucracy. Chicago: University of Chicago Press, 1963. Exchange and Power in Social Life. New York: Wiley, 1964. Blau, P. M., W. V. Hydebrand, and R. E. Stauffer. "The Structure of Small Bureaucracies." American Sociological Review, 1966, 31: 179-91. Blaunder, R. Alienation and Freedom. Chicago: University of Chicago Press, 1964. Bouchard, J. J. "Field Research Methods: Interviewing, Questionnaires, Participant Observation, Systematic Observation, Unobtrusive Measures." In Handbook of Industrial and Organizational Psychology, M. D. Dunnette (ed.), pp. 363-413. Chicago: Rand McNally, 1976. Buckley, W. Sociology and Modern Systems Theory. Englewood Cliffs, N.J.: Prentice-Hall, 1967. Burns, T., and G. M. Stalker. The Management of Innovation. London: Tavistock Publications, 1961. Clark, B. R. "Interorganizational Patterns in Education." Administrative Sciences Quarterly, 1965, 10: 224-37. Coleman, J. S. "Relational Analysis: A Study of Social Organization with Survey Methods." Human Organization 1958-1959, 17: 28-36. "Community Disorganization and Conflict." In Contemporary Social Problems, (2nd ed.) R. K. Merton and R. Nisbet (eds.), pp. 670-722. New York: Harcourt Brace Jovanovich, 1966. Crozier, M. The Bureaucratic Phenomenon. Stanford, Calif.: Stanford University Press, 1963. Cyert, R. M., and J. G. March. A Behavioral Theory of the Firm. Englewood Cliffs, N.J.: PrenticeHall, 1963. Davis, L. E., and A. B. Cherns. The Quality of Working Life (vol. 1). New York: Free Press, 1975. Dill, W. R. " E n v i r o n m e n t as I n f l u e n c e on Managerial Autonomy." Administrative Sciences Quarterly, 1957,2:409-43. Downey, H. K., and R. D. Ireland. "Quantitative versus Qualitative: The Case of Environmental Assessment in Organizational Studies." Administrative Sciences Quarterly, 1979, 24: 630-37. Emery, F. E., and E. L. Trist. "The Causal Texture of Organizational Environment." Human Relations, 1965, 18:21-32. Georgopolous, B. S., and F. C. Mann. The Community General Hospital. New York: Macmillan, 1962. Georgopolous, B. S., and A. S. Tannenbaum. "A Study of Organizational Effectiveness." American Sociological Review, 1957, 22: 534-40. Gouldner, A. W. Patterns of Industrial Bureaucracy. New York: Free Press, 1954. Hage, J. "A Strategy for Creating Interdependent Delivery Systems to Meet Complex Needs." Organization and Administrative Science, 1974, 5: 17-44. Hall, R. H. Organizations: Structure and Process (2nd ed.). Englewood Cliffs, N.J.: Prentice-Hall, 1977. Hannan, M. T., and J. H. Freeman. "The Population Ecology of Organizations." American Journal of Sociology, 1977, 82: 929-64. Hawley, A. H. Human Ecology: A Theory of Community Structure. New York: Ronald Press, 1950. Herzberg, F., B. Mausner, and B. Snyderman. The Motivation to Work. New York: Wiley, 1959. Hickson, D. J., C. R. Hinings, C. A. Lee, R. E. Schneck, and J. M. Pennings. "A Strategic Contin-

366 / O'BRIEN AND CHAILLE gencies Theory of Intraorganizational Power." Administrative Sciences Quarterly, 1971, 16: 216-29. Hurwicz, L. "Organization Structures for Joint Decision Making: A Designer's Point of View." In Interorganizational Decision Making, M. Tuite, R. Chisholm, and M. Radnor (eds.), pp. 37-44. Chicago: Aldine Publishing Company, 1972. Katz, D., and R. L. Kahn. The Social Psychology of Organizations. New York: Wiley, 1966. Klonglan, G., R. D. Warren, J. M. Winkelpleck, and S. Paulson. "Interorganizational Measurement in the Social Services Network: Differences by Hierarchical Level." Administrative Sciences Quarterly, 1976,21:675-87. Kuhn. T. The Structure of Scientific Revolution. Chicago: University of Chicago Press, 1970. Laumann, E. O., and F. O. Pappi. Networks of Collective Action. New York: Academic Press, 1976. Lawler, E. E., J. R. Hackman, and S. Kaufman. "Effects of Job Redesign: A Field Experiment." Journal of Applied Psychology, 1973,3:49-62. Lawrence, P. R. "How to Deal with Resistance to Change." Harvard Business Review, 1969, 47: 4-14. Lawrence, P. R., and J. W. Lorsch. Organization and Environment: Managing Differentiation and Integration. Cambridge, Mass.: Harvard University Press, 1967. Lazarsfeld, P. F., and H. Menzel. "On the Relationship between Individual and Collective Properties." In Complex Organizations: A Sociological Reader, A. Etzioni (ed.), pp. 426-35. New York: Holt, Rinehart and Winston, 1961. Levine, S., and P. E. White. "Exchange as a Conceptual Framework for the Study of Interorganizational Relationships." Administrative Science Quarterly, 1961, 5: 583-600. Lind, S. D., and J. E. O'Brien. "The General Problem of Program Evaluation: The Researcher's Perspective." The Gerontologist, 1971, 11:43-50. Lipset, S. M., M. A. Trow, and J. S. Coleman. Union Democracy. New York: Free Press, 1956. Litwak, E., and J. Rothman. "Towards the Theory and Practice of Coordination between Formal and Informal Organizations." In Organizations and Clients, W. R. Rosengren and M. Leftor (eds.), pp. 137-86. Columbus, Ohio: C. E. Merrill, 1970. McGregor, D. The Human Side of the Enterprise. New York: McGraw-Hill, 1960. March, J. G., and H. A. Simon. Organizations. New York: Wiley, 1958. Marcus, H. One Dimensional Man. Boston: Beacon Press, 1964. Meyer, M. W., and Associates. Environments and Organizations. San Francisco: Jossey-Bass, 1978. Meyer, M. W., and M. C. Brown. "The Process of Bureaucratization." American Journal of Sociology, 1977,83:364-85. Michels, M. Political Parties. New York: Free Press, 1966. Miller, G. A. "Professionals in Bureaucracy: Alienation among Industrial Scientists and Engineers." American Sociological Review, 1967,32: 750-67. Mott, B. J. "Conflict and Coordination." In Anatomy of a Coordinating Council, pp. 105-31. Pittsburgh: Pittsburgh University Press, 1968. Mott, P. E. The Characteristics of Effective Organizations. New York: Harper and Row, 1972. Mowday, R. T., and R. M. Steers. Research in Organizations. Santa Monica, Calif.: Goodyear Publishing Company, 1979. Mulford, C. L., G. E. Klonglan, R. D. Warren, and J. P. Padgitt. "A Multidimensional Evaluation of Effectiveness in a Non-economic Organization." Organization and Administrative Sciences, 1976-1977,7: 125-43. Negandhi, A. R. Interorganizational Theory. Kent, Ohio: Kent State University Press, 1975a. Organization Theory in an Open System. New York: Dunellen Press, 1975b. Nisbet, R. The Quest for Community. New York: Oxford University Press, 1953. O'Brien, J. E. "Exchange Theory and Interorganizational Analysis." Paper presented to the Annual Meeting of the American Sociological Association, September 1-3, 1976. O'Brien, J. E., B. D. Lebowitz, N. Whitelaw, and R. Cherry. "Evaluating Coordinated Community

ORGANIZATIONAL PROPERTIES / 367 Service Systems." In Evaluative Research on Social Programs for the Elderly, J. E. O'Brien and G. F. Streib (eds.), pp. 81-105. Washington, D.C.: U.S. Government Printing Office, 1977. O'Brien J. E., and P. J. Mullaney. "Policy Implementation for Organizational Compliance." Minneapolis: Industrial Relations Center Working Paper 79-09, University of Minnesota, 1979. O'Brien, J. E., and T. T. Wetle. Analysis of Conflict in the Coordination of Human Service Organizations. Final Report to the U.S. Administration on Aging. Portland, Ore.: Portland State University Institute on Aging, 1974. O'Brien, J. E., T. T. Wetle, and M. Lindsey. Testing a Community Intervention Model. Report to the Administration on Aging. Portland, Ore.: Portland State University Institute on Aging, 1978. O'Brien, J. E., and N. Whitelaw. Analysis of Community Based Alternatives to Institutional Care. Report to U.S. Administration on Aging. Portland, Ore.: Portland State University Institute on Aging, 1973. Olson, M. The Logic of Collective Action. Cambridge, Mass.: Harvard University Press, 1965. Perrow, C. "Goals in Complex Organizations. "American Sociological Review, 1961, 26: 854-65. Goals in Complex Organizations. Englewood Cliffs, N.J.: Prentice-Hall, 1969. Complex Organizations (2nd ed.). Glenview, 111.: Scott, Foresman and Company, 1979. Perrucci, R., and M. Pilisuk. "Leaders and Ruling Elites: The Interorganizational Bases of Community Power. "American Sociological Review, 1970,35: 1040-57. Pfeffer, J. "Merger as a Response to Organizational Interdependence." Administrative Sciences Quarterly, 1972, 17: 382-94. Price, J. L. Handbook of Organizational Measurement. Lexington, Mass.: D. C. Health and Company, 1972. Pugh, D. S., D. J. Hickson, C. R. Hmings, and C. Turner. "The Context of Organizational Structures. " Administrative Sciences Quarterly, 1969, 14:91-114. Reif, W. E., R. M. Monczka, and J. W. Newstrom. "Perceptions of the Formal and the Informal Organization Objective Measurement through the Semantic Differential Technique." Academy of Management Journal, 1973, 16: 389-406. Rothhsberger, F. J., and W. J. Dickson. Management and the Worker. Cambridge, Mass.: Harvard University Press, 1939. Rogers, D. P. "Towards a Scale of Interorganizational Relations." Sociology and Social Research, 1974,59:61-70. Schermerhorn, J. R. "Determinants of Interorganizational Cooperation." Academy of Management journal, 1975, 18:846-56. "Openness to Interorganizational Cooperation: A Study of Hospital Administrators." Academy of Management Journal, 1976, 19: 225-36. Seashore, S. E. C., and E. Yuchtman. "Factorial Analysis of Organizational Performance." Administrative Sciences Quarterly, 1967, 3: 377-95. Selznick, P. TUA and the Grass Roots. Berkeley, Calif.: University of California Press, 1949. Simon, H. A. Administrative Behavior. New York: Macmillan, 1961. "On the Concept of Organizational Goal." Administrative Sciences Quarterly, 1969, 9: 1-22. Spencer, L. "The Federal Approach to Service Organizations." Urban and Social Change Review, 1974,7:7-12. Steers, R. M. "Problems in the Measurement of Organizational Effectiveness." Administrative Sciences Quarterly, 1975, 20: 546-58. Stinchcombe, A. J. "Bureaucratic and Craft Administration of Production: A Comparative Study." Administrative Sciences Quarterly, 1959,4: 108-87. Stone, E. F. Research Methods in Organizational Behavior. Santa Monica, Calif.: Goodyear Publishing Company, 1978. Terreberry, S. "The Evolution of Organizational Environments." Administrative Sciences Quarterly, 1968, 12:590-613. Thompson,). Organizations in Action. New York: McGraw-Hill, 1967.

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Abstracts ORGANIZATIONAL EFFECTIVENESS B. S. Georgopolous and F. C. Mann, 1962 Definition of Variable or Concept Organizational effectiveness is the variable measured with this instrument. "Organizational effectiveness says something about how well an organization is doing in achieving its ob|ectives. . ." (Georgopolous and Mann, 1962, p. 271).

Description of Instrument This instrument consists of four items measuring interrelated dimensions of hospital effectiveness: (1) nursing care, (2) medical care, (3) noncomparative overall patient care, and (4) comparative overall patient care. The last two items are intended to differentiate the absolute level quality of services versus the perceived level of quality of services in comparison to other units of like type.

Method of Administration This four-item measure can be self-administered in a questionnaire or in a personal interview.

ORGANIZATIONAL PROPERTIES / 369

Sample Ten hospitals in Michigan were chosen; they ranged in size from 100 to 350 beds. Four types of staff members were chosen: physicians (434), nurses (559), laboratory technicians (125), and administrators (147). Those 1,264 individuals represented 92% of those solicited to participate. Of those, approximately 880 responded to three effectiveness questions concerning nursing care and noncomparative and comparative overall care; only physicians were asked to judge the quality of medical care.

Scoring, Scale Norms, and Distribution Respondents judged the effectiveness items by choosing one of seven alternatives from a Likerttype scale. The choices were (l)outstanding, (2) excellent, (3) very good, (4) good, (5) fair, (6) rather fair, and (7) poor. The scores on each item were averaged for all respondents in each hospital.

Tests of Reliability The rank-order correlations for the four items were significant at the .05 level. The matrix of correlations is presented with the instrument.

Tests of Validity An effort was made to support the validity of this measure. For example, the ratio of registered to nonregistered nurses on staff was correlated at .71 with the perceived level of nursing care. However, predictive validity has not been established.

General Comments and Recommendations The range of scores on the items is not very great, suggesting that the seven response categories are not able to discriminate the underlying concept very well. There is a significant need for further studies to establish the predictive determinants and consequences of effectiveness as measured by this instrument. With proper care, this approach could be modified for use in other types of service settings.

Reference Georgopolous, B. S., and F. C. Mann. The Community General Hospital. New York: Macmillan, 1962.

Instrument See Instrument V3.9.I.2.

SCALE OF INTENSITY OF INTERORGANIZATIONAL RELATIONS D. P. Rogers, 1974 Definition of Variable or Concept This instrument measures the intensity of the connections that link two organizations in a particular community. Conceptually, the items in the instrument vary in terms of the type and level of resource investment that one unit reportedly makes in another.

Description of Instrument The scale consists of six items describing potential links that might exist between two organizations: (1) director acquaintance, (2) director interaction, (3) information exchange, (4) resource

370 / O'BRIEN AND CHAILLE exchange, (5) overlapping boards, and (6) written agreements. The conception was that the intensity of the linkages between units increases as links become more formal. Furthermore, for any one level to exist, all prior linkages in the list must also exist.

Method of Administration This instrument may be used in a questionnaire or as part of a semistructured interview. Agency executives are given a list of other organizations in their community and are asked to indicate which of the six ties in the list exist with each organization.

Sample A standard set of 15 organizations that are prominent in rural counties in the Midwest was identified. Ten organizations were public: a social conservation service, an agricultural stabilization and conservation service, a farmer's home administration, a forest service, a welfare agency, an employment agency, a community action agency, a planning commission, a zoning commission, and a county conservation board. Five organizations were private: a ministerial association, a farm bureau, a bankers' association, an industrial development corporation, and an electric cooperative. The administrator of each agency was asked to describe the ties of his or her unit with all other organizations on the list. The work was done in 16 counties, with no reference given to how they were chosen. Since not all the units were found in all the counties, the actual number of units studied was 116.

Scoring, Scale Norms, and Distribution Between-umt scores range from 0 when there are no ties to 6 when all ties are reported. The average number of reported ties was 3.86. Although each director reported on all others in the community, there are actually two reports on the ties between any two units. No effort was made to determine whether the reports of unit A's director about ties with unit B are the same as those reported by unit B's director about ties with unit A. Furthermore, no structural patterns were examined for the counties as a whole based on the intensity of reported ties among all the units located in the county.

Tests of Reliability The Guttman coefficient of reproducibility for this scale was .91.

Tests of Validity One indicator of convergent validity is that the number of joint programs reported to have been undertaken during the preceding 5 years was significantly correlated with the intensity of interaction score (r = .55,p < .01).

General Comments and Recommendations This instrument is an example of current efforts to develop measures of the structure of community interorgamzational ties. A basic problem with the approach is that the number of units is much larger in metropolitan areas. Hence, this type of multiple-measure sociographic instrument is difficult to use in urban communities. In addition, agencies in urban communities are much larger and the meaning of answers about specific ties with other agencies may be only indirectly associated with the actual nature of the ties that emanate from other levels of the organization.

Reference Rogers, D. P. "Towards a Scale of Interorganizational Relations." Sociology and Social Research, 1974, 59:61-70.

Instrument See Instrument V3.9.I.b.

ORGANIZATIONAL PROPERTIES / 371

INTERORGANIZATIONAL TIES IN THE SOCIAL SERVICES NETWORK G. Klonglan, R. D. Warren, Y. M. Winkelpleck, and S. Paulson, 1976 Definition of Variable or Concept This instrument measures the intensity of positive connections between two organizations; negative or conflict linkages are not considered. The concept of intensity of involvement is defined as ". . . an ordinal continuum of forms for resource attainment that represent increasing involvement with organizations in the task environment" (Klonglan et al., 1976, p. 687).

Description of Instrument This eight-item instrument is a modified form of the six-item Rogers (1974) instrument described in the preceding abstract. The instrument was developed in one study (Klonglan, Paulson, and Rogers, 1972); subsequently, Rogers (1974) used the six-item subset in his study and Klonglan and associates (1976) used the entire eight-item version in a third study from which these data are taken. The eight items were arranged in a theoretical order that constitutes a Guttman-type scale. However, no extant theory is presented to justify that ordering.

Method of Administration The items can be self-administered as part of a questionnaire or a semistructured interview. This study included 156 informants from health-related organizations in Iowa. Some of the units were at the state level, some at the district level, and others at the county level. Each informant used the instrument to describe the intensity of his or her host unit's ties with a standard list of 18 contact organizations that purportedly existed in the task environment of each unit.

Sample There is no description of exactly what health-related or contact organizations were involved in the study or how they were selected. The informants themselves were reportedly the highest-paid administrators in each unit. Because of the empirical interest in examining the different patterns of linkages at each of the three levels, the data were presented separately for state-, district-, and countylevel respondents. Hence, it is not possible to be exactly sure how many informants were from units at each level of the hierarchy. We estimate the numbers to be 35 state-level, 45 district-level and 76 county-level informants.

Scoring, Scale Norms, and Distribution Informants answered the eight-item scale 18 times and indicated whether or not the particular statement was judged to be true. The intensity of interaction with any unit is the sum of the number of affirmative answers given. The possible range is 0 to 8; the mean score for respondents at the county level was 3.76.

Tests of Reliability The Guttman coefficient of reproducibility was .93 for the county-level informants.

General Comments and Recommendations This instrument is relatively easy to apply to studies of network linkages among organizations. Since the data were not clearly presented in the available article, there would be some difficulty in replicating the design for establishing validity. The response pattern suggests that items 3 through 7 in the scale are measuring basically the same thing. If so, this would tend to inflate the coefficient of reproducibility while adding little new information.

372 / O'BRIEN AND CHAILLE

Reference Klonglan, G. E., S. Paulson, and D. Rogers. "Measurement of Interorgamzational Relations: A Deterministic Model." Paper presented to the Annual Meeting of the American Sociological Association, New Orleans, August 27-29, 1972. Klonglan, G., R. D. Warren, J. M. Winkelpleck, and S. Paulson. "Interorgamzational Measurement in the Social Services Network: Differences by Hierarchical Level." Administrative Sciences Quarterly, 1976,21:675-87. Rogers, D. P. "Towards a Scale of Interorganizational Relations." Sociology and Social Research, 1974,59:61-70.

Instrument See Instrument V3.9.I.C.

OPENNESS TO INTERORGANIZATIONAL COOPERATION J. R. Schermerhorn, 1976 Definition of Variable or Concept This instrument is intended to assess the orientation of administrators of human service units toward participation in cooperative programs.

Description of Instrument As with many organizational studies reported in the literature, a precise report of the measurement procedures used in this study is lacking. Hence, this instrument is deduced from the published account rather than directly extracted from it. Data from hospital administrators in a single state were secured by a mail survey. One question in the survey inquired, "Given the operating practices of your hospital, how important do you personally feel the following task activity should be at present —increase cooperation and coordination with other hospitals?" (Schermerhorn, 1976, p. 229). A five-point fixed-choice response of "importance" was then used to establish the concept. Elsewhere in the questionnaire, a three-question set was used to establish the concept of community goal orientation. In this case, each respondent indicated on a five-point scale the degree of importance placed on: (1) providing community health leadership, (2) improving community relations, and (3) searching for new ways to meet the community's health needs. This yielded a composite score ranging from 3 to 15 points. The scores on the community goal orientation and openness to cooperation measures correlate at + .52; on that basis, it is suggested that all four questions be used to generate a multiitem measure with a score range of 4 to 20.

Method of Administration This instrument can be self-administered in a questionnaire or as part of a semistructured interview.

Sample The 42%-response-rate mail survey netted 87 "usable" responses. The respondents were predominantly male (86%), with an average age 46 years and an average job tenure of 9 years. No comparable data were provided on the properties of the hospitals with which they were affiliated.

Tests of Validity The mtercorrelation of the single-item measure and the three-item composite score was reasonably high (r = .52).

ORGANIZATIONAL PROPERTIES / 373 General Comments and Recommendations This particular study highlights a number of recurrent prohlems both in the way organizational studies are conducted and in the way they are reported in the literature. First, it is uncertain whether the unit of analysis is more than the personality orientation of the administrators who responded to the questionnaire. Second, the connection between theoretical issues and the process of measurement is not established. Finally, the description of the sample was weak, and distributional properties of the measures were not reported.

Reference Schermerhorn, J. R. "Openness to Interorganizational Cooperation: A Study of Hospital Administrators. " Academy of Management Journal, 1976, 19: 225-36.

Instrument See the description of the instrument given above.

DOMAIN CONSENSUS J. K. Benson, J. Kunce, C. Thompson, and D. Allen, 1973 Definition of Variable or Concept For any particular focal organization, this instrument measures the level of agreement among agency personnel and those in adjacent agencies as to the "proper" service functions of a focal organization.

Description of Instrument The domain of an organization is defined as the services/technologies/products that it delivers and the territory within which it operates. Domain consensus is concerned with the clarity and similarity of the image that individuals inside and outside the organization hold regarding its domain. Not surprisingly, when domain consensus is low, confusion exists. That, in turn, generates uncertainty about when to approach the unit for bargaining or other purposes. This situation can interfere with effective input-output processes and jeopardize the organization's effectiveness and survival. In the study, members of four types of organizations were interviewed. Each was provided a standard 26-item list of services that in principle could be offered by any of the four units. Respondents indicated: (a) which of the 26 services they thought their own unit offered and (b) which of the 26 services were approved of as appropriate for the other three units to provide. A comparison of the first agency's claims regarding which services are offered to the other agencies' judgments regarding which services ought to be offered allows the calculation of a number that is defined as an index of domain consensus.

Method of Administration This instrument can be self-administered as part of a semistructured interview or in a questionnaire. Each respondent is provided with a grid that includes the following 26-item list of potential services. 1. Child support 2. Preschool training 3. Child placement 4. Marriage counseling 5. Food allowances or food stamps 6. Legal aid 7. Day care for children

374 / O'BRIEN AND CHAILLE 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26.

Rent payments or supplements Home improvement programs Providing public housing Organizing urban renewal programs Creating or supporting self-help organizations or mutual aid societies Creating or supporting pressure groups for the poor Supporting indigenous gangs in low-income areas Organizing strikes, boycotts, demonstrations Providing settlement houses Vocational and occupational testing Personality testing Sheltered workshops Job development "On-the-job" training for clients Preemployment training Medical examinations Transportation to ]obs Unemployment compensation Job placement

SOURCE: J. Benson, J. Kunce, C. Thompson, and D. Allen. Coordinating Human Services: A Sociological Study of an Inter organizational Network. Research Series No. 6. Columbia, Mo.: Regional Rehabilitation Research Institute, 1973. Reprinted with permission. The list is scanned once for each organization in the study, first to determine which services are provided by one's own agency and then to determine which are judged appropriate functions for each of the other agencies. If the instrument is to be used for studying other types of agencies, then the list of potential services would have to be modified accordingly. As is evident, however, a long list of service activities places practical limits on how large an organizational set can be studied before the patience of the respondents is depleted.

Sample Respondents were connected with units located in one rural, nine-county administrative district in the state of Missouri. One hundred and fifty "client contact workers" were interviewed: 55 from the community action program (CAP), 51 from the public welfare (PW) agency, 29 from the public employment (ES) agency, and 15 from the public vocational rehabilitation (VR) agency. The group of respondents did not include administrators and clerical personnel. Surveys were taken of all the remaining professional staff in three of the agencies, with a one-third random sample of caseworkers taken to select respondents in the welfare agency.

Scoring, Scale Norms, and Distribution Each respondent went through the list and noted whether or not the particular services were actually offered by his or her agency. When 50% or more of the staff in an agency claimed that the service was actually offered by their agency, then it was assumed to be so. Next, each respondent indicated whether or not each activity on the 26-item list was a proper service for each of the three types of agencies to provide. Relative to a particular service (S-l), the ratio of the percentage of staff from one agency (A-l) claiming that S-l was offered by A-l to the percentage of staff from an adjacent unit indicating approval that A-l might properly provide S-l is defined as the measure of domain consensus for A-l on

ORGANIZATIONAL PROPERTIES / 375 S-l. For example, if 90% of the staff of the community action program claimed that their agency provided preschool training but only 72% of the staff from the vocational rehabilitation agency indicated that preschool training was a proper service for community action programs to offer, then the domain consensus would be 72 -r- 90 = .80. Since, however, each unit offers more than one service and since domain consensus is thought to be globally related to the entire service package of an agency, a further step in the calculations is taken. This step is to add up the actual percentages for those services reported by 50% or more of the unit's staff and the actual percentages of the approval rates given by the staff of an adjacent agency to this same set of services. The ratio of the sums of these percentages is called the index of domain consensus between the two organizations. For instance, assume that 50% or more of the staff of the CAP claims that there are three and only three services offered by their agency: preschool training, day care, and urban development. Table 9-2 presents the hypothetical data with which to calculate the domain consensus of the CAP relative to the ES. The domain consensus of the CAP relative to the ES is (124 -^ 218) = .569. TABLE 9-2 Computation of Domain Consensus

Type of Service Preschool training Day care Urban renewal Sum of percentages

Percentage of CAP Respondents Claiming Service

Percentage of ES Respondents Approving

82% 71% 65% 218%

52% 48% 24% 124%

Finally, the domain consensus scores can be averaged for a particular unit relative to all other organizations in its organizational set to get an indicator of the total domain consensus of the organization in its community, service market, or whatever is the defining ecological unit within which the study is being conducted.

Tests of Validity It was hypothesized that high levels of domain consensus would be directly associated with higher rates of mteragency ideological consensus, work coordination, and evaluation of the efficiency of outputs. Rank-order correlations of +.77 and +.83 were found between domain consensus and measures of the other three concepts.

General Comments and Recommendations The concept of domain consensus is thought to be important because organizations cannot do business unless they u n d e r s t a n d one a n o t h e r ' s f u n c t i o n s . This i n s t r u m e n t was an effort to operationahze the concept empirically. However, it is curious to note that in the CAP, withinagency agreement regarding services offered never exceeded 80%. In other words, whatever the service package actually was, at least one in five of the agency staff members did not recognize the package. This raises a set of interesting problems for organizational research in general.

Reference Benson, J., J. Kunce, C. Thompson, and D. Allen. Coordinating Human Services: A Sociological Study of an Interorganizational Network. Research Series No. 6. Columbia, Mo.: Regional Rehabilitation Research Institute, 1973.

376 / O'BRIEN AND CHAILLE

Instrument See the method of administration described above.

PERCEPTIONS OF THE FORMAL AND INFORMAL ORGANIZATION W. E. Reif, R. M. Monczka, and J. W. Newstrom, 1973 Definition of Variable or Concept This instrument consists of 16 items divided equally among concepts judged to be characteristic of the formal versus informal organization. Each item is evaluated by informants from an organization to provide the data with which to generate an organizational profile regarding the organization's perceived formal and informal structure.

Description of Instrument Each of the 16 scale items is evaluated on the same set of eight semantic differential scales. The bipolar adjectives of each continuum were selected from the "potency" and "evaluative" subscales (Osgood, Suci, and Tannenbaum, 1957). There are three potency adjective pairs: weak —strong, soft —hard, and small —large. The remaining five sets are from the evaluative scale: fair—unfair, good —bad, valuable —worthless, pleasant —unpleasant, and hazy —clear. The formal and informal organizational concepts that were evaluated against those bipolar adjective pairs are listed in Tables 9-3 and 9-4.

Method of Administration The instrument is self-administered through a questionnaire. Each respondent goes through the eight-item semantic differential scale 16 times, once for each of the basic structural concepts.

Sample The sample consisted of a 341-person convenience sample of white-collar employees from 164 organizations who were enrolled in a management development short course during 1972.

Scoring, Scale Norms, and Distribution Each concept is given two scores ranging from 1 to 7. One score is the average of the three potency items, and the other score is the average of the five evaluative items. Tables 9-3 and 9-4 show the mean scores for the 16 concepts.

Tests of Reliability In an earlier management seminar, participants of the type who provided the data for this study were given a set of "over 100" organizational concepts, and they were asked to categorize them according to whether they related to formal or informal organization. The final set of 16 concepts consisted of those classified with levels of agreement in excess of 90%.

General Comments This instrument could be adapted to an examination of how patterns of formal versus informal organization are associated with the performance of multiorganizational activities. However, some type of factor analysis could be applied in order to improve the efficiency and interpretability of the scoring procedure.

References Osgood, C. E., G. J. Suci, and P. H. Tannenbaum. The Measurement of Meaning. Urbana, 111.: University of Illinois Press, 1957.

ORGANIZATIONAL PROPERTIES / 377 TABLE 9-3 Formal Concept Means: Evaluative and Potency Concept Authority Job description Performance appraisal Chain of command Policies Controls Organizational objectives Supervisor Overall mean

Evaluative

Potency

5.76 5.51 5.55 5.74 5.70 5.63 6.01 5.90 5.73

5.32 4.74 4.83 5.02 5.07 5.10 5.41 5.13 5.08

SOURCE: W. E. Reif, R. M. Monczka, and J. W. Newstrom. "Perceptions of the Formal and the Informal Organization Objective Measurement through the Semantic Differential Technique." Academy of Management Journal, 1973, 16: 389-406. Reprinted with permission. TABLE 9-4 Informal Concept Means: Evaluative and Potency Concept Voluntary teamwork Clique Personal influence Coworker evaluation Social interaction Group cohesion Social group membership Grapevine Overall mean

Evaluative

Potency

5.83 3.14 5.16 4.74 5.25 5.45 5.18 3.27 4.75

4.76 3.88 4.86 4.41 4.49 4.76 4.41 4.24 4.47

SOURCE: W. E. Reif, R. M Monczka, and I. W. Newstrom. "Perceptions of the Formal and the Informal Organization Objective Measurement through the Semantic Differential Technique." Academy of Management journal, 1973, 16: 389-406. Reprinted with permission. Reif, W. E., R. M. Monczka, and J. W. Newstrom. "Perceptions of the Formal and the Informal Organization Objective Measurement through the Semantic Differential Technique." Academy of Management Journal, 1973, 16: 389-406.

Instrument See the description of the instrument and the scoring section in the instrument.

378 / O'BRIEN AND CHAILLE

FORMALIZATION OF INTERORGANIZATIONAL RELATIONS T. T. Wetle, N. Whitelaw, M. Peterson, D. Montgomery, and J. E. O'Brien, 1976 Definition of Variable or Concept The variable being measured is an informant's judgment regarding the degree of formalization of the multiagency programs that would be most in keeping with the operating style of the unit being studied.

Description of Instrument Interorgamzational service programs can be "loosely coupled" so as to maximize the administrative autonomy of the separate units. Conversely, highly formalized programs allow the integration of the administrative authority of the separate entities. Each informant selects one alternative from five to indicate the degree to which his or her unit prefers multiorganizational service ventures to be highly integrated.

Method of Administration This measure can be self-administered in an interview or as part of a questionnaire.

Sample Data were supplied by i n f o r m a n t s from o r g a n i z a t i o n s located in three d i f f e r e n t types of communities: an urban service market (48 units in a single county with a population of 560,000), a mixed urban/rural service market (42 units in a three-county area with a population of 350,000), and a rural service market (35 units in a three-county area with a total population of 35,000). Approximately half of the informants were interviewed and half responded by mail questionnaire. Cooperation was secured from informants in 72% of the organizations that were originally approached for the study.

Scoring, Scale Norms, and Distribution Each response is scored from 1 to 5. The higher the score, the greater the reported level of acceptance of highly formalized Interorgamzational service arrangements. The mean score for the measure was 3.27, and the standard deviation was 1.05.

General Comments It is worth noting that the skew in the distribution reveals a disinclination to endorse a very loose coupling of service agencies and a surprisingly frequent endorsement of highly formalized program integration. The variability of preferences must be recognized and strategically assessed prior to implementing or modifying service-coordination ventures.

Reference Wetle, T. T., N. Whitelaw, M. Peterson, D. Montgomery, and J. E. O'Brien. Closing the Gaps: Strategies for Technical Assistance. Report to the U.S. Administration on Aging. Portland, Ore.: Portland State University Institute on Aging, 1976.

Instrument See Instrument V3.9.I.g.

MEASURE OF COMMUNITY POLICY IMPACT J. E. O'Brien and T. T. Wetle, 1974

ORGANIZATIONAL PROPERTIES / 379

Definition of Variable or Concept This instrument records judgments of the impact of policy actions at the local level. It was tested in a study that examined the impact of the service-coordination efforts carried out by area agencies on aging (530 of which have been established since 1973 across the United States) to promote the improvement in local services for the elderly.

Description of Instrument Informants were provided with a checklist of items that described potential changes resulting from the implementation of a federal policy aimed at local organizations. The checklist described potential impacts (nine items) in the informant's organization, potential impacts (five items) in the community of service organizations, and potential impacts (six items) in the situation of the elderly as client/beneficiaries of the policy. The items were developed in one study (O'Brien and Wetle, 1974) and modified in a second study from which the data reported here were taken (Wetle et al., 1976). The instrument is used to reassess periodically various policy impacts, with the information used to guide ongoing adjustments of the policy-implementation process.

Method of Administration The measure is self-administered as part of an interview or a questionnaire. Complete instructions for the use of the instrument are included with the instrument. In general, the informants are asked to indicate the positive or negative impact of the area agency on their operations.

Sample For a description of the sample, see the preceding i n s t r u m e n t , F o r m a l i z a t i o n of Interorganizational Relations. Of the 126 informants surveyed, 96 completed all the items in the three parts of the instrument.

Scoring, Scale Norms, and Distribution For each item, informants indicate their best judgment of the degree of change along a five-point scale: (1) much better off, (2) somewhat better off, (3) no different, (4) somewhat worse off, or (5) much worse off. The mean score averaged across items and cases for the nine potential organizational impacts was 2.35; for the five potential community impacts, 2.36; and for the six potential client/ beneficiary impacts, 2.34. The grand mean for the 20 items was 2.36, with a standard deviation of .73.

Tests of Reliability A Cronbach's alpha of .71 was reported.

Tests of Validity Factor analysis on the 20-item set showed that the first factor accounted for 52% of the total variance and 86% of the common variance. The eigenvalue of the second factor was only .94. This indicates that the scale is a unidimensional measure of judgments of perceived policy impact.

General Comments This instrument is a relative measure and can be used to compare rates of change but not absolute levels of impact across communities or through time. The instrument appears to vahdly capture many essential aspects of policy impact. With minor modifications, it could be adapted for use with a variety of i n d i v i d u a l s u b s t a n t i v e policy issues directed at organizational processes in local communities.

References O'Brien, J. E., and T. T. Wetle. Analysis of Conflict in the Coordination of Human Service Organizations. Final report to the U.S. Administration on Aging. Portland, Ore.: Portland State University Institute on Aging, 1974.

380 / O'BRIEN AND CHAILLE Wetle, T., J. O'Brien, M. Peterson, and N. Whitelaw. Closing the Gaps: Strategies for Technical Assistance. Final report to the U.S. Administration on Aging. Portland, Ore.: Portland State University Institute on Aging, 1976.

Instrument See Instrument V3.9.I.h.

ORGANIZATIONAL RESISTANCE TO POLICY COMPLIANCE MECHANISMS J. E. O'Brien and P. J. Mullaney, 1979 Definition of Variable or Concept This instrument assesses the level of organizational resistance to the use of different compliance mechanisms that might be used to implement federal policies.

Description of Instrument The implementation of policies that require local organizational change generally involves the use of compliance mechanisms to assure the achievement of the desired effects. Those mechanisms involve some mixture of inducements (rewards/incentives) and coercive procedures (regulations/ penalties) to obtain the desired responses. Selecting the proper compliance mechanism in terms of a package of inducements and coercive tactics is a difficult problem. The instrument consists of 16 items that describe alternative tactics that can be used as policy-compliance mechanisms in human services development and that vary in terms of the blend of inducement and coercive potential they possess. As reported in O'Brien and Mullaney (1979), the instrument is a refined form of an earlier version used in an earlier study (Wetle et al., 1976). Although ordered differently for administration, the items constitute four Guttman scales: (1) five items with a high inducement, low coercive content, (2) three items w i t h a low i n d u c e m e n t , low coercive c o n t e n t , (3) three items w i t h a high inducement, high incentive content, and (4) five items with a low inducement, high coercive content.

Method of Administration The instrument can be self-administered by questionnaire or as part of a semistructured interview. Informants from target units in local communities are provided with a checklist. Forced choice responses are secured on a four-category Likert-type response set.

Sample Data were supplied by informants in 183 human service organizations located in six middle-sized cities: San Francisco, Calif. (28), Tacoma, Wash. (32), Las Vegas, Nev. (31), Tucson, Ariz. (30), Boulder, Colo. (31), and Salt Lake City, Utah (31). The organizations of which the informants were members were involved in supplying services to community-residing elderly persons. The agencies' services included public health, home care, legal aid, nutrition, transportation, recreation, housing, education, protection, economic assistance, day care, and employment assistance. Institutional services such as hospitals and nursing homes were excluded. The units were chosen in a two-stage process. First, personal interviews were conducted with informants from local agencies that controlled resource flow for human services in the local market area. Included were the public welfare, mental health, United Way, Title XX, community activity programs, and the state program on aging. Informants provided the names for a list of the direct service units involved in providing aid for the elderly. The goal was to interview 30 additional

ORGANIZATIONAL PROPERTIES / 381 informants from that list of direct service units in each community. All informants held executive, administrative, or supervisory positions in their respective units. The rate of participation was 91 %.

Scoring, Scale Norms, and Distribution For each item, informants indicated their judgment of the tactic for change on a four-point scale: (1) very appropriate, (2) somewhat appropriate, (3) somewhat inappropriate, or (4) very inappropriate. Answers were then dichotomized as appropriate (score = 0) or inappropriate (score = 1). Judgments of inappropriateness were interpreted as indicators of resistance to the use of a particular change tactic. The disapproval score on each subscale indicates the anticipated resistance to the package oi tactics represented.

Tests of Reliability The coefficients of reproducibihty of the four subscales were as follows: scale I, .91; scale II, .87; scale III, .83; and scale IV, .97 (O'Brien and Mullaney, 1979).

General Comments Promoting local change consistent with federal policy goals is a complex problem. This instrument is intended to allow for the assessment of strategic alternatives so as to enhance their use or modification. The scale could also be modified to deal with human service policies not related to aging as well as to handle strategic assessments of how the central office of a large firm might effectively direct the reorganization of decentralized subumts.

References O'Brien, J. E., and P. J. Mullaney. "Policy Implementation for Organizational Compliance." Minneapolis: Industrial Relations Center Working Paper 79-09, University of Minnesota, 1979. Wetle, T. T., N. Whitelaw, M. Peterson, D. Montgomery, and J. E. O'Brien. Closing the Gaps: Strategies for Technical Assistance. Report to the U.S. A d m i n i s t r a t i o n on Aging. Portland, Ore.: Portland State University Institute on Aging, 1976.

Instrument See Instrument V3.9.I.J.

ORGANIZATIONAL SELF INTERESTCOMMON INTEREST (SI—CD J. E. O'Brien, T. T. Wetle, and M. Lindsey, 1978 Definition of Variable or Concept This pair of instruments assesses the strength of an organization's self-interests and common interests as criteria that influence interorgamzational bargaining positions.

Description of Instrument Each instrument consists of 12 items divided into three subscales. The subscales measure the way in which community factors, market factors, and organizational factors are judged to be important criteria for guiding negotiations. These three factors were conceptually derived from a theoretical review of the sources of mediating values in interorgamzational or multiorgamzational negotiations (O'Brien, 1976). For each item, the informant is asked to indicate the extent to which it is an important criterion for assessing the merits of an organization's external agreements. Informants are provided with a hy-

382 / O'BRIEN AND CHAILLE pothetical case that is intended to standardize their mental orientation relative to the negotiational situation.

Method of Administration These scales can be self-administered as part of an interview or a questionnaire. The complete instructions given to informants are presented with the instrument. Each informant is presented with the self-interest checklist and asked to check the box that indicates the importance of each criterion in assessing interagency agreements relative to their own agency. After being asked to continue to keep in mind the short hypothetical case, respondents are presented a copy of the common interest checklist and asked to indicate the importance of each criterion in assessing the merits of interagency agreements relative to the community at large.

Sample Data were supplied by informants in 183 human service organizations located in six middle-sized cities: San Francisco, Calif. (28), Tacoma, Wash. (32), Las Vegas, Nev. (31), Tucson, Ariz. (30), Boulder, Colo. ( 3 1 ) , and Salt Lake City, U t a h ( 3 1 ) . The organizations supplied services to community-residing elderly persons. The units were chosen for study in a two-stage process. First, personal interviews were conducted with informants from local agencies that controlled resource flow for human services in the local market area. Included were the public welfare, mental health, United Way, Title XX, community activity programs, and the state program on aging. These informants provided the names for a list of the major service units involved in aid for the elderly. The objective was to interview 30 informants from that list. All informants held executive, administrative, or supervisory positions in their respective units. The rate of participation was 91%.

Scoring, Scale Norms, and Distribution Each item is scored on a five-point Liken response scale of importance: (1) very important, (2) somewhat important, (3) moderately important, (4) somewhat unimportant, and (5) not important at all. Responses are dichotomized as (1) very important for category 1 or (0) not very important for categories 2 through 5. The score on each subscale is the number of items judged to be very important.

Tests of Reliability The coefficients of reproducibility are: self-interest/community factors, .77; self-interest/market factors, .93; self-interest/organization factors, .84; common interest/community factors, .84; community interest/market factors, .90; community interest/organization factors, .86.

Tests of Validity A factor analysis of all 24 items revealed eight factors, of which the first five accounted for 90.4% of the total common variance. Items on the self-interest scales did not cross-load onto the commoninterest scales; however, the factor structure did not reproduce the conceptualization of community, market, and organizational factors (O'Brien, Wetle, and Lindsey, 1978, pp. 174-77). Factor analysis of the 12 self-interest items revealed two factors —autonomy and internalization (O'Brien, Wetle, and Lindsey, 1978, pp. 179-81) —and the factor analysis of the 12 common-interest items revealed the two other factors — i n s t r u m e n t a l coordination and expressive coordination (O'Brien, Wetle, and Lindsey, 1978, pp. 181-83). A factor analysis of the six Guttman scales reported here revealed two factors with eigenvalues greater than 1.0. The common-interest scales defined the first factor, and the self-interest scales defined the second factor.

ORGANIZATIONAL PROPERTIES / 383

General Comments The notion of self-interests as determinants of organizational bargaining is widely asserted; the centrality of common interests in similar situations is less widely accepted. From these data, the common-interest factors seem dominant. The predictive validity of the scales could be questioned because of the uncertain effect of using a "hypothetical case" as a response stimulus.

References O'Brien, J. E. "Exchange Theory and Interorgamzational Analysis." Paper presented to the Annual Meeting of the American Sociological Association, September 1-3, 1976. O'Brien, J. E., T. T. Wetle, and M. Lindsey. Testing a Community Intervention Model. Report to the U.S. Administration on Aging. Portland, Ore.: Portland State University Institute on Aging, 1978.

Instrument See Instrument V3.9.I.J.

Instruments V3.9.I.a ORGANIZATIONAL EFFECTIVENESS B. S. Georgopolous and F. C. Mann, 1962 'For each item below, please check the box indicating your judgment of the nature of care given in this hospital." (See response categories above.) Low* High Average Rating 1. How good would you say is the nursing care given to 2.44 3.18 2.86 patients in this hospital? 2. How good would you say is the medical care 1.46 2.85 2.39 (including surgical work) given to patients in this hospital? 3. On the basis of your experience and information, 1.99 2.94 2.51 how would you rate the quality of the overall care that the patients generally receive from this hospital? 4. How would you rate the quality of overall patient care 2.01 3.17 2.55 in this hospital as compared to similar community general hospitals? *The lower the score, the higher the rating. Intercorrelation of Responses 2 3 4

1 .60 .91 .82 2 .67 .78 3 .96 SOURCE: B. S. Georgopolous and F. C. Mann. The Community General Hospital. New York: Macmillan, 1962. Reprinted with permission.

384 / O'BRIEN AND CHAILLE

V3.9.I.b SCALE OF INTENSITY OF INTERORGANIZATIONAL RELATIONS D.P. Rogers, 1974 Percent Answering "Yes"

1 Director acquaintance:* Are you acquainted with the director or person in charge of in your county? 2. Director interaction: Have you met with the director of at any time during the past year to discuss the activities of your respective agencies? 3.3. Information exchange: Is on your organization's mailing list to receive your newsletter, annual reports, and other information releases? OR: Is your organization on the mailing list of to receive any of their newsletters, annual reports, or other information releases from them?

68%

54%

32%

4. Resource exchange: Has your organization shared, loaned, or provided resources, such as meeting rooms, personnel, equipment, or funds to at any time during the last two years? OR: Has shared, loaned, or provided resources such as meeting rooms, personnel, equipment, or funds to your organization at any time during the last two years?

32%

5. Overlapping boards: Does anyone, including staff, board members, or members from your organization serve on boards, councils, or committees of ? OR: Does anyone from serve on boards, councils, or committees of your organization?

6.

11%

Written agreements: Does your unit of this organization have any written agreements with pertaining to specific programs or activities, personnel, commitments, client referrals, procedures for working together, or other joint activities?

10%

*Each administrator went through the six-item instrument once for each of the other units being studied in his or her county. Answers are "yes" or "no". SOURCE: D. P. Rogers. "Towards a Scale of Interorganizational Relations." Sociology and Social Research, 1974, 59: 61-70. Reprinted with permission.

V3.9.I.C INTERORGANIZATIONAL TIES IN THE SOCIAL SERVICES NETWORK G. Klonglan, R. D. Warren, J. M. Winkelpleck, and S. Paulson, 1976

ORGANIZATIONAL PROPERTIES / 385 In this case, two new items are added to the Rogers instrument shown in the previous section. Full descriptions of the six repeated items are located there. However, the two new items are: "Director Awareness: As far as you know, is the (name of other organization) in this (state, area or county)?" and "Joint Programs (coalitions): Within the last three years, has your organization worked jointly in planning and implementing any specific programs or activities with (contact organization)?" The items as named below are listed in the order of the "theoretical" Guttman rank which they were designed to assume. Following each item is a number indicating the percentage of county level informants who reported the particular type of connection to exist with each of the various "contact" organizations on the standard 18 agency list: 1. Director Awareness 58% 5. Resource Exchange 12% 2. Director Acquaintance 24% 6. Overlapping Board 9% 3. Director Interaction 11% 7. Joint Programs 11% 4. Information Exchange 11% 8. Written Agreements 1% SOURCE: G. Klonglan, R. D. Warren, J. M. Winkelpleck, and S. Paulson. "Interorganizational Measurement in the Social Services Network: Differences by Hierarchical Level." Administrative Sciences Quarterly, 1976, 21:675-87. Reprinted with permission.

V3.9.I.d OPENNESS TO INTERORGANIZATIONAL COOPERATION J. R. Schermerhorn, 1976 See the description of the instrument in the abstract.

V3.9.I.e DOMAIN CONSENSUS J. Benson, J. Kunce, C. Thompson, and D. Allen, 1973 See the method of administration in the abstract.

V3.9.I.f PERCEPTIONS OF THE FORMAL AND INFORMAL ORGANIZATION W. E. Reif, R. M. Monczka, and J. W. Newstrom, 1973 See the description of the instrument in the abstract.

V3.9.I.g FORMALIZATION OF INTERORGANIZATIONAL RELATIONS T. T.Wetle, N. Whitelaw, M. Peterson, D. Montgomery, and J. E. O'Brien, 1976 Service Programs for the Elderly: LOW 1

• should be as separate and autonomous as possible from one another

Score

% Choosing

1

1

386 / O'BRIEN AND CHAILLE • should be organized to allow easy consultation between them as the need arises

2

29

* should be organized with the provision for regular 3 21 and frequent meetings, information exchange, liaison regarding clients and the like on a routine basis • should be centrally coordinated to facilitate the work4 28 ing out of common priorities, service approaches and target group strategies • should be centrally administered by a single agency 5 12 in hopes of eliminating overlap and duplication of HIGH services among agencies SOURCE: T. T. Wetle, N. Whitelaw, M. Peterson, D. Montgomery, and J. E. O'Brien. Closing the Gaps: Strategies for Technical Assistance. Report to the U.S. Administration on Aging. Portland, Ore.: Portland State University Institute on Aging, 1976. Reprinted with permission.

V3.9.I.h MEASURE OF COMMUNITY POLICY IMPACT J. E. O'Brien and T. T. Wetle, 1974 A. As you may know, one purpose of the Area Agency is to improve the way service organizations conduct activities so as to help them to better meet the needs of older people. How different, better or worse, would you say your organization is than it would be if the Area Agency on Aging did not exist relative to the following: Check the appropriate box for each item: Mean* 1. Ability to arrange for multiple services to the elderly who need them. 2.12 2. Ability to exchange information with other units about clients. 2.22 3. Understanding and acceptance of other unit's service functions. 2.39 4. Shared feelings about doing something meaningful for the elderly. 2.17 5. Ease in relating to the State Program on Aging. 2.46 6. Budget. 2.58 7. Prestige in the community. 2.56 8. Ability to affect local political decisions. 2.54 9. Knowledge and ability relative to the elderly. 2.22 B. In addition to the earlier effects of the Area Agency in the community, I would like to ask about the following potential outcomes of Area Agency activity. How different, better or worse, would you say the service community at large is than it would be if the Area Agency on Aging did not exist, relative to the following: Check the appropriate box for each item: 1. Increasing the priority of older clientele for all local human services. 2. Increasing the number of staff in local service agencies with special training and knowledge regarding the service needs and intervention approaches appropriate for older adults.

Mean* 2.19 2.54

ORGANIZATIONAL PROPERTIES / 387 3. Increasing the efficiency of the planning and evaluation functions carried out by agencies dealing with older adult clientele. 4. Filling of gaps in the local services sector so that all critical services needed by older adults do exist. 5. Developing, where necessary, and improving, where they already exist, critical linkage services by which to get elderly people appropriately tied into available services.

2.34 2.41 2.25

C. How different, better or worse, do you think the elderly in this community are than they would be if the Area Agency on Aging did not exist, in respect to the following? Check the appropriate box for each item. Mean* 1. Income, financial condition. 2.85 2. Prestige or status in the community. 2.40 3. Feelings of contribution to the community. 2.28 4. Ability to affect local service decisions. 2.51 5. Knowledge about services. 1.99 6. Ability to get needed services. 2.16 * Response scale of 1-5. SOURCE:}. E. O'Brien and T. T. Wetle. Analysis of Conflict in the Coordination of Human Service Organizations. Final report to the U.S. Administration on Aging. Portland: Portland State University Institute on Aging, 1974. Reprinted with permission.

V3.9.I.i ORGANIZATIONAL RESISTANCE TO POLICY COMPLIANCE MECHANISMS J. E. O'Brien and P. J. Mullaney, 1979 I. Scale: High Inducement—Low Coercive

1. 2. 3. 4. 5.

Guttman Mean Item Score: 28* Item Government should provide short-term in-service training to service providers regarding special techniques (12) Government should provide information about organizations to make it easier for them to work together (10) Government should provide fee reimbursement for services delivered (8) Government should establish eligibility requirements for an agency's clients (2) Government should award unrestricted grants for building agency capacity (11)

% Disapprove 7 13 28 41 52

II. Scale: Low Inducement—Low Coercive

Guttman Mean Item Score: 32* Item

1. Government should assess compliance with contracts (13)

% Disapprove

8

388 / O'BRIEN AND CHAILLE 2. Government should evaluate program effectiveness (16) 3. Government should have authority to monitor and approve all agreements between organizations (9)

12 76

III. Scale: High Inducement—High Coercive Guttman Mean Item Score 65* Item 1. Government should competitively award service contracts as incentives for desired behavior (1 ) 2. Government should centralize client intake for all social service agencies (14) 3. Government should control the information exchanged among organizations (7)

% Disapprove 41 66 89

IV. Scale: Low Inducement—High Coercive

1. 2. 3. 4. 5.

Guttman Mean Item Score: 76* Item Government should act as the ultimate judge when organizations differ (3) Government should regulate the types of contracts an agency may enter into (4) Government should have authority to approve/disapprove all aging programs (6) Government should have authority to take control of an agency's budget to ensure desired behavior (15) Government should determine the way an organization can spend all its funds (5)

% Disapprove 63 67 82 83 84

NOTE: Respondents were asked "At times, government attempts to bring about changes in organizations. Please indicate the extent to which the following are appropriate or inappropriate means by which government should try to influence the way service organizations carry out their business." The numbers in parentheses are the item sequence numbers as printed on the scale during the interviewing. *We have interpreted the Guttman mean item score to represent the resistance potential of the change tactics represented in each subscale. SOURCE: J. E. O'Brien and P. J. Mullaney. "Policy Implementation for Organizational Compliance." Minneapolis: Industrial Relations Center Working Paper 79-09, University of Minnesota, 1979. Reprinted with permission.

V3.9.I.J ORGANIZATIONAL SELF INTEREST-COMMON INTEREST (SI-CI) J. E. O'Brien, T. T. Wetle, and M. Lindsey, 1978 General Instructions to Informants: "For purposes of the next series of questions, we would like to give you a hypothetical problem to consider. Assume that legislation is passed enacting Human Services Revenue Sharing. The program will be implemented by the designation of a local government agency to broker and monitor the pass through and use of the services funds. The actual service monies will be awarded through contracts with various local service agencies such as the one you work for. Assume that your agency is approached to participate

ORGANIZATIONAL PROPERTIES / 389 in the program. To do so will result in certain modifications in your program and in your funding picture. In order to participate, your agency must negotiate a contract setting down the terms of this inter-agency agreement. We are specifically interested in what factors you would consider in attempting both to decide whether or not to seek to participate in the program and later, assuming you were interested, in how you would set your priorities relative to the specifics involved in the contract." SELF INTEREST A. Relative to your agency, please check the extent to which each of the following would constitute an important criterion in your assessment of the merits of this type of agreement. IN CONSIDERING SUCH AGREEMENTS, IT IS IMPORTANT . . . % Claiming "Very Important" Community Factors: Mean Item Score = 35 to avoid new activities that do not match your agency goals 45 to maximize the return from the agreement to your agency 38 to further the wishes of your board 29 to advance the professional interests of your staff in any new programs 28 Market Factors: Mean Item Score = 24 to stress clear agreements which avoid long-run entanglements with other organizations to negotiate terms on a here-and-now basis since future obligations may be hard to count on to protect your agency by driving a hard bargain to avoid making the terms of such arrangements a public matter Organizational Factors: Mean Item Score = 3 5 to use such opportunities to increase the range of services your organization offers to avoid entanglements that diminish your agency's independence and self direction to concentrate on the bread and butter issues like maximizing your share of the contract money to use such opportunities to increase the size of your agency staff and departments

48 29 13 5 59 55 17 10

COMMON INTEREST STILL KEEPING IN MIND THE HYPOTHETICAL SITUATION ON THE PREVIOUS PAGE . .. B. Relative to the community, please check the extent to which each of the following would constitute an important criterion in your assessment of the merits of this type of agreement. IN CONSIDERING SUCH AGREEMENTS, IT IS IMPORTANT .. . % Claiming "Very Important" Community Factors: Mean Item Score = 66 to use the funds to strengthen the capacity for human services delivery 89 in the community

390 / O'BRIEN AND CHAILLE to assure open input from client representatives to seek consultation with community leaders before settling on specific terms to minimize the share of the resources which go for agency building and administration Market Factors: Mean Item Score = 49 to use the opportunity to link many community agencies for close coordination to avoid allowing the program to become a competitive struggle among many organizations to avoid participation if the distribution process is likely to be dominated by a few self serving agencies to exclude agencies which have been uncooperative with past community efforts Organizational Factors: Mean Item Score = 63 to promote a sense of cooperation among agencies in the community to set an example of fair play in conducting the negotiations to increase the positive regard of agencies for one another to discourage the award of funds to agencies with a reputation of not following through with their agreements

77 52 46

77 73 38 9

82 65 61 43

SOURCE:}. E. O'Brien, T. T. Wetle, and M. Lindsey, Testing a Community Intervention Model. Report to the U.S. Administration on Aging. Portland, Ore.: Portland State University Institute on Aging, 1978, Appendix i, pp. i-j. Reprinted with permission.

Chapter 10

Indexes for the Aging of Populations Toshi Kii

Demographers have known for some time that the populations of industrialized societies have been aging, or that the proportion of older people has been increasing. In the United States, the population has aged consistently from a 4.1% older population (65 years and over) at the turn of the century to 10.5% in 1975. It is expected to age further over the next few decades. The aging of a population is often attributed to the increasing longevity of human beings. This is not the principal cause, however. Certainly, longevity contributes to the aging of populations, but the major causal factor in the aging of a population is a secular decline in fertility (United Nations, 1954; 1956; Coale, 1956; 1972; Stolnitz, 1956; Valoaras, 1958; Hermalin, 1966; Keyfitz, 1968). Under conditions of improved mortality, the number of survivors to old age increases but the proportion of older people does not necessarily increase when high fertility continues to exist. Historically, the proportion of older people has increased because of the decline in fertility, which in turn has produced a decreasing proportion of younger people in the population. Three indicators are often used to measure the aging of populations: the median age, the proportion of older people, and the ratio of older people to younger people. Each indication has disadvantages in measuring the aging of populations. The best index of aging would be one that incorporated the distribution of all ages in a population. Such an aging index has not yet been developed. Coulson (1968) applied a regression model to the population pyramid in a study of age structure in Kansas City, Missouri. This model also is limited, but it has the potential to be a better 391

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index for the aging of populations since it takes into account the distribution of all age categories in a population.

Index of Aging in Terms of Median Age The median age is the age at which a population is divided into two halves, one older and one younger then the median age. Broadly speaking, countries with a median age of 30 years or over can be classified as old; those with a median age between 20 and 29 years, as intermediate; and those with a median age below 20 years, as young populations (Shryock, Siegel, and Associates, 1975). According to this index, the U.S. population became younger between the 1950s and the mid-1970s and has not returned to the previous aging pattern. However, median age is a poor measure of the aging of a population because the variation of its age composition is not adequately represented (Rosset, 1964).

Index of Aging in Terms of Proportion of Older Persons The aging index most often used is the proportion of persons aged 65 years and over in a population. This index is an appropriate measure of the aging of a population as long as the aging population is defined as one with an increasing proportion of people aged 65 and over, regardless of proportional changes in other age categories. According to this index, populations with less than 4% aged 65 and over can be classified as young; those with 4% to 6.9%, as youthful; those with 7% to 9.9%, as mature; and those with 10% or more, as aged (Cowgill, 1974). However, from the same logic it can be said that the population is being rejuvenated when the proportion of a younger population aged, say, 0 to 14 years is increasing. In fact, the U.S. population experienced this phenomenon between 1940 and 1960. In 1940, the proportion of the population aged 65 years and over was 6.8% and that under age 15 was 25.0%. These proportions had increased to 8.1% and 26.9%, respectively, by 1950 and to 9.2% and 31.1% by 1960 (Shryock, Siegel, and Associates, 1975). Hence, a population can be aging and rejuvenating simultaneously.

Index of Aging in Terms of Ratio of the Old to the Young The issue becomes one of defining what conceptually constitutes an aging population. When the process of population aging is reflected conceptually in both the proportion of older persons and the proportion of younger persons, the ratio comparing these two age-groups is a more sensitive index of population aging. Since this ratio is composed of both

INDEXES FOR THE AGING OF POPULATIONS / 393

ends of the age composition of a population, the index reflects the combined effects of the aging and "younging" of a population. These three measures yield different outcomes for expressing the aging of populations. Table 10-1 shows these indexes for selected countries (circa 1970), and Table 10-2 shows them for the United States since 1900. TABLE 10-1 Median Age, Proportion of Population Aged 65 and Over, and Ratio of Those Aged 65 and Over to Those Aged Under 15, for Selected Countries, Around 1970

Country (Year)

Median Age

Proportion 65 and Over

Ratio of 65 and Over to under 15

Sweden (1970) France (1971) U.S.A. (1970) Japan (1970) India (1971) Mexico (1970) Mauritius (1971) Niger (1969)

35.0 years 31.6 years 28.6 years 30.4 years 18.8 years 16.9 years 20.5 years 17.2 years

13.7% 13.5% 9.9% 7.1% 3.4% 3.7% 3.7% 2.9%

.66 .57 .35 .29 .08 .08 .09 .06

SOURCE: United Nations, 1975. TABLE 10-2 Median Age, Proportion of Population Aged 65 and Over, and Ratio of Population Aged 65 and Over to That Aged Under 15, United States, 1900-1975

Year

Median Age

Proportion 65 and Over

Ratio of 65 and Over to under 15

1900 1910 1920 1930 1940 1950 1960 1970 1975

22.9 years 24.0 years 25.2 years 26.4 years 29.0 years 30.1 years 29.4 years 27.9 years 28.6 years

4.1% 4.3% 4.6% 5.4% 6.8% 8.1% 9.2% 9.9% 10.5%

.12 .13 .15 .18 .28 .30 .30 .35 .40

SOURCE: U.S. Bureau of the Census, 1977b.

An Index of Aging in Terms of Years until Death Norman Ryder (1975) recently proposed an alternative measure of population aging that estimates the proportion of a population above the age

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corresponding to a life expectancy of 10 years. For this index, the entry point into old age is arbitrarily selected. For example, the age at which the remaining life expectancy is 10 years is obtained from life tables, and the proportion of the total population above this age is then obtained as an index of population aging. Although Ryder's proposal is a theoretical exercise utilizing stable population models with various proportions of the population above the age at which life expectation equals 10 years under various mortality and fertility conditions, it can be applied to actual populations in order to arrive at an index of population aging. In Table 10-3, this index is shown for the United States in selected years. Interpreting Ryder's index is difficult because the age at which 10 years of life remain is obtained from survival probabilities based on the assumption that a population will experience in the future the agespecific mortality conditions applying to the year the interpretation was being made. Combining a theoretically projected entry point to old age with the actual population to arrive at the proportion of the total population above that projected age makes this index less clear. However, the concept is attractive precisely because the entry into old age, though arbitrary, is measured in terms of the number of years remaining rather than the number of years elapsed. TABLE 10-3 Index of Aging in Terms of Years until Death, United States, 1900-1970

Year

Age at which Average Remaining Lifetime Equals 10 Years

Proportion of Total Population above This Age

1900 1930 1960 1970

68.6 years 69.1 years 72.5 years 73.7 years

2.7% 3.5% 4.2% 4.4%

SOURCE: U.S. Bureau of the Census, 1976, p. 11.

The Age Structure Index Coulson's (1968) index is a single quantitative summary measure for the age distribution of populations. A population histogram, which is a visual presentation of age compositions, can be generalized as a straight line: where Y is the proportion of a population of a given age, X is age (or age interval), a is a constant, b is the regression coefficient or slope of the least-squares trend line, and e is a normally distributed error term with 0

INDEXES FOR THE AGING OF POPULATIONS / 395

mean and unit variance. The value of b is the age structure index for a population. When the age and the proportion of the population in each age are plotted on the x-axis and the y-axis, respectively, the larger the b value, the older the population. Of course, like any other demographic index, this one is used in relative terms, that is, to compare one population with others. Coulson developed this index in a study of the population age structure of the Kansas City SMSA (standard metropolitan statistical area) by using census tracts as the units of comparison. The index ranged from 0.09141 for the tract with the oldest population to -0.19062 for the tract with the youngest population. The accuracy of the index was tested, since identical index values can be obtained from vastly different population distributions due to the method of least squares. The testing was based on the coefficient of determination, or the extent to which the regression line accounted for the variation among the age-groups. The coefficient of determination ranged from 0.0004 to 0.9450, with values above 0.3481 significant at the 99% level. What this test showed was that index values greater than -0.04200 were not reliable. In 36 of the 224 tracts, the observed population histograms were not significantly explained by the regression line. What were these tracts? They were primarily those with indexes indicating an old-age structure. As Coulson evaluated the age structure index, the weakness of it was confined to the very old values of the index but it was efficient for populations with comparatively young index values. Coulson's evaluation is correct as far as his study is concerned. Census tracts as basic units of comparison create problems because some tracts have particularly skewed age distributions. It is not necessarily that high index values create the problem; the problem can also arise with the low index values, as in a tract in which the proportion of younger members in the population is very high, but the deviation from the linear regression is substantial. The problem lies in the method of least squares. The index is, however, part of the regression equation and must be accepted with a knowledge of its weakness in predicting skewed population distributions. It might be interesting to apply this index of age structure to larger populations, such as cities, states, and countries. Larger populations are more likely to have fair representations of each age category and nearlinear population pyramids, unlike census tracts, so that the index could perhaps be used to measure population aging. Compared with the median age, the proportion of a population aged 65 and over, and the ratio of the proportion aged 65 and over to the proportion aged under 15, this index is conceptually more acceptable for measuring the aging of populations in

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that the distribution of ages in a population is explicitly examined in computing the index.

Projection of Future Older Population Whether the aging of the population will continue in the future depends primarily on the future course of fertility. The United States Bureau of the Census (1977b) projects three series of future populations on the basis of high fertility (series 1—2.7 births per woman), medium fertility (series II—2.1 births per woman), and low fertility (series III—1.7 births per woman). These series assume slight declines in death rates (it is assumed that the average life expectancy at birth in the United States will increase from 69.1 to 71.8 years for males and from 77.0 to 81.0 years for females between the years 1976 and 2040) and a net immigration of 400,000 persons per year in the future. Table 10-4 shows the projected numbers and proportions of the older population up to the year 2040. TABLE 10-4 Projected Numbers and Proportions of Population Aged 65 and Over, United States 1980-2040 Year

Numbers

Series I

Series II

Series III

1980 1990 2000 2010 2020 2030 2040

24,927 29,824 31,822 34,837 45,102 55,024 54,925

11.1% 11.7% 11.3% 11.1% 12.7% 14.0% 12.5%

11.2% 12.2% 12.2% 12.7% 15.5% 18.3% 17.8%

11.3% 12.6% 12.9% 13.9% 17.8% 22.1% 22.8%

NOTE: Numbers in thousands. SOURCE: U.S. Bureau of the Census, 1977a, p. 14.

One significant aspect of the aging of the population is that the older population itself is aging. Thus, when one looks at the age distributions within the older population, the proportions of the upper age-groups in the older population have been increasing. This trend is expected to continue at least until the year 2000 (Table 10-5).

Summary Various indexes for measuring the aging of populations are currently used, particularly the median age and the proportion of a population aged

INDEXES FOR THE AGING OF POPULATIONS / 397

TABLE 10-5 Estimated and Projected Proportions of Various Age Groups in the Population Aged 65 and Over, 1960-2010 Age 65-69 70-74 75-79 80-84 85 and over Total 65 and over

1960

1970

1980

1990

2000

2010

37.7% 28.6% 18.5% 9.6% 5.6% 100.0%

35.0% 27.2% 19.2% 11.5% 7.1% 100.0%

35.3% 27.5% 17.5% 11.2% 8.4% 99.9%

34.1% 26.5% 18.7% 12.1% 8.6% 100.0%

29.5% 26.3% 20.3% 13.3% 10.5% 99.9%

34.3% 23.9% 17.2% 13.0% 11.6% 100.0%

NOTE: Some of the percentages do not total 100 because of rounding. SOURCE: U.S. Bureau of the Census, 1976.

65 years and over. However, a conceptually grounded index, an index that takes into account the age composition of an entire population, has not been utilized. Coulson's (1968) age structure index may serve as a better index for measuring the aging of populations. REFERENCES Coale, A. J. The Growth and Structure of Human Populations: A Mathematical Investigation. Princeton, N.J.: Princeton University Press, 1972. "The Effects of Change in Mortality and Fertility on Age Composition." Milbank Memorial Fund Quarterly, 1956,34: 79-114. Coulson, M. "The Distribution of Population Age Structure." Annals of the Association of American Geographers, 1968, 58: 155-76. Cowgill, D. O. "The Aging of Populations and Societies." Annals of the American Academy of Political and Social Science, 1974,415: 1-18. Hermalm, A. I. "The Effect of Changes in Mortality Rates on Population Growth and Age Distribution in the United States." Milbank Memorial Fund Quarterly, 1966,44:451-69. Keyfitz, N. "Changing Vital Rates and Age Distributions." Population Studies, 1968, 22: 235-51. Population Reference Bureau. "The Elderly in America." Population Bulletin, 1975,30 (3). Rosset, E. Aging Process of Population. New York: Pergamon Press, 1964. Ryder, N. "Notes on Stationary Populations." Population Index, 1975,41:3-28. Shryock, H. S., J. S. Siegel, and Associates. The Methods and Materials of Demography (vols. 1 and 2). Washington, D.C.: U.S. Bureau of the Census, 1975. Stolnitz, G. J. "Mortality Declines and Age Distribution." Milbank Memorial Fund Quarterly, 1956, 34: 178-215. United Nations. "The Cause of the Aging of Populations: Declining Mortality or Declining Fertility?" Population Bulletin of the United States, 1954,4: 30-38. The Aging of Population and Its Economic and Social Implications. New York: United Nations, 1956. Demographic Yearbook. New York: United Nations, 1975. United States Bureau of the Census. Statistical Abstract of the United States: 1940. Washington, D.C.: Government Printing Office, 1940.

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Statistical Abstract of the United States: 1950. Washington, D.C.: Government Printing Office, 1950. Statistical Abstract of the United States: 1965. Washington, D.C.: Government Printing Office, 1965. "Demographic Aspects of Aging and the Older Population in the United States." Current Population Reports. Special Studies, Series P-23, No. 59. Washington, D.C.: Government Printing Office, 1976. Current Population Reports. Series P-25, No. 704. Washington, D.C.: Government Printing Office, 1977. _. Statistical Abstract of the United States: 1977. Washington, D.C.: Government Printing Office, 1977b. Valoaras, V. G. "Young and Aged Populations." Annals of the American Academy of Political and Social Sciences, 1958,316: 6'9-83.

Chapter 11

Demographic Characteristics Toshi Kii

This chapter, using the most recent data available, presents various descriptive accounts of the demographic, social, and economic characteristics of the older population in the United States. Some indexes relevant to measuring certain aspects of the older population have not been used extensively with older populations but are included in this chapter because they are conceptually interesting and hold some promise for future use. Three general areas are covered in this chapter: individual aging, or longevity; geographic distribution; and social and economic characteristics.

Individual Aging The best demographic indicator of individual aging can be expressed in terms of life expectancy and the probability of survival from one year to another. Such an indicator does not carry individual input but instead expresses the probability of an individual's survival if he or she experiences the same age-specific mortality conditions as the population to which he or she belongs. The life table provides this information. It also provides an interesting feature with respect to the modal age at which the greatest number of deaths occur in old age. Von Lexis termed this modal age the normal length of human life (Rosset, 1964). Another measure of individual aging was introduced by Palmore (1969), who, on the basis of the Duke Longitudinal Study, combined life expectancy (as obtained from the life table) with the social, psychological, and physical characteristics of individuals in order to predict their longevity. The measure is an improved index for predicting longevity compared to life expectancy alone. Life Expectancy Table 11-1 shows the life expectancy at various ages (0, 65, 75, 85) for the population by sex and race for selected years. Striking features of the 399

400 / KII

TABLE 11-1 Average Remaining Lifetime for Various Ages, by Race and Sex, United States, 1900-1974 (in years) Race and Sex

At Birth

At 65

At 75

At 85

48.2 59.1 66.3 67.9 68.9

11.5 11.8 12.8 13.0 13.4

6.8 7.0 7.8 8.0 8.3

3.8 4.0 4.4 4.6 4.9

51.1 62.7 72.0 75.4 76.6

12.2 12.8 15.0 16.9 17.6

7.3 7.6 8.9 10.2 10.7

4.1 4.2 4.8 5.5 6.0

32.5 47.6 58.9 60.9 62.9

10.4 10.9 12.8 12.8 13.4

6.6 7.0 8.8 8.9 9.5

4.0 4.3 5.4 6.0 6.5

35.0 49.5 62.7 69.0 71.3

11.4 12.2 14.5 15.9 16.8

7.9 8.6 10.2 11.0 12.0

5.1 5.5 6.2 7.0 8.1

White Males: 1900-1902 1929-1931 1949-1951 1969-1971 1974 White Females: 1900-1902 1929-1931 1949-1951 1969-1971 1974 Nonwhite Males: " 1900-1902 1929-1931 1949-1951 1969-1971 1974 Nonwhite Females:a 1900-1902 1929-1931 1949-1951 1969-1971b 1974b

a. Black only for 1900-1902 and 1929-1931. b. Deaths of nonresidents of the United States were excluded beginning in 1970. SOURCE: U.S. Bureau of the Census, 1976, p. 26.

life table are (1) the fact that there have been considerable increases in life expectancy at birth for all categories of people, but particularly nonwhite people during this century; (2) the fact that women live longer than men and that their improvement in life expectancy has exceeded that of men at all ages; and (3) the fact that life expectancy has been higher among whites than among nonwhites up to 75 years old, but that beyond 75 nonwhites' remaining years have exceeded those of whites. What the life table implies is that the tremendous increase in longevity during this cen-

DEMOGRAPHIC CHARACTERISTICS / 401

tury was in large part due to the decline in childhood mortality, particularly in infant mortality, and not so much due to improved mortality rates among the adult and older populations. Since childhood mortality rates are already very low, a future increase in longevity will depend on further improvements in adult mortality from such diseases as heart disease, malignant neoplasms, and cerebrovascular diseases. These three kinds of diseases contribute to more than three-fourths of the deaths among individuals in the older population. Index of Normal Length of Human Life Von Lexis proposed as his conception of the normal duration of life the age at which the greatest number of deaths occur in old age (Rosset, 1964). The age-specific mortality pattern of any population shows that after infancy the mortality rate declines rather drastically but again after approximately 10 years of age it increases steadily as age increases. Thus, the number of deaths that take place between one age and the next in the life table shows that after a relatively large number of deaths in infancy mortality rate decreases until about age 10 years. Beyond that age, the number of deaths generally increases steadily up to a certain age and then decreases until all of the original radix (the 100,000 newborns in the life table) dies out. The normal length of human life, according to von Lexis, is the age at which the number of deaths peaks, or the modal age at which the largest number of people die in old age. In Table 11-2, portions of the complete life table for the United States for 1969 to 1971 are shown to illustrate the von Lexis index of normal length of life. Since the greatest number of deaths occurred at the age of 80, 80 years was the normal length of life for people in the United States between 1969 and 1971. Measure of Predictive Longevity Palmore (1969) predicted longevity on the basis of physical, mental, social, and demographic (life expectancy) factors. His measure was constructed from the findings of the Duke Longitudinal Study of Aging, which began in 1955 with an initial sample of 268 volunteers aged 60 and over from the central region of North Carolina. The measure uses stepwise multiple regression to select 4 variables from 38 variables as having the greatest predictive power relative to longevity: (1) actuarial expectancy at initial testing, (2) physical functioning rating, (3) work satisfaction, and (4) intelligence. Predictive equations for longevity for the total sample—by age, sex, and race—are presented in Table 11-3. In general, life expectancy obtained from the standard life table yields the best prediction for an individual's longevity, followed by physical

402 / KII

TABLE 11-2 Number of Deaths in the Life Table for the United States, 1969-1971, Selected Ages (radix = 100,000) Age Number of Deaths

Age

Number of Deaths

78 79 80 81 82 83 84 85 90 95 100 105

2,947 2,960 2,962 2,948 2,906 2,831 2,730 2,626 1,720 718 167 26

2,002 30 136 149 294 657 1,348 1,794 2,269 2,759 2,845 2,909

0 10 20 30 40 50 60 65 70 75 76 77

SOURCE: U.S. Department of Health, Education, and Welfare, 1975, pp. 6-9. TABLE 11-3 Predictive Equations for Longevity Equation

Group Total Men 60-69 Men 70+ Women 60-69 Women 70+ Whites Negroes

Y= Y= Y= Y= Y= Y= Y=

12.7 + 13.0 + 9.0 + 16.8 + 11.7 + 13.0 + 12.2 +

0.87*£ 1.30*£ 1.33*£ 1.24xE 0.86xE 0.95*£ 0.75*£

+ 1.07xP + Q.l\xw+ 0.06xI + \.l\xw + 0.20*/ + 2.02xP + 0.09*, + 1.03*^+ 0.08*/ + 2.32xP

Standard Error 5.2 6.1 4.6 5.6 4.3 5.2 5.3

SOURCE: E. Palmore, "Physical, Mental, and Social Factors in Predicting Longevity". The Gerontologist, 1969, 9 (2):106. Reprinted by permission of the author and publisher. Y— Predicted longevity: years remaining after initial testing. £ = Life expectancy at time 1, which is derived from the standard life expectancy table by age, sex, and race for North Carolina. These life expectancies ranged from 2.5 to 20.0 years, with a mean of 11.5 years a standard deviation of 3.6 years. P= Physical functioning, which is a score given by a physician for the level of physical functioning in everyday activities on the basis of the medical history, physical and neurological examinations, audiograms, chest X-ray, electroencephalogram, electrocardiogram, and laboratory study of the blood and urine. The rating ranged from 1 (total disability) to 6 (no pathology), with a mean of 4.4 and a standard deviation of 1.2. W= Work satisfaction, which is part of an attitude questionnaire designed to measure a person's satisfaction with various areas of life. The scale awards 1 point for agreement with

DEMOGRAPHIC CHARACTERISTICS / 403 each of three positive statements (I am happy only when I have definite work to do; I am satisfied with the work I now do; I do better work now than ever before) and 1 point for disagreement with each of three negative statements (I can no longer do any kind of useful work; I have no work to look forward to; I get badly flustered when I have to hurry with my work). The score ranged from 0 to 6, with a mean of 3.7 and a standard deviation of 1.2. / = Intelligence, which is the weighted performance score on the Wechsler Adult Intelligence Scale (Wechsler, 1955). It is made up of tests on digit symbols, picture arrangement, and object assembly. The mean score was 27.1, with a standard deviation of 13.1.

functioning, work satisfaction, and intelligence performance, as shown in Table 11-4. However, there are variations among different sex, age, and racial groups. For example, physical functioning did not contribute any significant improvement to the prediction of longevity for men, but for women aged 60 to 69 physical functioning was the most important factor predicting longevity. Among women aged 60 to 69 neither work satisfaction nor intelligence was significant, but for men aged 60 to 69 work satisfaction was the best predictor of longevity. Among both men and women over age 70, life expectancy and intelligence were the only factors significantly predicting longevity. For blacks physical functioning was the most important predictor, though for whites it was insignificant. The equations presented exclude the insignificant variables.

TABLE 11-4 Step wise Regression of Four Predictors with Longevity (N= 234) Predictors Life expectancy at time (E) Physical functioning (P) Work satisfaction ( W) Intelligence (/)

Zero-Order Correlation .56 (p< .39 (p< .19 (p< .32 (/»