Merging missions and methods: A study of restructuring and adaptation in nonprofit health care organizations

Julie Pietroburgo¹, Stephen P Wernet<sup>2

1</sup>Department of Public Administration and Policy Analysis, Southern Illinois University Edwardsville, IL, USA; ²School of Social Work and Department of Public Policy Analysis, Saint Louis University, MI, USA

Abstract: Health care nonprofit organizations often approach change with a fundamental resistance based on a stalwart commitment to charitable missions and vulnerable clientele. Yet they are being forced to adapt as government devolution, increased competition, and greater demand for their services, threaten their resource bases. While health care nonprofits are j­oining forces to better accommodate their diminished resources, little is known about the manner, motivation, and impacts of restructuring and adaptation. This study examines restructuring through review of collaborative activities in nonprofit ­hospices. Using a theoretical framework of political economy, 250 nonprofit hospices ­operating within a six-state region were surveyed regarding their restructuring experiences in order to understand why and how restructuring takes place. Results indicate that organizations that restructure have strong economic bases and pursue restructuring as a way of achieving greater financial stability. The demographic characteristics of age and size were found to be predictive of ­decisions to join forces with restructuring, most commonly impeded by internal political factors, including ­differences in management, governance, and structure. Finally, the study found that ­restructuring was perceived as fulfilling its promise through the enhanced economic and political status of organizations.

Keywords: nonprofit restructuring, mergers, alliances, collaboration, adaptation