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really developed thesis. Joe Eyer’s follow- ing chapter sketches in an historical picture of the interactive history of modern society since the industrial revolution and develop- ments in medical practice and systems. Stylized as this presentation is, it adds perspective to the argument. Whilst it is instructive and helpful in mapping the his- torical inter-linking of economy and health, this is unlikely to become in any sense definitive. Eyer is too eager to pro- ceed with his model and insufficiently scho- larly in his source material to win the day. In reading his interpretation, I was mindful of the recent reappraisal of the previously supposed beneficial relationship between elderly people and their caring families in times past. Karl Marx’s own studies in nineteenth century public health in Britain may have provided the author with more reliable evidence than the dubious data drawn from eastern Europe.

Paradoxically, Robert Crawford’s re- porting of a study of sixty adults from Chicago appears as one of the strongest sections of the book. I say paradoxically because a handful of Chicagoans seen through the eyes of an ethnographer is unlikely material for the political economy dialogue. Nonetheless its very grounded- ness produced more resonance than the heavy-weight Navarro, with his too global- ly macro examination of the political logic and financial structure of private health care (with welcome international compari-

S T E P H E N M . S H O R T E L L a n d ARNOLD D. KALUZNY (Eds), Health Care Management: A Text in Organization Theory and Behavior, New York: John Wiley and Sons, 1983, 500 pages. Price (UK) f30.00 hardback.

The United States and the United King- dom seem, to someone who has under- taken research and teaching on both sides of the Atlantic over the last twenty years, to approach the matter of health care management quite differently. In the Un- ited Kingdom, health care management has been discussed from a theoretic pers- pective reflecting wider philosophic con- cerns with equity, autonomy; but practised

sons and data), and was intellectually more satisfying. Bodenheimer’s devastating surgery on the international pharmaceutic- al industry also brought the discussion down to a level where it could be evi- denced and disputed. Charles Derber, be- cause he focussed so exclusively on the American medical profession and the way he sees it *being managed by corporate interests, does less for the total case. His analysis is not one to be dismissed in other parts of the world, but it cannot be taken as a template either.

If one’s own reactions are any sort of guide to the field, we still have a long way to go in uncovering the salient issues in the political economy of health. This volume will fuel the convictions of those of us who broadly share the thesis, but provides too little reliable evidence for those who re- main sceptical. McKinlay has done a con- siderable service in marking out the new field of play. His book will be valued for this. Yet much remains to be done, by way of observing the teams at play, before societies and their sceptical representatives can feel confident about which side to place their money on in the furtherance of health.

MALCOLM JOHNSON, Professor and Director, Department of

Health and Social Welfare, The Open University, Milton Keynes, UK.

in a rather restricted way. The United States, on the other hand, has always been quite self-conscious about health care man- agement as a separate set of activities undertaken by health care managers in their own right, and has undertaken an impressively large number of empiric but rather atheoretic research studies. This has led in the USA to a substantial imbalance between theoretic under-development and empiric over-development of fragmented items of information, lacking a cohesive theoretic or even conceptual framework.

It is within the context of this imbalance that this USA textbook is particularly to be welcomed as a comprehensive integration of hitherto disparate streams of research,

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distillation from them of a theoretical framework on which may be based future research endeavors, and successful linkage of health care management to the wider context of organizational behavior. The book is edited by two paramount scholars in the area, Stephen Shortell of Northwest- ern University and Arnold Kaluzny of the University of North Carolina, and begins with a useful foreword in which Basil Georgopoulos calls, quite properly, ‘. . .not so much for research. . .but for conceptual and theoretical reflections, empirical synthesis, and scholarly con- solidation of relevant knowledge from the literature already available’.

The book is organized around a para- digm on the functional needs of organiza- tions and managers which, in Part I, are identified both for organizations (Chapter 1 on ‘Organization Theory and Health Care Management’ by Stephen M. Shortell and Arnold D . Kaluzny) , and for managers (Chapter 2 on ‘The Managerial Role’ by Fred C. Munson and Howard S. Zucker- man). Thus, Part I1 deals with the need to motivate and lead people and groups by satisfying individual needs and values (Chapter 3 on ‘Perception and Motivation’ by Stephen Strasser and Thomas S. Bate- men), by providing direction (Chapter 4 on ‘Leadership and Decision Making’ by Law- ton R. Burns and Selwyn W. Becker), and by recognizing the nature of groups (Chap- ter 5 on ‘The Social Structure of Work Groups’ by Robert W. Hetherington and Thomas G. Rundall). Part I11 deals with the need to operate the technical system by determining the appropriate work design (Chapter 6 on ‘Work Design’ by Martin P. Chams), by establishing communication and co-ordination mechanisms (Chapter 7 on ‘Communication and Co-ordination’ by Jerald Hage), and by controlling perform- ance (Chapter 8 on ‘Power and Influence’ by Laura L. Marlock and Constance A. Nathanson).

Part IV deals with the need to renew the organization by determining appropriate organization design (Chapter 9 on ‘Orga- nization Design’ by John R. Kimberly, Peggy Leatt and Stephen M. Shortell), by acquiring resources and managing the en- vironment (Chapter 10 on ‘Organization- Environment Relationships’ by David Starkweather and Karen S. Cook), by managing changes and innovation (Chap- ter 11 on ‘Organizational Change and In- novation’ by Arnold D. Kaluzny and s. Robert Hernandez), and by attaining goals (Chapter 12 on ‘Organizational Perform- ance: Managing for Efficiency and Effec- tiveness’ by W. Richard Scott and Stephen M. Shortell). Part V deals with the need to chart the future by managing strategicaily (Chapter 13 on ‘Strategic Management’ by Roice D. Luke and Bettina Kurowski), and by anticipating the future (Chapter 14 on ‘Challenges for the Future’ by Arnold D. Kaluzny and Stephen M. Shortell).

Several aspects of this book are striking- ly attractive in addition to its comprehen- siveness and theoretic integration of indi- vidual, group and organization-wide be- havior. First, it is exceptionally well edited in its clarity, lay-out, and organization. Second, it accords a central role to mana- gers as an intervening force in determining organizational behavior. Third, it is a su- perb instructional textbook: it has short case studies, discussion questions and sug- gestions for additional reading. Indeed, on that last point, maybe the next edition could very usefully have an Instructor’s Guide, and ‘floppy discs’ of data sets re- levant to specific chapters to be used by students of health care management for hypothesis testing.

GEOFFREY GIBSON, Professor of Health Care Management,

Baruch CollegelMt. Sinai School of Medicine, City University of New York, USA.