Essays on the Organization and Delivery of Cancer Care

Open Access
Louis, Christopher John
Graduate Program:
Health Policy and Administration
Doctor of Philosophy
Document Type:
Date of Defense:
November 14, 2014
Committee Members:
  • Jonathan Rogers Clark, Committee Chair
  • Susan Diane Brannon, Committee Member
  • Marianne Messersmith Hillemeier, Committee Member
  • Barbara Louise Gray, Committee Member
  • Eugene Joseph Lengerich, Committee Member
  • organization
  • cancer
  • breast cancer
  • patient navigation
  • health system
  • organizational attention
  • organization design
This dissertation is comprised of three empirical studies that examine the organization and delivery of cancer care. The first study entitled “Spanning Boundaries: System Dynamics, Externalities, and Patient Navigation,” creates a theoretical framework for why the need for cancer patient navigation has emerged. Using qualitative data to assess cancer patient navigation, we found that navigators commonly functioned in boundary spanning roles and leveraged their social networks to overcome negative externalities in the health system. The second study entitled “The Effects of Organization-level Characteristics on Delays in Breast Cancer Diagnosis: A Population-based Study,” uses a population-based sample of breast cancer patients to assess whether certain types of hospitals diagnose breast cancer in a more timely way than others. These findings suggest that for-profit hospitals and those with comprehensive oncology services had shorter diagnosis delays than their counterparts while system membership and size did not reveal significant differences. The third study included in the dissertation is entitled, “How Structural Design Relates to Attention in Three Health Systems: A Comparative Case Study.” This study uses exploratory evidence from three health systems to understand how the structural design of health care organizations influences where health systems focus their attention. Three distinct foci of attention (tactical-focused attention, patient-focused attention, and provider relationships-focused attention) emerged from the data and provide insights as to how the placement of organizational boundaries (i.e., physician contracting paradigm used, the extent of inter-organizational coordination, clinical structure, and location of breast cancer services) can create situations where an organization’s structural design distributes the focus of attention across different types of issues.