Mary L. Fennell Professor of Sociology, Professor of Health Services, Policy and Practice, Director of the C.V. Starr Program in Business, Entreprneurship and Organizations

I am professor of Sociology, and Health Services Policy and Practice, and I am affiliated with the Center on Gerontology and Health Care Research. I am Senior Associate Editor of Health Services Research, and I am active in the American Sociological Association, The Academy of Management, and AcademyHealth. My areas of research include formal organizations, health care organizations, professional work and changes in professional careers and professional organizations over time. I use theories about organizations to look at problems in health care delivery and to study health care organizations. I teach courses on organizational theory, health care organizations, research methods, and health care policy. From 2000 through 2004 I served Brown as the Dean of the Faculty; and from 2005 through 2008 as Chair of the Sociology Department.  I am currently the Faculty Director of the CV Starr Program in Business, Entrepreneurship and Organizations.

Brown Affiliations

Research Areas

scholarly work

“Assessing Research Collaborations:  The Final Report On NCCCP Sites Engagement In Collaborative Relationships,”  2014.   Final Report to the National Cancer Institute.   

“Multilevel Intervention Research:  Building From the Conference and Special Issue.”  White Paper produced for the National Cancer Institute under contract #HHSN261201100512P.  March 2014.

“Understanding and Influencing Multilevel Factors Across the Cancer Care Continuum,” with Stephen Taplin, Rebecca Anhang Price, Heather Edwards, Mary Foster, Erica Breslau, Veronica Chollette, Irene Prabhu-Das, Steven Clauser, and Jane Zapka. 2012:  Journal of the National Cancer Institute Monograph #44. Pp.2-10.

“Multilevel Approaches and the Challenges of Implementing Genomic Medicine,” with Muin Khoury, Ralph Coates, Russell Glasgow, Maren Scheuner, Sheri Schully, Marc Williams and Steven Clauser.  2012:  Journal of the National Cancer Institute Monograph #44. Pp.112-120

"Health Reforms as Examples of Multilevel Interventions in Cancer Care,” with Ann Flood and Kelly Devers.  2012:  Journal of the National Cancer Institute Monograph #44. Pp. 80-85.

“Geographic Concentration and Correlates of Nursing Home Closures:  1999-2008,” with Zhanlian Feng, Melissa Clark, Denise Tyler, David Barton Smith and Vince Mor.    Archives of Internal Medicine. 2011, Vol.171 (9): 806-813.

                        “US Healthcare Organizations:  Complexity, Turbulence and Multilevel          Change,”  with       Crystal Adams.  Annual Review of Sociology. 2011. Vol.37: 205-219.


“Growth of Racial and Ethnic Minorities in US Nursing Homes Driven by Demographics And Possible Disparities in Care Options,” with Zhanlian Feng, Denise Tyler,  Melissa Clark, and Vincent Mor.  Health Affairs. 2011. Vol.30 (7):  1358-65.

"Despite Small Improvement, Black Nursing Home Residents Remain Less Likely Than Whites to Receive Flu Vaccine,” with Shubing Cai, Zhanlian Feng, and Vincent Mor. Health Affairs. 2011. Vol. 30 (10):  1939-1946.

“Elderly Hispanics More Likely to Reside in Poor-Quality Nursing Homes,” with Zhanlian Feng, Melissa Clark and Vincent Mor.  Health Affairs 2010, Vol.29, No. 1, 65-73.

“The Organization of Multidisciplinary Care Teams: Modeling Internal and External Influences on Cancer Care Quality,” with Irene PrabhuDas, Steve Clauser, Nicholas Petrelli, and Andrew Salner.  Journal of the National Cancer Institute Monographs,  2010,  Number 40:  72-80.

“Who Staffs the US Leaning Tower? Organizational Change and Diversity,” with Kevin T. Leicht. Equal Opportunities International, 2008.  Vol.27, No. 1: 88-106.

“Racial Disparities in Access to Long-Term Care:  The Illusive Pursuit of Equity,” with David Barton Smith, Zhanlian Feng, Jacqueline Zinn and Vincent Mor.  Journal of  Health Politics, Policy and Law, 2008.  Vol. 33, No. 5: 861-881.

“Home Health Agency Profit Orientation and Risk for Hospitalization:  A Propensity Score Analysis of Population Weighted Data,” with Laura Smith, Kate Lapane, Edward Miller, and Vince Mor. Home  Health Care Services Quarterly  2008.

“Improving Clinical Research and Cancer Care Delivery in Community Settings: Evaluating the NCI Community Cancer Centers Program,” with Steve B. Clauser, Maureen R. Johnson, Donna M. O’Brien, Joy M. Beveridge, and Arnold D. Kaluzny.  Implementation Science 2009. Vol.4, No.63: 1-11.


"Financial Correlates and Consequences of Rural Hospital Long-Term Care Strategies," with Bruce Stuart, Susan Campbell and R. Sun. Forthcoming in Health Care Management Review, February 2006.

Editorial Essay: "Racial Disparities in Care: Looking Beyond the Clinical Encounter," Health Services Research, December 2005, Vol.40: 6: 1713-1721

"The Relationship of Membership in Research Networks to Compliance with Treatment Guidelines for Early Stage Breast Cancer," with Linda Laliberte and George apandonatas. 2005 Medical Care, Vol 43, No.4, pp.471-479.

"Linkages in the Rural Continuum: The Balanced Budget Act and Beyond," with Joseph Angelelli, Ray Hyatt, and Joyce McKenney. 2003, The Gerontologist, Vol.43, No.2, 54-60.

"Factors Associated with Site of Death," with Sherry Weitzen, Joan Teno, and Vince Mor. 2003. Medical Care, Vol.41, No.2, 323-335.

"Health Care Delivery Services," in: Smelser, N., Baltes, P. (eds.) International Encyclopedia of Social and Behavioral Sciences 2002, Pergamon, Oxford, UK, Vol.10, pp 6515-6520.

"Managed Care in the United States: A Sociological Perspective on Change in the Medical Profession," Chapter in Trasformazione Dei Sistemi Sanitari e Sapere Sociologico, 2002, edited by Costantino Cipolla. Milano, Italy: Franco Angeli, pp.92-122.

"Community-Based Service Providers for People with Chronic Care Needs," with Susan Allen and Linda LaLiberte. Research in Social Problems and Public Policy, The Organizational Response to Social Problems, (2001) Vol.8. Elsevier Science. Pp. 43-57.

"Dying Trajectory in the Last Years of Life: Does Cancer Trajectory Fit Other Diseases?" with Joan Teno, Sherry Weitzen and Vince Mor. 2001, Journal of Palliative Medicine, Vol.4, No.4, 457-464.

Professional Work: A Sociological Approach, with Kevin Leicht. 2001. Blackwell Publishers, London and New York, 254 pp.

"Hospital Diversification into Long-Term Care," with Ann (Petrisek) Shah and Vince Mor. Summer 2001, Health Care Management Review, 86-100.

"Facility Effects on Racial Differences in Nursing Home Quality of Care," with Susan Miller and Vince Mor. American Journal of Medical Quality. (July-August 2000) Vol. 15, No. 4: 174-181.

"Key Challenges in Studying Organizational Issues in the Delivery of Health Care to Older Americans," with Ann B. Flood. Health Services Research (June, 1998) Vol.33:2, Part II; 424-433.

For the Record: Protecting Electronic Health Information, with the Committee on Maintaining Privacy and Security in Health Care Applications of the National Information Infrastructure. 1997, National Academy Press, Washington D.C., 288 pp.

"The Changing Organizational Context of Professional Work", with Kevin T. Leicht, The Annual Review of Sociology (1997), Vol. 23, pp 215-231.

"Gender, Interaction and Leadership", with Henry A. Walker, Barbara C. Ilandi, and Anne M. McMahon. Social Psychological Quarterly. 1996, Vol. 59 (3): pp. 255-72.

"Linkage Strategies of Rural Hospitals," with L.D.Gamm, C. Kassab, and S.D.Brannon. Hospital and Health Services Administration, Summer 1996, Vol.4 (2): pp.236-54.

"The Effects of Hospital Characteristics and Radical Organizational Change on the Relative Standing of Health Care Professions: A Longitudinal Analysis," with Kevin Leicht and Kristine Witkowski. Journal of Health and Social Behavior, June 1995, Vol.36 (2): pp.151-167.

"Through the Lenses of Organizational Sociology: The Role of Organizational Theory and Research in Conceptualizing and Examining Our Health Care System," with Ann B. Flood. Journal of Health and Social Behavior, Extra Issue, August 1995, pp.154-169.

"Perspectives on Organizational Change in the U.S. Medical Care Sector," with Jeffrey A. Alexander. Annual Review of Sociology, 1993, Volume 19:89-112.

"Leadership Instability in Hospitals: The Influence of Board-CEO Relations and Organizational Growth and Decline," with Jeffrey Alexander and Michael Halpern. Administrative Science Quarterly, 1993, Volume 38 (1): 74-99.

"Multihospital System Affiliation as a Survival Strategy for Rural Hospitals Under PPS," with Michael T. Halpern and Jeffrey A. Alexander. The Journal of Rural Health, 1992, Vol.8 (2): 93-105.

"Shelter Staff Satisfaction with Services, the Service Network and Their Jobs," with Russell K. Schutt. In Current Research on Occupations and Professions, 1992, Vol. 7: pp. 173-198. Greenwich, Connecticut: JAI Press.

"Managed Care Systems as Governance Structures: A Transaction Cost Interpretation," with Robert E. Hurley. Chapter 9 (pp.241 268) in Innovations in the Organization of Health Care: New Insights into Organization Theory, 1990, edited by Stephen S. Mick. San Francisco: Jossey Bass.

"Interorganizational Systems Approaches," with Kathleen Dockett. In Homelessness and Mental Illness: Toward the Next Generation of Research Studies, edited by J.P. Morrissey and D.L.Dennis, Proceedings of an NIMH sponsored conference, for the Office of Programs for the Homeless Mentally Ill, National Institute of Mental Health. January, 1990; pp.114-124.

"Governing Boards and Profound Organizational Change in Hospitals," with Jeffrey A. Alexander. Medical Care Review, Vol.46 (2), Summer, 1989: 157 187.

"Perceptions of an Employee Assistance Program and Willingness To Participate," with Michael M. Harris. Journal of Applied Behavioral Science, Vol.24 (4), 1988: 423 438.

The Diffusion of Medical Innovation: An Applied Network Analysis, with Richard B. Warnecke.1988, Plenum Press. 271 pp.

"A Multivariate Model of Job Stress and Alcohol Consumption," with Michael M. Harris. Sociological Quarterly, Vol.29 (3), Fall, 1988: 391 406.

"Organizational Boundary Spanning in Institutionalized Environments," with Jeffrey A. Alexander. Academy of Management Journal, Vol. 30 (3), September 1987, pp.456 476.

"Organizational Environment and Network Structure," with Christopher O. Ross and Richard B. Warnecke, in Research in the Sociology of Organizations, Vol.5, 1987, edited by Samuel P. Bacharach and Nancy DiTomaso, JAI Press. pp. 311 340.

"Macro Issues of Accountability, Authority, and Decision Making in Institutional Mergers." Pages 1 18 in Mergers and Ventures: Creative Responses to Shifting Resources, edited by M. Pettengill and L.A.Young, Midwest Alliance in Nursing Inc. 1987.

"Gender Differences in Roles Differentiation and Organizational Task Performance," with Henry A. Walker. Annual Review of Sociology, Vol.12, 1986: 255 275.

"Patterns of Decision Making in Multihospital Systems," with Jeffrey A. Alexander. Journal of Health and Social Behavior, Vol. 27 (1), March, 1986: 014 27.

"Synergy, Influence and Information in the Adoption of Administrative Innovations," Academy of Management Journal, Vol.27 (1), March, 1984: 113 129.

"Structural Clarity of Interdisciplinary Teams: A Research Note," with Gary D. Sandefur. Journal of Applied Behavioral Science, Vol.19 (2), May, 1983: 193 202.

"Network Demonstration Projects and Cancer Control: The Head and Neck Demonstration Networks," with Richard B. Warnecke and Penny Havlicek, in Advances in Cancer Control, Vol.3, Edited by Paul Engstrom and Paul Anderson, Alan B. Liss Publishers, 1983: 247 265.

"Context in Organizational Groups: The Case of Hospital Clusters." Journal of Health and Social Behavior, Vol.23 (1), March, 1982: 65 84.

"Problems in the Work Setting, Drinking and Reasons for Drinking," with Miriam B. Rodin and Glenda K. Kantor, Social Forces, Vol.60 (1), September, 1981: 114 132.

"The Effects of Environmental Characteristics on the Structure of Hospital Clusters," Administrative Science Quarterly, Vol.25 (3), September, 1980: 485 510.

"An Alternative Perspective to Sex Differences in Organizational Settings: The Process of Legitimation," with Patricia Barchas, Anne McMahon, Elizabeth Cohen and Polly Hildebrand, Sex Roles: A Journal of Research, Vol.4 (4), 1978: 589 604.

Please see full CV for complete list of publications.

research overview

My areas of research include formal organizations and health services research. I often use theories about organizations to look at problems in health care delivery. My earlier work focused on the diffusion of medical treatment innovations through hospital networks, linkages between rural hospitals and long term care providers, and change in professional work and the organizational settings within which professional work occurs. I am currently studying transitions in the long term care service delivery system, and the transformation of cancer care delivery in community settings. My most recent publications have appeared in Health Affairs (2010, 2011), the Archives of Internal Medicine (2011),  the Annual Review of Sociology (2011), and the Journal of the National Cancer Institute (2012).

research statement

I have long studied processes of change in organizations, and much of my research has focused on health care organizations. I am particularly interested in how organizations link/connect to other organizations, and in examining how such linkages influence their performance: for health care organizations, this translates into an examination of the impact of connections between hospitals, community cancer programs, skilled nursing facilities and other health care organizations on quality of patient care and cost of patient care.

I am also interested in change in professional work, professional careers, and in the organizations where professionals do their work. With Kevin Leicht, I have examined the history and theory of managerial and professional work, and we have described specific contemporary changes in professions and work-settings (see Professional Work: A Sociological Approach , 2001, Blackwell). Our primary thesis is that managerial prerogatives are expanding, while professionals find their autonomy and sphere of discretion shrinking. We have also detailed recent demographic changes in the workplaces of professionals, and we revealed an increasingly unified elite division of labor that casts the role of the manager as a "new professonal."

Another research interest is the analysis of racial concentration of patients in nursing homes, and disparities in nursing home quality of care. Working with Vince Mor (Community Health, CGHCR) and others, we have combined national datasets on nursing home quality of care with data on nursing home segregation and community residential segregation, to determine how and why inequalities in nursing home care develop. Both access to nursing homes and the quality of care received by elderly patients in nursing homes can be described as "separate" (nursing homes tend to be either well financed and located in resource-rich areas, or poorly equipped and located in poor communities) and "unequal" (poorer homes tend to have lower quality care processes and outcomes). Many factors are thought to contribute to this sorry picture, including patterns of residential segregation, local long term care (LTC) market structure, state level reimbursement policies, nursing home (NH)-level strategic decisions, and patient level characteristics which can influence the sorting of individuals into particular types of nursing homes, depending upon their location in different neighborhoods.

I am also working with colleagues at the National Cancer Institute (Dr. Steve Clauser, Dr. Irene Prahbudas) on community-level efforts to increase cancer research efforts (connected to innovations in genomic medicine, IT, etc.) available within local communities as well as to spread the diffusion of state-of-the-art cancer treatment. I have contributed to efforts to understand the impact of multidisciplinary treatment teams in cancer care delivery, the development of research connections between NCI cancer centers and community cancer programs, and the use of multilevel models and approaches to study cancer care.