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LESS IS MORE? PUBLICNESS, MANAGEMENT STRATEGY, AND ORGANIZATIONAL PERFORMANCE IN MENTAL HEALTH TREATMENT FACILITIES.

INTRODUCTION

Publicness theory is a central line of research in the fields of public administration, public organization theory, and public management. In fact, Lan and Anders (2000, 162) identify publicness as public administration's "foremost governing paradigm" because of scholarly commitment to exploring the meaning and implications of being a "public organization" (see also Riccucci, 2010). Specifically, publicness research aims to uncover both the primary influences on organizational publicness (Bozeman, 1987; Bozeman and Bretschneider, 1994; Moulton, 2009; Rainey, Backoff, and Levine, 1976) and the effects of publicness on organizational outcomes, including behavior (e.g., Brewer and Brewer, 2011; Wheeler and Brady, 1998; Wittmer and Coursey, 1996) and performance (e.g., Andrews, Boyne, and Walker 2011; Bozeman and Straussman, 1990; Goldstein and Naor, 2005; Zhu and Johansen, 2014; Nutt and Backoff, 1993). Due in large part to Bozeman's (1987) theoretical demonstration that "all organizations are public" at varying levels due to exposure to political authority--namely, government ownership, government funding, and government regulation--scholars have empirically employed dimensional publicness as a framework to not only understand the effects of publicness on outcomes in government organizations, but also outcomes in private and nonprofit organizations seeking to achieve public value.

Recent scholarship maintains that publicness is indeed captured by the extent to which an organization is subject to political authority, while also positing that "current operationalizations [of publicness] are not sufficient to account for public outcomes, as would be predicted by the full underlying theory of dimensional publicness" (Moulton, 2009, 899; see also Boyne, 2002; Heinrich and Fournier, 2004). These theoretical and empirically grounded propositions have motivated scholars to build upon Bozeman's (1987) dimensional publicness framework to better understand the primary mechanisms that draw organizations to higher levels of publicness, namely public value institutions. Moulton (2009), for instance, observes that publicness may be captured by regulative, associative, and cultural cognitive public values institutions (see also Scott, 2008).

As the essence of publicness has developed from conceptualization centered on political authority (Bozeman, 1987) to the level at which an organization is comprised of public value institutions (Moulton, 2009; see also Feeney and Welch, 2012), scholars have more frequently explored how organizational leaders can "manage publicness". Despite conceptual development in this area, Bozeman's dimensional model has remained integral to emerging publicness frameworks (Moulton, 2009). Nevertheless, scholars sometimes view public values frameworks associated with publicness as a management tool, while overlooking the management strategies that can be gained from Bozeman's original publicness model. More succinctly, factors of dimensional publicness (government ownership, funding, and regulation) can also be managed to achieve public outcomes in organizations. Additionally, while recent research often prescribes integrating public value institutions within the organization to achieve public outcomes, prior scholarship demonstrates that maintaining or seeking higher levels of publicness in organizations is not an inherently normative condition (Bozeman, 1987). Dimensional publicness, specifically, may offer a framework to guide management strategy, specifically better understanding of the negative effects of publicness on organizations. Therefore, this research seeks to answer the question: In what primary respects does publicness constrain an organization's ability to achieve public outcomes?

We explore our question of interest by employing grounded theory methodology to analyze insights of government, business, and nonprofit managers in the mental health arena. Grounded theory enables scholars to probe complex structures, phenomena, and processes through practitioner perspectives (Agranoff, 2007), and has been utilized to explore the meaning of or outcomes resulting from: bureaucratic values (Stark, 2014), nonprofit policy influence (Fyall, 2016), informal accountability (Romzek, LeRoux, and Blackmar, 2012), policy implementation structures (Sandfort, 2000), effective organizational rules (Dehart-Davis, 2009), government-organized public participation (Buckwalter, 2014), leadership in nonprofit organizations (Vasavada, 2012), and collaboration (Romzek, LeRoux, Johnston, Kempf, and Piatak, 2014), among others. To date, however, few studies have explored grounded insights to understand the potential constraints publicness imposes on organizations. Organizational leaders' perceptions of these constraints are vital, as these individuals are responsible for directing their respective service organizations toward public value attainment.

The remainder of this study provides a review of publicness theory. In doing so, we highlight the opportunity to contribute to scholarship regarding the effects of publicness. Next, we outline the data and methodology, followed by a discussion of findings. We conclude by highlighting the study's implications for managing publicness across sectors and offering directions for future research.

PUBLICNESS THEORY

Scholarship on public organization theory frequently analyzes the internal and external factors related to a range of organizational behaviors and performance outcomes. Studies in this area frequently employ the core or dimensional publicness approach to uncover the role of publicness in shaping these outcomes. Moulton (2009), Su (2016), Zhu and Johansen (2014), and Merritt (2014) are among the scholars who have recently documented the meaning and implications of publicness for organizations. From the research documented in these studies, we discover that publicness is not merely a theoretical mechanism for classifying "public" organizations; it also offers implications for the practice of public management (Merritt, 2014).

Core publicness identifies distinctions in the legal ownership of organizations--in essence, whether an organization is government- or privately owned (Rainey et al., 1976). Rainey and colleagues (1976) contend that, due to legal ownership, government and private organizations vary in their internal design, environmental conditions, and transactions between the organization and the environment. Fundamental to the public-private distinction is the division between political authority and the market economy, and their unique impacts on government and private organizations, respectively (Perry and Rainey, 1988; Dahl and Lindblom, 1953; Wamsley and Zald, 1973). Allison's (1987) classic work demonstrates that the contrasting legal statuses of government and private organizations have implications for management issues, such as personnel constraints, performance measurement and management, and exposure to public scrutiny.

Building on the core publicness approach, Bozeman's (1987) theory of dimensional publicness integrates the factors of government funding and regulation with government ownership to identify the extent to which an organization is public (see also Andrews et al, 2011; Petrovsky, James, and Boyne, 2015; Wamsley and Zald, 1973). According to this framework, "an organization may be considered 'more' or 'less' public based on the political and economic authority to which it is exposed--in addition to, or in spite of, its sectoral designation as public, nonprofit, or for-profit" (Carter, 2016, 5). Dimensional publicness is associated with organizational outcomes (e.g., behaviors, performance), such as: inequality (Zhu and Johansen, 2014), service to vulnerable populations (Su, 2016), administrative practices related to integrity (Molina, 2015), regulatory administration approach (Carter, 2016), strategic management (Bozeman and Straussman, 1990; Nutt and Backoff, 1993), ethical work climate (Wheeler and Brady, 1998; Wittmer and Coursey, 1996), productivity (Bozeman and Bretschneider, 1994), quality management (Goldstein and Naor, 2005), and performance (Feeney and Welch, 2012; Heinrich and Fournier, 2004). These studies demonstrate that publicness may empower or constrain organizations in their pursuit of organizational outcomes.

Following the core and dimensional publicness theories, more recent research has conceptualized publicness using a public values framework (i.e., "normative publicness"), which evaluates publicness based on the extent to which organizations are comprised of public-value mechanisms related to regulatory, associative, and cultural cognitive institutions specifically integral to an organization's realization of public outcomes (Moulton, 2009; see also Antonsen and Jorgensen, 1997; Bozeman, 2007). According to Scott (2008), public value institutions are regulative to the extent that they are legally sanctioned. Associative institutions involve the creation of normative values that introduce prescriptive, evaluative, and obligatory standards into social life (Scott, 2008). Lastly, cultural cognitive institutions center on "the creation of shared conceptions that constitute the nature of social reality and the frames through which meaning is made" (Scott, 2008, 57). Research employing the normative, public values-based framework to understand the effects of publicness often emphasize the outcomes and benefits that higher levels of publicness generate for organizations (Moulton, 2009; Feeney and Welch, 2012). Normative publicness also lends itself to the notion that publicness can be managed (Bozeman and Moulton, 2011). Managing publicness integrates empirical and normative publicness, where "'empirical publicness' seeks to explain organizations and their management, in contradistinction to 'normative publicness,' which seeks to infuse values or to prescribe" (Bozeman and Moulton 2011, i363, italics in original). Commitment to integrating empirical and normative publicness is motivated by the belief that public outcomes can be achieved by designing organizational structures and strategies to leverage mechanisms of publicness (Bozeman and Moulton, 2011), namely public value institutions (Moulton, 2009).

GAP IN THE LITERATURE: GROUNDED MANAGERIAL INSIGHTS ON THE CONSTRAINTS OF PUBLICNESS

While prescribing public value institutions to achieve public outcomes in organizations has been the subject of recent research related to normative publicness, empirical (i.e., dimensional) publicness associated with political authority may also offer prescriptions for managers seeking to achieve public outcomes in organizations. Bozeman (1987) notes that political authority "is not intrinsically good or bad and must be judged instead in relation to management strategies and characteristics of the organization's environment... In some instances, publicness is an effective shelter; in others, it is an effective shackle" (98). While scholarship provides quantitative insights on the conditions during which empirical/dimensional publicness serves as a constraint or catalyst, we have limited grounded insights on the conditions during which publicness manifests as a constraint. Furthermore, given that normative publicness often aims to incorporate higher levels of public value institutions in organizations to achieve public outcomes, scholarship may also benefit from understanding of the conditions during which publicness may constrain organizational performance. This would potentially contribute to a more holistic understanding of the meaning and consequences of managing publicness, particularly given that grounded insights emerge from actors familiar with an organization's internal and external environments, the contexts from which publicness mechanisms originate (Bozeman and Bretschneider, 1994; Rainey et. al., 1976).

METHODOLOGY

This study constitutes a grounded theoretical investigation on the manner in which publicness constrains the policies and practices of facilities seeking to achieve public outcomes in the mental health arena. Grounded theory methodology is appropriate because, to date, studies have offered limited insights on the potentially negative consequences publicness may introduce for organizations seeking to achieve public outcomes, including within the mental health policy environment. Requiring a continual and often simultaneous interplay between data collection and analysis (Jaccard and Jacoby, 2010), grounded theory methodology provides a "middle ground in which systematic data collection [can] be used to develop theories that address the interpretive realities of actors in social settings" (Suddaby, 2006, 634). Below, we describe and justify the current study's mental health research context, case selection, data collection, and data analysis procedures. Methodological procedures employed in the present study are in step with earlier studies analyzing grounded insights as they relate to organizational phenomena (e.g., Romzek et al., 2012; Waring, Currie, and Bishop, 2013).

Research Context

The mental health and substance abuse treatment context informs the question at the center of our analysis, and provides an ideal context to explore questions related to publicness (Heinrich and Fournier, 2004; Miller and Moulton, 2014; Merritt, 2014). These facilities administer treatment and recovery support for individuals coping with mental health illnesses and substance abuse. Mental health is among the policy areas in which public debate on the role of social services in fulfilling the public good has intensified (Heinrich and Fournier, 2004). Integral to this debate is the extent to which private and nonprofit facilities are committed to the achievement of public outcomes given that their commitment to non-state stakeholders may potentially contradict the objectives of government funding sources (Heinrich and Fournier, 2004). Publicness is a particularly useful framework for understanding the outcomes of organizations shaped by both political and economic authority (Bozeman, 1987), such as behavioral health organizations. On the political authority dimension of this analysis, mental health facilities across sectors accept client payments associated with Medicare, Medicaid, and state-financed health insurance plans (Heinrich and Fournier, 2004; Merritt, 2014). Such institutions, despite influences of economic authority (e.g., pressure to maximize profits), subject organizations to greater political authority, which may uniquely empower or constrain these facilities to attain public outcomes (Bozeman, 1987). By uncovering the manner in which publicness may constrain organizational abilities to realize public outcomes through grounded insights from managers, we may gain a more holistic view of the effects of publicness, particularly given that research to date has focused on the empowering effects publicness provides organizations.

Case Selection

Case selection began when members of the research team generated a single list of government, private, and nonprofit organizations assembled in the Mental Health Treatment Facility Locator, an online repository provided by the United States Substance Abuse and Mental Health Services Administration (SAMHSA), an agency housed within the United States Department of Health and Human Services. On the date this database was accessed, the Locator generated a total of 7,744 facilities, and provided the organizational name, address, telephone number, and website (if applicable) for each facility. After obtaining a list of facilities, we randomly assigned each facility a number using STATA software. This randomly assigned number determined the order in which the research team invited senior managers of behavioral health facilities to participate in the current study. Specifically, we e-mailed facility managers one-by-one over a span of nine months and inquired about their willingness to participate in a telephone interview. The formal invitation provided the purpose and goals of the study, consent processes, and confidentiality associated with results. In line with recent case selection approaches

employed in grounded inquiries into organizational phenomena (e.g., Dehart-Davis, 2009; Henderson, 2013), we randomly selected facilities to approximate the diversity of perspectives represented in the general population of United States behavioral health organizations.

A total of 46 senior managers participated in interviews, out of the 845 to whom we sent invitations. With the exception of three practitioners who played roles in their organizations equivalent to that of a Senior Vice President, managers were the most senior officials in their facilities and served as President & CEO or equivalent. Of participating respondents, the strong majority were male and averaged just over ten years of experience in their current organizational leadership capacities. The 46 facilities represented by senior managers contained diverse attributes with respect to organizational size (i.e., fulltime equivalent employees), location, legal ownership, primary focus, and structure. Table 1 provides the sample's distributions within descriptive categories.

Data Collection

The research team collected primary data in two waves through open-ended, semi-structured telephone interviews. Twenty-one senior managers were interviewed during the first wave conducted from December 2013 to February 2014. For this initial wave, we employed an open and grounded approach to data collection in which the insights, perspectives, and experiences of facility managers exclusively guided emerging themes. Twenty-five managers were interviewed during a second wave executed from December 2014 to July 2015. While we remained committed to openness to original ideas derived from managerial responses, the second wave of interviews was more targeted as we aimed to confirm the conditions during which publicness constrained facilities. The phase between the first and second waves provided time for the research team to exhaustively process the initial set of interviews. We discontinued data collection after reaching the point when data did not offer evidence divergent from viewpoints provided during earlier interviews, what Strauss and Corbin (1990) identify as theoretical saturation.

Lasting an average of approximately one hour in length, we recorded interview responses following consent from managers, and subsequently transcribed responses verbatim prior to coding and analysis. Prompt questions were provided to all respondents, although the semi-structured format of interviews produced variation in participant-driven discussions. We first asked managers to identify the influences on organizational publicness in the general population of mental health treatment facilities. Second, we asked respondents to identify mechanisms of publicness in the facilities by which they were employed and to demonstrate the presence of these mechanisms by offering specific and detailed examples. Third, given that inputs to the fulfillment of public outcomes are frequently organizational and environmental mechanisms that are public in nature (Antonsen and Jorgensen, 1997; Bozeman, 2007; Moulton, 2009), we asked managers to identify the performance outcomes of their facilities that the broader public considers important (i.e., public outcomes) and, thereafter, identify internal and environmental mechanisms that empowered or constrained their facilities' abilities to achieve the identified public outcomes. Fourth, we prompted managers to envision a hypothetical management scenario in which their facilities were underperforming in the public outcomes their organization's desired (identified in responses to the third prompt question), and to identify the organizational and environmental mechanisms that would engender improvement for each outcome. The specific prompt questions for interviews presented to managers were as follows:

1. Generally speaking, and not considering the organization for which you work, what does being a "public organization" mean to you?

2. What characteristics make your facility a "public organization"?

3. What performance outcomes of your organization does the broader public consider important? What characteristics enable your organization to perform well in these areas?

4. Envision a scenario in which your organization is not performing effectively enough to achieve the public outcome(s) you identified (in Prompt Question 3): As a manager, what strategies or activities do you implement to improve performance in these areas?

5. Envision a scenario in which your organization is not performing effectively enough to achieve the public outcomes you identified (in Prompt Question 3): What outside sources dictate your management decisions when you seek to improve performance in these areas?

This series of prompt questions served three core purposes. First, responses provided understanding of the primary influences on publicness in mental health facilities. Secondly, questions enabled the team of researchers to distinguish mechanisms associated with publicness from outcomes that result from an organization's publicness. Finally, these questions facilitated the analysis process by enabling the research team to identify consistencies between those features managers identified as being associated with publicness (prompt questions 1-2) and mechanisms utilized during actual (prompt question 3) and hypothetical (prompt questions 4-5) strategic management processes specifically aimed at achieving public outcomes in mental health treatment facilities.

After asking managers prompt questions 1-5 and gaining a sense of how respondents conceptualized publicness, we asked managers the following question at the heart of the present study:

6. In light of the public outcomes your organization is pursuing, in what manner, if any, does publicness constrain your facility's ability to achieve these outcomes?

Data Analysis

Our approach to data analysis was guided by previous studies employing grounded theory methodology to explore public administration concepts (e.g., Romzek et al., 2012; Waring, Currie, and Bishop, 2013). Accordingly, at the data analysis stage, two researchers participated in a process of open coding to identify and categorize patterns emerging from the data (Glaser and Strauss, 1967). This commenced with two coders engaging in an independent and iterative process of close reading of transcripts from primary data collection, note-taking, open coding, and constant comparisons of codes within and across cases. In doing so, researchers aimed to unpack codes that reflected publicness from managerial responses across interview prompt questions 1-5, as opposed to codes emerging from responses to any single question. This approach to analysis enabled the researchers to unpack codes that, from managers' standpoints, captured publicness as opposed to mere open activities and external relationships of any kind. Researchers, thereafter, aggregated codes into specific dimensions based on thematic relationships. After independently executing these steps, coders pursued inter-coder reliability by comparing coding patterns and emerging themes, while also participating in extensive discussions to resolve discrepancies in coding. This process ultimately generated agreement on the primary factors respondents associated with publicness.

Based on the influences of publicness identified by respondents and confirmed through inter-coder reliability, 43 of 46 managers identified political authority as among the primary influences on organizational publicness. Managers demonstrated that political authority emerged from government ownership, funding, and regulation, thereby confirming Bozeman's (1987) original theoretical observation that political authority is a fundamental feature of publicness. After identifying managerial perceptions of publicness, we then aimed to uncover the conditions during which publicness (i.e., political authority) constrained the organizational achievement of public outcomes managers identified. We explored this condition solely through the lens of managers who identified political authority as an influence on publicness, given that political authority is the sole factor included across various publicness frameworks (see Moulton, 2009; Merritt, 2014; Rauh, 2015). Therefore, the views of 43 managers were included in this analysis (93.5%), with the research team only omitting only three observations.

When evaluating the conditions during which publicness constrained organizations pursing public outcomes, the researchers again analyzed data independently, engaging once more in an iterative process of close reading of transcripts from primary data collection, note-taking, open coding, and constant comparisons of codes within and across cases. After this step, the researchers reconvened to discuss the manner in which publicness presented constraints to facility performance, specifically by agreeing upon common themes across unique cases to achieve inter-coder reliability.

FINDINGS AND INTERPRETATION

Through data collection and analysis structured to identify organizational conditions during which publicness constrained organizational performance, two distinct themes consistently emerged. Under the first theme, publicness, with respect to funding and regulation by government, constrained organizational efficiency. Secondly, publicness posed constraints when political authority, again in the form of funding and regulation, produced mission drift, a condition during which organizational practices situated organizations further away from achieving their central missions. The conditions during which publicness constrained organizational publicness in the current study's context are discussed below.

Publicness and Constraint on Organizational Efficiency

Mental health managers identified publicness in the form of government funding (through grants, contracts, Medicaid, Medicare, stated-financed health insurance plans) as often constraining efforts to efficiently achieve desired public outcomes. This left managers sharing the sentiment maintained by a nonprofit manager who noted that government is not inherently bad, but that their organization would more efficiently use human and financial resources to achieve public outcomes with "less interference from bureaucracy", namely by a reduction of stipulations associated with funding received from various levels of government.

In addition to government funding, managers identified government regulations as contributing to less efficiently achieving public outcomes. As one manager stated,
There is a tremendous amount of wasteful oversight that just consumes
our time, and so sometimes government gets just out of control in the
way they feel as though they can micromanage us. So, less [publicness]
means we can be more entrepreneurial and not waste so much money on
trivial oversight-related activities.


These comments were partnered with remarks that publicness from government regulations led to public reporting requirements that also made organizations less efficient in providing substance abuse intervention, transitioning youth and adults into community living, and initiating outreach to underserved populations. In the current study, reporting requirements were placed heavily on nonprofit organizations seeking to maintain 501(c)3 status. As one nonprofit manager commented,
With all that publicness comes a whole lot of standards and
expectations and rules that we as an organization need to abide by and
document that we are meeting those rules and regulations. It's an
enormous burden to our ability to provide care to clients.


Simply put, adherence to government regulatory requirements was a time-consuming task and often took away from efficient care. The transparency resulting from facility reporting and, in turn, public knowledge of organizational performance also led organizations to take into account public opinion deriving from public forums for government facilities and stakeholder advisory committees (or the like) for private and nonprofit facilities. Public opinions shared through these forums sometimes countered an organization's mission. While organizations and managers valued feedback from the general public, respondents noted that sometimes the public may not fully understand the missions, objectives, and competencies of their facilities. Taking public feedback into account to guide organizational practices, albeit generally valuable, further complicated organizational efforts to provide efficient care to clients.

Publicness and Constraint on Mission Attainment

Managers contended that publicness introduced constraints to organizational mission attainment, primarily when government funding diverted organizational attention to issues that, while important, were outside the scope of an organization's primary objectives. Nonprofit managers in the present study, in particular, aimed to fulfill missions that were not always the foremost priority of government funders. As one manager said,
I think less publicness would allow our board of directors to make
decisions that might be a little hard to make because we're so public.
Right now, because we're so public, we get all kinds of input from all
kinds of government funding sources about any decisions that are being
made. I think that a little bit less publicness would allow the board
to make decisions that are in the best interest of the organization. In
the sense of, for example, if we wanted to close down a particular
program.


This excerpt demonstrates the constraint of political authority over leadership decisions. This manager highlighted the difficulties in navigating the expectations of outside government interests. Specifically, this particular respondent identified the challenges of adhering to the contractual obligation of government institutions that did not fully understand the mission of the organization, and whose priorities countered the long-term vision of the facility. This interview shed light on the balancing act that managers must execute to simultaneously serve both the internal goals of the organization and the external interests of government funding sources.

Two additional managers identified distinct, yet mutually undesirable, forms of constraint on organizational mission attainment resulting from government funding. In these particular instances, publicness manifested itself as a constraint when it dictated the populations the organization could serve. For example, one of these managers expressed concern about the potential diminishing quality of care clients would receive if the volume of clients increased beyond standard capacity due to government funding being contingent on an increased clientele base. He discussed the importance of limiting the scope of the population served to more effectively provide care to a smaller selection of clients their organization traditionally serves (and championed in the facility's mission statement)--low income individuals. The second respondent, a nonprofit manager, was hesitant to pursue funding from government agencies because, in one particular instance, funding was contingent upon the organization focusing more exclusively on youth in the community, as opposed to the general population needing mental healthcare.

Beyond the constrains related to government funding, managers in the current study expressed concern regarding the heavy administrative burden related to government regulation that, while well-meaning, diverted organizational attention away from core mission, objectives, and strategies.
We are subject to regulation on many fronts. We're subjected to
reporting, audits, all kinds of review by people that are employed by
the governmental entities to oversee the work that we do... The
heavy-handed level of governmental oversight really adds a tremendous
amount of overhead expense to our company and doesn't necessarily
further our mission.


Of the managers who identified similar effects of regulatory constraint, the strong majority were employed by nonprofit institutions. These nonprofits primarily served child and adolescent clients, or offered child services in their programming. Despite this commonality, the organizational managers who indicated the mission-centered burdens of publicness through regulation were wide-ranging, including advocacy organizations, direct human service providers, and educational organizations. The seeming link between the demographics served and how managers viewed publicness is interesting and we recommend further research in this area before concluding that regulation creates onerous restrictions specific to youth-serving institutions. Simply put, nonprofit organizations are inherently mission-driven institutions bound by their charter, and develop their services to achieve the goals of those missions. This value held within the third sector was reflected in the statements made by nonprofit managers, including the following,
Because I tend to look at my work in the context of the vision that I
came with, and that was that whatever we did we would lead with
quality. That suggests to me, then, that less [publicness] is better.
That we spend our resources, that we make our choices around a small
number of service possibilities--that allows us to use our resources
more effectively, engage in a better opportunity to have the impact
that we seek.


It was through responses regarding the effects of publicness on organizational mission in particular that we were able to identify the differences in the specific constraints of publicness in a given legal sector. For example, it was only managers employed by for-profit businesses who viewed lower levels of publicness as integral to the mission of protecting trade secrets. As one manager said,
If those trade secrets were made public due to reporting expectations
then it would make other entities able to compete in a manner that
we've spent a great deal of time, effort, and money in perfecting.


While the divulgence of trade secrets may better enable mental healthcare recipients outside of this particular facility to make informed decisions about their mental healthcare options (McGarity and Shapiro, 1980), this would counteract the objectives of respondents managing for-profit facilities, whose organizations were mostly committed to profit generation. While germane, the constraints placed on the missions of private firms through publicness were less severe than those placed on public and nonprofit organizations. In our analysis, government organizations generally viewed publicness as threatening their ability to provide quality of care to the broader public (as opposed to specific or exclusive patient populations), while nonprofits aimed to avoid the constraint of publicness on mission attainment. Nevertheless, the constraint of publicness across sectors was accurately articulated by a government manager with experience across multiple sectors.

I have worked in both public and private organizations, and the less public an organization is, the more strategic and more focused they are able to be.

DISCUSSION AND CONCLUSIONS

The objective of this study was to explore the primary respects in which publicness constrained organizational performance, namely the achievement of public outcomes, from the standpoint of senior managers in the mental health arena. Our findings demonstrate that publicness introduced particular constraints on organizational efficiency and mission attainment. Interestingly, publicness mechanisms of government funding and regulation posed limitations in these areas, while the dimension of government ownership in and of itself was not considered a constraint by the managers interviewed for this study.

One of the most notable observations from our analysis was the constraint that publicness imposed on the missions of organizations serving exclusive patient populations. In particular, nonprofit facilities providing services to youth were more inclined to identify publicness as a constraint than other organizations. Additional research would benefit from exploring the constraints of publicness specific to these kinds of organizations beyond efficiency and mission attainment. Another direction for future research is to explore, through quantitative analysis, the interactive effects of government ownership, funding, and regulation, as these dimensional mechanisms of publicness are not independent of one another. Managers in the current study repeatedly expressed concern over the complexities of effectively managing mechanisms of publicness that were in conflict with one another. For example, stipulations associated with an organization maintaining financial support from a local government agency could potentially contradict the expectations of a state-level funder. While there is recognition of the balancing act that managers must perform under the sometimes competing influences of publicness, additional research is necessary to fully understand the practical influence one feature of publicness may wield over another under various conditions.

We must discuss caveats and limitations related to the current study. The manner in which publicness may constrain organizations is not based on authoritative and objective insights and may have differing effects in policy contexts outside of the mental health arena. Therefore, our findings here are not necessarily generalizable to other policy environments, such as education, law enforcement, and housing and community development. Findings may also be distinct from the perspectives of practitioners operating in different hierarchical roles to implement organizational goals, such as middle managers and street-level bureaucrats. In addition, despite the sample for the study being fairly representative of the general population of mental health and substance abuse treatment facilities with respect to legal ownership and regional location (SAMSHA, 2014), the low response rate suggests potential problems of sampling bias. For example, the analysis draws heavily on the perceptions of private nonprofit managers, so the findings presented may not sufficiently capture the potential range of organizational and environmental publicness influences constraining the achievement of public outcomes in government and private for-profit facilities. Along these lines, the differing managerial views across the government, business, and nonprofit sectors would have provided interesting insights about the distinctiveness of the constraints of publicness with respect to a particular legal sector. Our sample was also comprised of a relatively small portion of female managers. Pynes (2000), citing Gibelman (2000), notes that "in human service nonprofits defined as offering services oriented toward the prevention, amelioration, or resolution of health, mental health, social or environmental problems that affect individuals, families, specific groups or communities, men were disproportionally represented in upper-level management" (35). This reality limited understanding of the meaning and constraints of publicness in the current study to a male-dominated perspective. Given that this is an exploratory study, these caveats and limitations are certainly acceptable.

This study has implications for public management. Specifically, understanding the constraints of publicness may better enable organizational leaders to manage and leverage publicness to achieve public outcomes. Managing publicness is a process whereby the realization of public outcomes is predicted by the "public value institutions that influence management strategy" (Moulton 2009, 891). The current study informs scholars and practitioners that managing publicness is not simply about pursuing and engaging mechanisms that elevate the publicness of organizations. Rather, under certain conditions, maintaining or decreasing an organization's publicness (where controllable), by, for example, not applying for a government grant that reduces organizational autonomy, provides increased efficacy. Moulton (2009, 889) demonstrates the importance of managers across sectors understanding the positive and negative effects of publicness on organizations, stating that managers must not simply understand what makes an organization public, but "what makes an organization likely [or less likely] to provide for public outcomes". In other words, central to effectively managing publicness is organizational leaders' understanding of the mechanisms fundamental to public outcome attainment and failure--the latter of which is sometimes overlooked in public management research, but explored in the present study.

Understanding the conditions during which publicness constrains organizations may require additional exploration as conceptualizations of the primary influences on publicness expand. For example, Moulton (2009) demonstrates that regulative, associative, and cultural cognitive public value institutions are not inherently governmental, but are nonetheless primary influences on the realization of public outcomes. For the purposes of managing publicness, understanding the constraints that such public value institutions impose on organizations may be equally as critical as understanding the constraints that emerge from political authority. Regardless of the publicness framework employed in future empirical analyses to understand organizational outcomes, scholars may benefit from further uncovering the conditions during which publicness constrains--and not simply empowers--organizations. Both of these considerations are critical to the knowledge base of managers leading organizations to achieve public good across legal sectors. Through additional empirical analysis of the empowering and constraining effects of publicness, a more holistic understanding of its effects on organizational outcomes can be leveraged by managers seeking to achieve public outcomes.

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CULLEN C. MERRITT

Indiana University-Purdue University Indianapolis

KATHLEEN CORDELL

United Way of Central Indiana

MORGAN D. FARNWORTH

Indiana University-Purdue University Indianapolis
Table 1
Descriptive Statistics

Characteristics                                     Percentages

Gender
Male                                                80.4
Female                                              19.6
Years of Experience in Current Management Position
<6                                                  39.1
6-10                                                28.3
11-15                                                8.7
15<                                                 23.9
United States Census Region
Midwest                                             36.9
West                                                28.3
Northeast                                           23.9
South                                               10.9
Legal Ownership
Private nonprofit                                   80.4
Government                                          13.1
Private for-profit                                   6.5
Organization FTE
<100                                                19.6
100-500                                             54.3
501-1,000                                           13.0
1,001-1,500                                          8.7
1,500<                                               4.4
Organization Service Type
Outpatient                                          65.2
Residential treatment center for children           19.6
Private psychiatric hospital                         6.5
State psychiatric hospital                           4.3
Residential treatment center for adults              2.2
Multi-setting mental health facility                 2.2
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Author:Merritt, Cullen C.; Cordell, Kathleen; Farnworth, Morgan D.
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Date:Mar 16, 2018
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