Goal Ambiguity, Management, and Performance in U.S. Nursing Homes

AuthorAnna Amirkhanyan,Miyeon Song,Kenneth J. Meier
Published date01 September 2020
Date01 September 2020
DOI10.1177/0095399720901343
Subject MatterArticles
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Article
Administration & Society
2020, Vol. 52(8) 1170 –1208
Goal Ambiguity,
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Performance in U.S.
Nursing Homes
Miyeon Song1 , Kenneth J. Meier2 ,
and Anna Amirkhanyan2
Abstract
Public administration research has produced a large literature on the
determinants, consequences, and complexities of goal clarity and ambiguity.
This article contributes to this line of work by examining how perceived goal
ambiguity and goal multiplicity condition the effect of top administrators’
management on performance. In the context of U.S. nursing homes, we find
that the positive effect of management on service quality tends to decrease
when administrators report facing high levels of goal ambiguity and pursue
numerous priorities that they consider important. This study improves
our understanding of the complex mechanisms through which managerial
strategies influence organizational outcomes.
Keywords
goal ambiguity, public management, organizational performance
Introduction
Public and private organizations are social entities pursuing various goals,
and individuals in these organizations are selected, recruited, trained, and
1University of South Carolina, Columbia, USA
2American University, Washington, DC, USA
Corresponding Author:
Miyeon Song, University of South Carolina, 349 Gambrell Hall, 817 Henderson Street,
Columbia, SC 29208-4114, USA.
Email: misong@sc.edu

Song et al.
1171
directed to work toward their attainment (Barnard, 1938). Not surprisingly,
the attributes of these goals—goal conflict, goal specificity, goal ambiguity,
and others—have a profound effect on how individuals, units, and organiza-
tions operate. Over the past several decades, organizational theory and public
administration research has produced a large body of theoretical and empiri-
cal literature on the determinants, consequences, and complexities of goal
clarity and ambiguity (Rainey, 1983, 1993; Chun & Rainey, 2005a, 2005b).
Within that literature, some attention has been paid to managerial perceptions
of goals and their impact on managers’ work and organizational outcomes.
This study contributes to this line of work by examining perceived goal ambi-
guity and how it conditions the effect of top administrators’ management
strategies on organizational performance.
This article examines the interactive relationship between management
and goal ambiguity in the context of U.S. nursing homes. While this industry
includes over 15,000 public, nonprofit, and for-profit organizations, the ser-
vices they deliver are largely paid for by the federal Medicaid and Medicare
programs and thus, represent a public program implemented through public,
nonprofit, and for-profit organizations (Thomas, n.d.; Kaiser Family
Foundation, 2017). A high degree of publicness of these institutions
(Bozeman, 1987) is also determined by an extensive regulatory regime—
licensure, certification, inspections, sanctions, and other regulatory tools—
applied to all organizations accepting federal funding.
Nursing home care is an interesting empirical context for this research.
First, past studies confirm the effect of management on performance in this
context (Amirkhanyan, Holt, et al., 2018; Amirkhanyan, Meier, et al., 2018).
Understanding how goal ambiguity conditions the effect of management
strategies on performance can, therefore, help draw a more nuanced picture
of this relationship. Second, nursing home administrators face multiple and
conflicting goals related to financial performance, regulatory compliance,
service quality, census/occupancy, access to care, and others. This goal mul-
tiplicity, not at all uncommon for other public-sector settings, presents an
opportunity to observe variation in managerial perceptions operating within
specific policy contexts.
We analyze a hybrid data set that combines archival data available from the
Centers for Medicare and Medicaid Services (CMS) with a recent nursing home
administrators’ survey focusing on their behaviors and perceptions. The findings
confirm earlier evidence of positive statistically significant effect of management
strategies on performance. This study also finds that a perceptual goal ambiguity
measure and two perceptual goal multiplicity measures have a significant moder-
ating effect on the relationship between management strategies and performance.
The positive effect of management on service quality (measured by regulatory

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Administration & Society 52(8)
violations and quality ratings) decreases when administrators face high levels of
goal ambiguity and pursue numerous priorities they consider “very important.”
By shedding light on perceptions of goal ambiguity, this research improves our
understanding of the complex mechanisms through which managerial strategies
influence organizational outcomes.
Frameworks and Evidence on Goal Ambiguity
Theories of Goal Ambiguity
Goals are desired states that organizations seek to achieve, and thus, they
regulate and direct human behavior (Locke & Latham, 1990; Rainey, 2009).
In contemporary organizations, the reality of goal setting and attainment can
be complex: Organizations pursue broader, mission-level goals and more
specific, operational goals, most of which are likely to be perceived and pri-
oritized differently by the internal and external stakeholders (Bozeman &
Kingsley, 1998; Rainey & Jung, 2015). The conceptualization and analysis of
goals and their role in organizations help reveal their multidimensionality
(Davis & Stazyk, 2014; Stazyk & Goerdel, 2011). To date, researchers have
focused on goal content, clarity, specificity, intensity, scope, diversity, con-
flict, difficulty, ambiguity/vagueness, timeliness, multiplicity, and others
(Bozeman & Kingsley, 1998; Dahl & Lindblom, 1953; Jung, 2011b; Latham
& Locke, 1991; Locke & Latham, 1990; Wright, 2004).
Goal ambiguity and multiplicity have been studied more extensively, par-
ticularly, in public organizations. Goal ambiguity refers to “the extent to
which an organizational goal or set of goals allows leeway for interpretation,
when the organizational goal represents the desired future state of the organi-
zation” (Chun & Rainey, 2005a, p. 2). Some theories of goal ambiguity sug-
gest that less ambiguous, more clearly stated goals are likely to improve
individual commitment, motivation, persistence, direction, mobilization of
effort, perception of self-efficacy, and satisfaction, and thus, enhance indi-
vidual performance and organizational outcomes (Davis & Stazyk, 2014;
Jung, 2014c; Jung & Ritz, 2014; Latham & Locke, 1991; Locke & Latham,
1990, 2002; Rainey & Jung, 2015). Clearer goals can connect individuals and
organizations by spelling out the expectations, actions, and evaluation crite-
ria (Pandey & Wright, 2006). Meanwhile, vague and unclear goals can be
part of a vicious cycle leading to bureaucratic pathologies such as red tape,
employees’ role ambiguity, managerial insecurity, and poor performance
(Rainey, 1993; Rainey et al., 1995; Thompson, 1967; Wright, 2004).
Another important factor—goal multiplicity—is in some instances
approached as a dimension and a measure for goal ambiguity and in others as

Song et al.
1173
a separate goal attribute. Having multiple goals in and of itself is not be prob-
lematic if the goals are clear, consistent, and well prioritized. In most cases,
however, organizations pursue more than one goal that are unclear and diffi-
cult to prioritize (Rainey, 2009), and managers either deal with several con-
flicting goals or have several nonconflicting goals but limited resources to
achieve them all or limited capacity to prioritize them.
Every goal imposed on an organization reflects a value or something wor-
thy of commitment (Wilson, 1989). Having multiple goals is likely to neces-
sitate a trade-off between different values, when some actions that managers
take (and resources they use) to satisfy one goal interfere and conflict with
their actions and resources to satisfy another. Organizational goals are also
closely tied to the context. James Q. Wilson (1989) labels these as contextual
goals—“descriptions of desired states of affairs other than the one the agency
was brought into being to create” (p. 129). For example, a police department
aims at apprehending criminals, deterring possible offenders, and preventing
crimes while trying to protect the constitutional rights of the accused, such as
confidentiality and others. Working toward these conflicting goals can get
complicated and lead to greater goal ambiguity in organizations.
Even if the goals do not conflict with one another, the existence of multi-
ple goals can still result in significant goal ambiguity in cases when no clear
priorities are established. Related to this, Chun and Rainey (2005a) suggest a
concept of priority goal ambiguity reflecting “the level of interpretive leeway
in deciding on priorities among multiple goals” (p. 4). Priorities in this con-
text mean “decisions about which goals should take precedence over others”
(p. 4). Chun and Rainey (2005a) argue that “the presence of multiple goals
without any hierarchical arrangement and prioritization leaves much room
for interpretation of such priorities and about which goals...

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