Abstract
The purpose of this study was to obtain data which would identify perceptions of strengths and weaknesses in the internal environment of home health care organizations; and provide a pathway for identifying management areas needing change in order to improve the practice of home health care in California. Four hundred and thirty four Medicare Certified and Private Duty Agencies in California were surveyed. The survey instrument was in two parts: (1) demographic and (2) the Organizational Diagnostic Questionnare (ODQ). The variables: purpose, structure, leadership, relationships, rewards, helpful mechanisms, and attitude toward change profiled the formal and informal activity in organizations and formed the criteria of "what ought to be" good management. The data subjected to descriptive statistics formed "what is" the activity that actually occurs in organizations. "Real" vs "ideal" comparisons were obtained from various organizational types: hospital based, regional based, national/franchised, VNA, and sole proprietorship. Differences in perception, by middle managers were examined. The mean response score of each variable in each structural type was computed and the differences among the variables and types were examined. The variable "purpose" had the closest proximity to the ideal; and "rewards" the furthest. The structural type "VNA" had the closest proximity to the ideal; "regional based" had the furthest. No statistical significance at the p $<$.05 and p $<$.01 levels among the types was found using the parametric test ANOVA. The informal activity, "what is" actually occurring in the organizations was not ideal and indicated a need for improved management practices that will strengthen and enhance the field of home health care.