Daniel M. Walker, Timothy R. Huerta and Mark L. Diana
Policy makers and practitioners argue that electronic exchange of clinical data across the healthcare system is a key component of improving health service delivery in the United…
Abstract
Policy makers and practitioners argue that electronic exchange of clinical data across the healthcare system is a key component of improving health service delivery in the United States. Provider administrators, however, question the strategic value of participation in health information exchanges (HIEs) and remain reluctant to participate. Existing research fails to adequately illuminate the potential value derived from HIEs by participating organizations. This paper addresses this gap by developing a conceptual model informed by the complementary theoretical perspectives of the relational view and systems theory to specify both a provider organizationʼs internal conditions and the HIE structure necessary for both financial accrual and quality improvement. This two-sided model can assist policymakers as they attempt to encourage HIE development, as well as provider and HIE leadership that seek to benefit from HIEs. The propositions developed from this model can also help guide researchers as they evaluate the impact of HIEs.
Yoon Hee Kim, Luv Sharma and Daniel M. Walker
Extant research documents the cost benefits of group purchasing organizations (GPOs) to member hospitals, but understudies concerns about the market dominance of a few large GPOs…
Abstract
Purpose
Extant research documents the cost benefits of group purchasing organizations (GPOs) to member hospitals, but understudies concerns about the market dominance of a few large GPOs and the relatively weakened buyer power of hospitals in the US healthcare product supply chain. To fill the gap in the literature, this study investigates whether GPO size and a hospital’s relative power to its GPO affect the hospital’s supply expenses, and whether and how system membership moderates the power–performance link.
Design/methodology/approach
For this study, we collect the panel data from various secondary sources on GPO–hospital dyads, which include the seven largest GPOs and their 2,590 unique acute care hospital members in 51 states over the period of 2009–2017. To address the endogeneity issue associated with simultaneity, we establish a one-year time lag between dependent and independent variables and analyzed the 15,527 hospital-year observations using the time-series regression with fixed-effect.
Findings
We find that a hospital’s relative power to its GPO is the most critical factor to reduce its supply cost while GPO size has no effects. We also find that a nonsystem hospital achieves greater cost savings by leveraging its relative power to its GPO while a system hospital gains no benefits.
Originality/value
To the best of our knowledge, this study is the first to address the paradox of GPO size and a hospital’s relative power and the moderating role of system membership for the hospital’s purchasing efficiency using a large nation-wide dataset of US hospitals–GPO dyads.
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Megan E. Gregory, Daniel M. Walker, Lindsey N. Sova, Sheryl A. Pfeil, Clayton D. Rothwell, Jaclyn J. Volney, Alice A. Gaughan and Ann Scheck McAlearney
Health-care professionals undergo numerous training programs each year in order to fulfill licensure requirements and organizational obligations. However, evidence suggests that a…
Abstract
Health-care professionals undergo numerous training programs each year in order to fulfill licensure requirements and organizational obligations. However, evidence suggests that a substantial amount of what is taught during training is never learned or transferred back to routine work. A major contributor to this issue is low training motivation. Prior conceptual models on training transfer in the organizational sciences literature consider this deficit, yet do not account for the unique conditions of the hospital setting. This chapter seeks to close this gap by adapting conceptual models of training transfer to this setting that are grounded in organizational science. Based on theory and supplemented by semistructured key informant interviews (i.e., organizational leaders and program directors), we introduce an applied model of training motivation to facilitate training transfer in the hospital setting. In this model, training needs analysis is positioned as a key antecedent to ensure support for training, relevant content, and perceived utility of training. We posit that these factors, along with training design and logistics, enhance training motivation in hospital environments. Further, we suggest that training motivation subsequently impacts learning and transfer, with elements of the work environment also serving as moderators of the learning-transfer relationship. Factors such as external support for training content (e.g., from accrediting bodies) and allocation of time for training are emphasized as facilitators. The proposed model suggests there are factors unique to the hospital work setting that impact training motivation and transfer that should be considered when developing and implementing training initiatives in this setting.
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Steven E. Daniels and Gregg B. Walker
The recent impasse over federal forest management in the Pacific Northwest region of the United States has been a living laboratory of conflict and its management, and provides…
Abstract
The recent impasse over federal forest management in the Pacific Northwest region of the United States has been a living laboratory of conflict and its management, and provides the context for this case study. While most of the media attention has been focused on regional or national events such as President Clinton's Forest Conference of April 1993, a larger number of localized conflicts have shaped the controversy at the grassroots level. This case study focuses on a pivotal meeting in one such conflict: the Shasta Costa planning process. Outside intervenors mediated the meeting, and USDA Forest Service personnel, timber industry representatives, and environmentalists participated Participant observation and a supplemental survey led to the following conclusions: (1) measures of standing (the legal and social basis for legitimate participation) differed between the industry and environmental representatives, (2) reliance on science differed between groups, and (3) the process was not able to overcome a power imbalance. These findings suggest that there may be little hope for local dispute efforts if there is substantial policy uncertainty at the national level. Implications for managing forestry conflict in the region are discussed.
The Bureau of Economics in the Federal Trade Commission has a three-part role in the Agency and the strength of its functions changed over time depending on the preferences and…
Abstract
The Bureau of Economics in the Federal Trade Commission has a three-part role in the Agency and the strength of its functions changed over time depending on the preferences and ideology of the FTC’s leaders, developments in the field of economics, and the tenor of the times. The over-riding current role is to provide well considered, unbiased economic advice regarding antitrust and consumer protection law enforcement cases to the legal staff and the Commission. The second role, which long ago was primary, is to provide reports on investigations of various industries to the public and public officials. This role was more recently called research or “policy R&D”. A third role is to advocate for competition and markets both domestically and internationally. As a practical matter, the provision of economic advice to the FTC and to the legal staff has required that the economists wear “two hats,” helping the legal staff investigate cases and provide evidence to support law enforcement cases while also providing advice to the legal bureaus and to the Commission on which cases to pursue (thus providing “a second set of eyes” to evaluate cases). There is sometimes a tension in those functions because building a case is not the same as evaluating a case. Economists and the Bureau of Economics have provided such services to the FTC for over 100 years proving that a sub-organization can survive while playing roles that sometimes conflict. Such a life is not, however, always easy or fun.
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Arieh Riskin, Peter Bamberger, Amir Erez and Aya Zeiger
Incivility is widespread in the workplace and has been shown to have significant affective and behavioral consequences. However, the authors still have a limited understanding as…
Abstract
Incivility is widespread in the workplace and has been shown to have significant affective and behavioral consequences. However, the authors still have a limited understanding as to whether, how and when discrete incivility events impact team performance. Adopting a resource depletion perspective and focusing on the cognitive implications of such events, the authors introduce a multi-level model linking the adverse effects of such events on team members’ working memory – the “workbench” of the cognitive system where most planning, analyses, and management of goals occur – to team effectiveness. The model which the authors develop proposes that that uncivil interpersonal behavior in general, and rudeness – a central manifestation of incivility – in particular, may place a significant drain on individuals’ working memory capacity, affecting team effectiveness via its effects on individual performance and coordination-related team emergent states and action-phase processes. In the context of this model, the authors offer an overarching framework for making sense of disparate findings regarding how, why and when incivility affects performance outcomes at multiple levels. More specifically, the authors use this framework to: (a) suggest how individual-level cognitive impairment and weakened coordinative team processes may mediate these incivility-based effects, and (b) explain how event, context, and individual difference factors moderators may attenuate or exacerbate these cognition-mediated effects.
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A distinction must be drawn between a dismissal on the one hand, and on the other a repudiation of a contract of employment as a result of a breach of a fundamental term of that…
Abstract
A distinction must be drawn between a dismissal on the one hand, and on the other a repudiation of a contract of employment as a result of a breach of a fundamental term of that contract. When such a repudiation has been accepted by the innocent party then a termination of employment takes place. Such termination does not constitute dismissal (see London v. James Laidlaw & Sons Ltd (1974) IRLR 136 and Gannon v. J. C. Firth (1976) IRLR 415 EAT).
Within North American institutions of higher education, the sociopolitical construct of whiteness comprises an often implicit set of lessons that are reflected not only in policy…
Abstract
Within North American institutions of higher education, the sociopolitical construct of whiteness comprises an often implicit set of lessons that are reflected not only in policy and curricula but also in the teaching practices of faculty. Such lessons perpetuate white centricity and supremacy, at enormous costs to those who have been negatively racialized. Therefore, it is critical for white faculty to engage meaningfully with ongoing processes of self-reflection, self-education, and skill development so that they can contribute positively to the interrogation and disruption of whiteness in higher education. This chapter discusses seven processual considerations for white educators who seek to interrogate and disrupt the problem of whiteness in teaching and learning.